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1473 Prognostic Significance of Bone Marrow Infiltration Detected By PET-CT in Newly Diagnosed Diffuse Large B Cell Lymphoma

Non-Hodgkin Lymphoma: Biology, excluding Therapy
Program: Oral and Poster Abstracts
Session: 622. Non-Hodgkin Lymphoma: Biology, excluding Therapy: Poster I
Saturday, December 5, 2015, 5:30 PM-7:30 PM
Hall A, Level 2 (Orange County Convention Center)

Jin-Hua Liang1*, Jin Sun2*, Li Wang1*, Lei Fan, MD., PhD.1*, Li Tian-Nv2*, Jian-Yong Li, MD, PhD1 and Wei Xu1*

1Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
2Department of Nuclear Medicine, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China

Purpose

The aim of this study was to examine the prognostic value of bone marrow involvement (BMI) assessed by PET-CT in treatment-naïve patients with diffuse large B-cell lymphoma (DLBCL).

Patients and methods

All patients from a single centre diagnosed as DLBCL between 2005 and 2014 had data extracted from staging PET-CT, bone marrow biopsy (BMB), and treatment records. The final diagnosis of BMI was defined as: (i) positive bone marrow biopsy; (ii) positive PET-BMI confirmed by guided biopsy or targeted MR imaging; (iii) concomitant disappearance of bone marrow uptake and uptake in other lymphoma lesions on PET-CT after R-chemotherapy.

Results

Of 169 patients, 20 patients (12%) had BMI on BMB, whereas 35 patients (21%) had positive BMI according to PET-CT findings (PET-BMI(+)). Thirty-three out of the 35 patients with PET-BMI(+) showed a focal pattern and 2 a diffuse pattern, respectively. In multivariate analyses, PET-BMI(+) remained significant for overall survival (OS) (HR 2.90, 95%CI 1.21−6.96, P=0.017) while progressive-free survival (PFS) was significant only in univariate analysis (P<0.001) (Table 1). Among patients with PET-BMI(+) at diagnosis (N=35), patients with SUVmax of bone marrow (SUVmax(BM)) more than 8.6 were significantly associated with high IPI score (3−5) (P=0.002) and worse PFS and OS (P=0.025 and P=0.002, respectively) (Figure 1). In the 68 stage IV cases, three-year OS was higher for patients with negative PET-BMI (PET-BMI (−)) than patients with PET-BMI(+) (84.2%¡À6.5% vs. 44.1%¡À8.6%, respectively; P=0.003) while PFS only shown a trend of statistic significance (P=0.077) between the 2 groups, with estimates of 3-year PFS at 49.3%¡À9.2% and 28.6%¡À7.6%, respectively (Figure 2). Among the 69 patients with inter-risk of IPI (2−3), patients with PET-BMI(+) (N=21) had significantly inferior PFS and OS than patients with PET-BMI(−) (N=48) (P=0.009 and P<0.001, respectively) (Figure 3).

Conclusions

Our data raised several important issues about the predictive significance of BMI assessed by PET-CT in DLBCL: (i) The bone marrow status assessed by PET-CT is an independent predictor of OS independent of IPI; (ii) For baseline PET-BMI(+) patients, the optimal cutoff value of SUVmax(BM) to predict the survival outcomes was 8.6; (iii) In patients with stage IV disease, worse survival outcomes were observed in patients with BMI than that without BMI; (iV) Patients with PET-BMI(+) in the intermediate risk-group should be managed as high-risk group patients.


Table 1. Cox regression analysis for PFS and OS for all the patients with DLBCL (N=169)

PFS

OS

Univariate analysis

Multivariate analysis

Univariate analysis

Multivariate analysis

HR (95%CI)

P

HR (95%CI)

P

HR (95%CI)

P

HR (95%CI)

P

PET-BMI+

3.96 (2.38-6.59)

<0.001

-

-

6.73 (3.40-13.34)

<0.001

2.90 (1.21-6.96)

0.017

BMB-BMI+

4.49 (2.53-7.98)

<0.001

-

-

6.24 (3.06-12.73)

<0.001

-

-

IPI>2

7.27 (4.19-12.63)

<0.001

3.12 (1.31-7.47)

0.010

9.02 (3.94-20.61)

<0.001

3.62 (1.01-13.03)

0.049

Age >60

1.61 (0.98-2.64)

0.060

1.18 (0.61-2.27)

0.627

Stage III or IV

6.08 (2.77-13.36)

<0.001

-

-

6.78 (2.08-22.12)

0.002

-

-

ECOG 2-4

2.79 (1.65-4.71)

<0.001

1.97 (1.12-3.47)

0.019

3.39 (1.75-6.55)

<0.001

-

-

LDH>ULN

4.68 (2.82-7.78)

<0.001

-

-

4.31 (1.96-9.48)

<0.001

-

-

Extranodal site >1

3.15 (1.91-5.18)

<0.001

-

-

3.04 (1.58-5.86)

0.001

-

-

Figure 1. Survivals according to SUVmax in patients with PET-BMI(+) at diagnosis


Figure 2. Survivals according to PET-BMI status in cases with stage IV

Figure 3. Survivals according to PET-BMI status in cases with IPI score of 2-3

Disclosures: No relevant conflicts of interest to declare.

*signifies non-member of ASH