open access

Vol 22, No 1 (2019)
Original articles
Published online: 2019-01-31
Submitted: 2018-11-18
Accepted: 2018-12-27
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Productivity of 18F-FDG-PET/CT Diagnostic Tool in the Management of Pediatric Lymphoblastic Lymphoma

Ahmed Elhussein, Mohamed Fawzy, Hany Abdel Rahman, Walid Omar, Elshaymaa Mohamed Hussein
DOI: 10.5603/NMR.2019.0004
·
Nucl. Med. Rev 2019;22(1):23-28.

open access

Vol 22, No 1 (2019)
Original articles
Published online: 2019-01-31
Submitted: 2018-11-18
Accepted: 2018-12-27

Abstract

BACKGROUND: Lymphoblastic lymphoma (LL) comprises approximately 20% of childhood non-Hodgkin lymphoma (NHL); however, few studies had investigated the role of 18F-FDG-PET/CT in pediatric LL patients. We aim in this study to assess the role of 18F-FDG-PET/CT in the initial staging of newly diagnosed pediatric patients with LL as well as in the assessment of response after induction chemotherapy.

PATIENTS AND METHODS: A prospective study enrolled biopsy proven newly diagnosed pediatric LL patients presenting in the Children Cancer Hospital Egypt (CCHE) during the period from October 2014 to October 2016. 18F-FDG-PET/CT was done initially before therapy and after induction chemotherapy in all patients. The patients were followed until the end of April 2018 (mean 23.5 months).

RESULTS: All lymphoma involvement lesions (n = 43) were FDG avid and the intensity of nodal FDG uptake was variable. Two patients (11%) had bone marrow (BM) involvement by < 25% blast cells with corresponding positive BM focal uptake in 18F-FDG-PET/CT (SUVmax = 4 and 4.5). Evaluation post induction phase; CT detected 8 residual lesions in 8 patients (44.4%), while 18F-FDG-PET/CT detected only 3 Deauville-positive residual lesions in 3 patients (16.6%). No intensification of therapy was done in all post-induction positive patients. Repeated 18F-FDG-PET/CT at week 18 for post-induction patients revealed cleared all Deauville-positive residual lesions. On the other hand, repeated CT at week 18 detected regression but still residual in 4/8 (50%) post-induction CT lesions with clearance of the rest (50%).

CONCLUSION: In initial staging, 18F-FDG-PET/CT is a useful tool for disease extent evaluation of pediatric LL. Moreover, it could provide a diagnostic hint for BM involvement. 18F-FDG-PET/CT done after induction therapy has a good negative predictive value with higher specificity than CT alone, but is not an indication for treatment intensification due to false positive results. However, larger sample size is required for better conclusion.

Abstract

BACKGROUND: Lymphoblastic lymphoma (LL) comprises approximately 20% of childhood non-Hodgkin lymphoma (NHL); however, few studies had investigated the role of 18F-FDG-PET/CT in pediatric LL patients. We aim in this study to assess the role of 18F-FDG-PET/CT in the initial staging of newly diagnosed pediatric patients with LL as well as in the assessment of response after induction chemotherapy.

PATIENTS AND METHODS: A prospective study enrolled biopsy proven newly diagnosed pediatric LL patients presenting in the Children Cancer Hospital Egypt (CCHE) during the period from October 2014 to October 2016. 18F-FDG-PET/CT was done initially before therapy and after induction chemotherapy in all patients. The patients were followed until the end of April 2018 (mean 23.5 months).

RESULTS: All lymphoma involvement lesions (n = 43) were FDG avid and the intensity of nodal FDG uptake was variable. Two patients (11%) had bone marrow (BM) involvement by < 25% blast cells with corresponding positive BM focal uptake in 18F-FDG-PET/CT (SUVmax = 4 and 4.5). Evaluation post induction phase; CT detected 8 residual lesions in 8 patients (44.4%), while 18F-FDG-PET/CT detected only 3 Deauville-positive residual lesions in 3 patients (16.6%). No intensification of therapy was done in all post-induction positive patients. Repeated 18F-FDG-PET/CT at week 18 for post-induction patients revealed cleared all Deauville-positive residual lesions. On the other hand, repeated CT at week 18 detected regression but still residual in 4/8 (50%) post-induction CT lesions with clearance of the rest (50%).

CONCLUSION: In initial staging, 18F-FDG-PET/CT is a useful tool for disease extent evaluation of pediatric LL. Moreover, it could provide a diagnostic hint for BM involvement. 18F-FDG-PET/CT done after induction therapy has a good negative predictive value with higher specificity than CT alone, but is not an indication for treatment intensification due to false positive results. However, larger sample size is required for better conclusion.

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Keywords

Pediatric lymphoblastic lymphoma, 18F-FDG-PET/CT, CCHE.

About this article
Title

Productivity of 18F-FDG-PET/CT Diagnostic Tool in the Management of Pediatric Lymphoblastic Lymphoma

Journal

Nuclear Medicine Review

Issue

Vol 22, No 1 (2019)

Pages

23-28

Published online

2019-01-31

DOI

10.5603/NMR.2019.0004

Bibliographic record

Nucl. Med. Rev 2019;22(1):23-28.

