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3710 18-FDG PET-CT Scan Is a Good Tool to Detect Bone Marrow Involvement in Patients with Diffuse Large B-Cell Lymphoma: A Retrospective Analysis of 602 Patients

Program: Oral and Poster Abstracts
Session: 902. Health Services and Quality Improvement - Lymphoid Malignancies: Poster II
Hematology Disease Topics & Pathways:
Clinical Practice (Health Services and Quality), Lymphomas, non-Hodgkin lymphoma, Diseases, Lymphoid Malignancies
Sunday, December 10, 2023, 6:00 PM-8:00 PM

Manju Sengar, MD, DM1, Tanuja Shet, MBBS, MD, DPB, DNB, DTM2*, Papagudi Ganesan Subramanian, MD3* and Prashant Tembhare, MD, DM3*

1Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
2Department of Pathology, Tata Memorial Centre, Mumbai, India
3Department of Hemato Pathology, Tata Memorial Centre, Mumbai, India

Background:

Bone marrow biopsy is considered a gold standard to detect the involvement in lymphomas. Multi-color flow cytometry improves the detection of low-volume disease and is expected to increase the sensitivity over a BM Biopsy. These procedures are painful, expensive and with the widespread use of 18FDG PET-CT scan as the preferred staging scan, their utility is being re-evaluated. We analyzed the utility of BM studies, including multi-color flow cytometry in DLBCL and developed an algorithm to identify patients where it would be useful.

Methods:

This is a retrospective study from a tertiary care center in India conducted on patients registered from 01/2018 till 12/2019. De-novo patients aged ≥15 years with DLBCL who underwent their staging workup including both a PET-CT scan and BM studies were included for this analysis. Bone marrow studies include assessment by morphology, flow cytometry (optional) and biopsy. A 13-16 color multi-parameter flow cytometry (BD Fortessa) was used and 500,000 to 1 million events were acquired for the analysis. We recorded the baseline characteristics, Lugano staging and findings from the PET-CT scan and Bone marrow studies. The primary objective was to study the value of BM studies in altering the stage and management compared to a PET-CT scan. Additionally, the positive and negative predictive value of PET-CT scan, reasons for discordant findings, value of flow cytometry studies and impact of BM studies on the final prognostic index were analyzed.

Results:

A total of 698 DLBCL patients were registered during the period, 602(86%) of whom underwent both a PET-CT scan and Bone marrow studies. Flow cytometry was performed in 572 patients (95%). The median age was 52 years (15-82 years), 425 (70%) were male patients. The stage-wise distribution was; stage I-64(11%), stage II-118(20%), stage III- 74(12%) and stage IV- 346(57%) patients. The utility of PET-CT scan and BM studies in classifying a patient as stage IV is summarized in Table 1. BM studies upstaged a patient to stage IV in only 18 (3%) cases. In the absence of BM studies, these patients would be classified as stage I (4), stage II (4) and stage III (10) (Table 2). A change in prognosis would happen in only 4 of these patients due to a change in stage in 3 (stage I-1, stage II-2) and a change in NCCN-IPI from low-intermediate to high-intermediate in one patient. A change in treatment would occur in only 1 patient. The PPV and NPV of PET-CT for BM involvement using BM studies as a gold standard were 44.2% and 92.3% respectively. While 23/29 (79%) diffuse uptake on PET scan was detected by BM studies, only 35/102 (34%) focal uptake was detected by BM studies. The histological involvement was concordant in 63 patients, while 32 patients had a discordant histological finding. Flow cytometry alone was positive in 32(5.6%) patients, of which 27 patients were already classified as advanced stage (Stage III-7, Stage IV-20).

Conclusions:

Bone marrow studies, including flow cytometry can be avoided in patients with DLBCL who undergo a PET-CT scan. The additional value of BM studies from a prognostic or therapeutic view is too low to justify a regular use of this painful and expensive test.

Disclosures: No relevant conflicts of interest to declare.

*signifies non-member of ASH