Program: Oral and Poster Abstracts
Session: 622. Non-Hodgkin Lymphoma: Biology, excluding Therapy: Poster I
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.
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