Abstract
The role of positron emission tomography/computed tomography (PET/CT) in identifying Richter Syndrome (RS) is well established, while its impact on the survival of patients with chronic lymphocytic leukemia (CLL) has been less explored. The clinical characteristics and PET/CT data of 40 patients with a biopsy-proven CLL who required frontline chemoimmunotherapy, FCR (fludarabine, cyclophosphamide, rituximab) in 20 patients, BR (bendamustine, rituximab) in 20, were retrospectively analyzed. Standardized uptake volume (SUVmax) values ≥ 5 were observed more frequently in patients with deletion 11q (p = 0.006) and biopsies characterized by a rate of Ki67 positive cells ≥ 30% (p = 0.02). In the multivariate analysis, the presence of large and confluent PCs emerged as the only factor with a negative impact on progression-free survival (PFS), and overall survival (OS). Deletion 11q also revealed a significant and independent effect on PFS. SUVmax values ≥ 5 showed no statistical impact on PFS while in multivariate analysis, they revealed a significant adverse impact on OS (median survival probability not reached vs. 56 months; p = 0.002). Moreover, patients with higher SUVmax values more frequently developed Richter Syndrome (p = 0.015). Our results show that higher SUVmax values identify CLL patients with a pronounced rate of proliferating cells in the lymph-node compartment, inferior survival, and an increased risk of developing RS.
Highlights
Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in adults in the Western World
2–10% of CLL patients develop additional genetic lesions leading to an increased risk of Richter Syndrome (RS), an aggressive lymphoma characterized by a high proliferative pattern [2,3,4]
Our results suggest a close relationship between a high 18F-FDG uptake, histologic features of increased cell proliferation in lymph nodes, and survival probability
Summary
Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in adults in the Western World. Several studies have demonstrated the important role of positron emission tomography/computed tomography (PET/CT) in detecting RS [5,6,7,8,9] This technique can distinguish tissues with a low 18F-fluorodeoxyglucose (18F-FDG) uptake, such as CLL, from those with a higher metabolic pathway, such as aggressive lymphomas and second malignancies [10,11,12,13,14,15]. Higher standardized uptake volume (SUVmax ) values ≥5 or ≥10, revealed a high sensitivity and specificity in detecting RS in patients treated with chemoimmunotherapy [5,6,7,8,9] On this basis, PET/CT has been considered a useful tool to identify both the presence of high metabolic disease and the optimal site for a diagnostic biopsy [5,6,7,8,9,16]. PET cannot replace histology in the diagnostic assessment of tissues with a high 18F-FDG uptake
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