The Role of 18F-FDG PET/CT in Staging and Prognostication of Mantle Cell Lymphoma: An Italian Multicentric Study.

Domenico Albano,Rexhep Durmo,Annarosa Cuccaro,Paola Ferro,Riccardo Laudicella,Agostino Chiaravalloti,Laura Evangelista,Michela Allocca,Matteo Bauckneht,Elisabetta Abenavoli,Lea Cuppari,Salvatore Annunziata,Flavia Linguanti,Sofya Kovalchuk,Viviana Frantellizzi,Ambra Buschiazzo,Giulia Santo,Alessia Castellino

doi:10.3390/cancers11121831

Abstract

Mantle cell lymphoma (MCL) is an aggressive lymphoma subtype with poor prognosis in which 18F-FDG-PET/CT role in treatment response evaluation and prediction of outcome is still unclear. The aim of this multicentric study was to investigate the role of 18F-FDG-PET/CT in staging MCL and the prognostic role of Deauville criteria (DC) in terms of progression-free survival (PFS) and overall survival (OS). We retrospectively enrolled 229 patients who underwent baseline and end-of-treatment (eot) 18F-FDG-PET/CT after first-line therapy. EotPET/CT scans were visually interpreted according to DC. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT for evaluation of bone marrow (BM) were 27%, 100%, 100%, 48% and 57%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT for evaluation of the gastrointestinal (GI) tract were 60%, 99%, 93%, 90% and 91%, respectively. At a median follow-up of 40 months, relapse occurred in 104 cases and death in 49. EotPET/CT results using DC significantly correlated with PFS, not with OS. Instead, considering OS, only MIPI score was significantly correlated. In conclusion, we demonstrated that MCL is an FDG-avid lymphoma and 18F-FDG-PET/CT is a useful tool for staging purpose, showing good specificity for BM and GI evaluation, but suboptimal sensitivity. EotPET/CT result was the only independent significant prognostic factor that correlated with PFS.

Highlights

Mantle cell lymphoma (MCL) accounts for 3% to 6% of all non-Hodgkin lymphoma and it is an aggressive lymphoma subtype with a high recurrence and mortality rate [1]
Patients were staged according to the Ann Arbor system as follows: stage of disease (stage I) (n = 4), stage II (n = 9), stage III (n = 32) and stage
A correct and an early identification of initial and extranodal disease may be crucial because it could potentially affect patient’s management and therapeutic choice. 18F-FDG PET/CT has shown a high accuracy in the detection of nodal involvement [7,8,9], but a low sensitivity in bone marrow (BM) and GI tract, being inadequate to replace BM biopsy and GI endoscopy in disease staging [10,11,12]

Summary

Introduction

Mantle cell lymphoma (MCL) accounts for 3% to 6% of all non-Hodgkin lymphoma and it is an aggressive lymphoma subtype with a high recurrence and mortality rate [1]. In the era of personalized and precision medicine, strong prognostic tools are needed in all lymphoma subtypes, such as MCL, to accurately predict possible further relapse of disease or death and to improve their treatment management. For this end-point, both clinical and imaging parameters are nowadays available, such as clinical scores and fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) derived parameters. 18F-FDG-PET/CT at baseline has been recently evaluated to complete the staging of disease at diagnosis, with possible implication of different prognostic risk in the follow-up. The aim of this study was to evaluate the role of 18F-FDG-PET/CT in patients with MCL as follows: assessing its power in staging

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