Keywords

Pediatric lymphoblastic lymphoma
18F-FDG-PET/CT
CCHE.

Authors

Ahmed Elhussein
Mohamed Fawzy
Hany Abdel Rahman
Walid Omar
Elshaymaa Mohamed Hussein

References (17)
  1. Bollard CM, Lim MS, Gross TG, et al. COG Non-Hodgkin Lymphoma Committee. Children's Oncology Group's 2013 blueprint for research: non-Hodgkin lymphoma. Pediatr Blood Cancer. 2013; 60(6): 979–984.
  2. Burkhardt B, Zimmermann M, Oschlies I, et al. BFM Group. The impact of age and gender on biology, clinical features and treatment outcome of non-Hodgkin lymphoma in childhood and adolescence. Br J Haematol. 2005; 131(1): 39–49.
  3. Uyttebroeck A, Suciu S, Laureys G, et al. Children's Leukaemia Group (CLG) of the European Organisation for Research and Treatment of Cancer (EORTC). Treatment of childhood T-cell lymphoblastic lymphoma according to the strategy for acute lymphoblastic leukaemia, without radiotherapy: long term results of the EORTC CLG 58881 trial. Eur J Cancer. 2008; 44(6): 840–846.
  4. Muljono A, Graf NS, Arbuckle S. Primary cutaneous lymphoblastic lymphoma in children: series of eight cases with review of the literature. Pathology. 2009; 41(3): 223–228.
  5. Murphy JJ, Tawfeeq M, Chang B, et al. Early experience with PET/CT scan in the evaluation of pediatric abdominal neoplasms. J Pediatr Surg. 2008; 43(12): 2186–2192.
  6. Cistaro A, Saglio F, Asaftei S, et al. The role of 18F-FDG PET/CT in pediatric lymph-node acute lymphoblastic leukemia involvement. Radiol Case Rep. 2011; 6(4): 503.
  7. Pui CH, Relling MV, Sandlund JT, et al. Rationale and design of Total Therapy Study XV for newly diagnosed childhood acute lymphoblastic leukemia. Ann Hematol. 2004; 83 Suppl 1: S124–S126.
  8. Murphy SB. Classification, staging and end results of treatment of childhood non-Hodgkin's lymphomas: dissimilarities from lymphomas in adults. Semin Oncol. 1980; 7(3): 332–339.
  9. Sandlund JT, Guillerman RP, Perkins SL, et al. International Pediatric Non-Hodgkin Lymphoma Response Criteria. J Clin Oncol. 2015; 33(18): 2106–2111.
  10. Boellaard R, Delgado-Bolton R, Oyen WJG, et al. European Association of Nuclear Medicine (EANM). FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015; 42(2): 328–354.
  11. Cheson BD, Fisher RI, Barrington SF, et al. Alliance, Australasian Leukaemia and Lymphoma Group, Eastern Cooperative Oncology Group, European Mantle Cell Lymphoma Consortium, Italian Lymphoma Foundation, European Organisation for Research, Treatment of Cancer/Dutch Hemato-Oncology Group, Grupo Español de Médula Ósea, German High-Grade Lymphoma Study Group, German Hodgkin's Study Group, Japanese Lymphorra Study Group, Lymphoma Study Association, NCIC Clinical Trials Group, Nordic Lymphoma Study Group, Southwest Oncology Group, United Kingdom National Cancer Research Institute. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014; 32(27): 3059–3068.
  12. Hasenclever D, Kurch L, Mauz-Körholz C, et al. qPET - a quantitative extension of the Deauville scale to assess response in interim FDG-PET scans in lymphoma. Eur J Nucl Med Mol Imaging. 2014; 41(7): 1301–1308.
  13. Park JH, Pahk K, Kim S, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography imaging of T-lymphoblastic lymphoma patients. Oncol Lett. 2016; 12(2): 1620–1622.
  14. Nakatani K, Nakamoto Y, Watanabe K, et al. Roles and limitations of FDG PET in pediatric non-Hodgkin lymphoma. Clin Nucl Med. 2012; 37(7): 656–662.
  15. Jain H, Menon H, Epari S, et al. Whole Body PET-CT In Management Of Lymphoblastic Lymphomas In Adults: Does It Have a Prognostic Impact? Blood. 2013; 122(21): 4314.
  16. Ellin F, Jerkeman M, Hagberg H, et al. Treatment outcome in T-cell lymphoblastic lymphoma in adults - a population-based study from the Swedish Lymphoma Registry. Acta Oncol. 2014; 53(7): 927–934.
  17. Becker S, Vermeulin T, Cottereau AS, et al. Predictive value of F-FDG PET/CT in adults with T-cell lymphoblastic lymphoma: post hoc analysis of results from the GRAALL-LYSA LLO3 trial. Eur J Nucl Med Mol Imaging. 2017; 44(12): 2034–2041.

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