Bone Marrow Involvement Research Articles

Continuous R-DA-EDOCH alternated with high-dose Ara-C induces deep remission and overcomes high-risk factors in young patients with newly diagnosed mantle cell lymphoma.

Our previous studies have indicated potentially higher proliferative activity of tumor cells in Chinese patients with mantle-cell lymphoma (MCL) than those in Western. Given the success and tolerability of R-DA-EDOCH immunochemotherapy in treating aggressive B-cell lymphomas, we designed a prospective, phase 3 trial to explore the efficacy and safety of alternating R-DA-EDOCH/R-DHAP induction therapy for young patients with newly diagnosed MCL. The primary endpoint was the complete remission rate (CRR) at the end of induction (EOI). A total of 55 patients were enrolled. The CRR at the EOI was 89.1% [95% confidence interval (CI) 78%-96%], and the overall response rate was 98.1% (95% CI 90%-100%). Most patients with bone marrow involvement quickly attained minimal residual disease (MRD) negative status, with a 95.7% rate at the EOI. The 3-year progression-free survival (PFS) and overall survival rates were 66.3% and 83.2%, respectively. No patients discontinued treatment because of adverse events. Univariate analysis identified pathologic morphology and TP53 mutations as risk factors for PFS. However, high tumor proliferative activity and certain cytogenetic abnormalities showed no significant adverse prognostic significance. Intensive therapy based on a high cytarabine dose and continuously administered EDOCH achieved a high MRD-negative rate and provides an optional induction choice for young patients with MCL with high-risk factors.

A novel prognostic model utilizing TMTV and SUVmax from 18F-FDG PET/CT for predicting overall survival in patients with extranodal NK/T- cell lymphoma

BackgroundSurvival prediction accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in extra-nodal natural killer/T-cell lymphoma (ENKTL) is controversial. This study aimed to evaluate the prognostic value of 18F-FDG PET/CT parameters including maximum standardized uptake value (SUVmax), total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG), and to develop a new prognostic model for ENKTL.MethodsWe analyzed 390 ENKTL patients with comprehensive clinical and survival data. All patients received asparaginase-based chemotherapy with or without radiotherapy, or radiotherapy alone. Metabolic tumor volume (MTV) was calculated using a 41% SUVmax threshold, and TLG was computed as MTV multiplied by the average SUV. Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan–Meier curves and compared with log-rank tests. Optimal cut-off values were determined using the Youden’ index. Cox regression analysis identified significant prognostic factors. A nomogram predicting 1-, 3-, and 5-year survival was developed and validated using the C-index and calibration curves. Statistical significance was set at p < 0.05.ResultsOf the 390 patients, 262 (67.2%) were included in the training set and 128 (32.8%) in the validation set. 18F-FDG PET-CT parameters with cutoff values of SUVmax > 12.8, TMTV > 16.4 cm3, and TLG > 137.0, were significantly associated with poorer OS (p = 0.009) and PFS (p = 0.003). Multivariable Cox regression identified the following as independent predictors of worse OS: age > 60 years (HR = 1.923, 95% CI: 1.001—3.693), presence of B symptoms (HR = 1.861, 1.132—3.059), ECOG score ≥ 2 (HR = 2.076, 1.165—3.699), extranodal involvement ≥ 2 sites (HR = 2.349, 1.384—3.988), bone marrow involvement (HR = 4.884, 2.137—11.163), SUVmax > 12.8 (HR = 2.226, 1.260—3.930), and TMTV > 16.4 cm3 (HR = 1.854, 1.093—3.147). The new prognostic model achieved a C-index of 0.772 for OS and 0.750 for PFS in the training set, and 0.777 for OS and 0.696 for PFS in the validation set. Area under the curve (AUC) values for 1-, 3-, and 5-year OS were 0.841, 0.804, and 0.767 in the training set, and 0.718, 0.786, and 0.893 in the validation set. Risk stratification divided patients into four groups with significant differences in survival (p < 0.001).ConclusionSUVmax, TMTV, and TLG are independent prognostic factors in ENKTL. Our new model, which integrates 18F-FDG PET/CT metrics with clinical data, enhances survival prediction and may support personalized treatment strategies, though further validation is required.

POEMS Syndrome.

POEMS Syndrome.

Imaging in multiple myeloma.

Imaging in multiple myeloma.

The optimal time and clinical implications of measurable residual disease detection in mantle cell lymphoma.

Recent advances in measurable residual disease (MRD) technology have significantly enhanced predictive accuracy for outcomes in various hematologic malignancies, serving as a crucial surrogate endpoint. However, in mantle cell lymphoma (MCL), identifying the optimal timing for MRD assessment and understanding the prognostic implications of MRD dynamics remain challenging, primarily due to limited extensive MRD data. Our study encompassed 102 patients with MCL, all presenting with clonal B-cell involvement in bone marrow as determined by multiparametric flow cytometry (MFC). MRD evaluations were conducted every two cycles. 75.5% (77/102) achieved MRD negativity during induction therapy. We found the MRD status at the end of four cycles treatment had the best predictive ability for survival (HR = 3.2, C-index = 0.664). 32 of 77 patients (41.6%) had a rapid tumor burden reduction and achieved MRD negativity within two cycles treatment. Notably, this swift shift to MRD negativity was observed more frequently in patients classified as MIPI high-risk. However, this rapid clearance of MRD did not confer any prognostic benefit to these patients. Subgroup analyses revealed that MRD negativity held prognostic value in almost all categories, except for those with blastoid/pleomorphic morphology. MRD assessment serves as a valuable complement to the traditional response evaluation, particularly benefiting for patients attaining partial remission. These findings highlighted the importance of MRD detection during response evaluation of MCL therapy and determined that after four treatment cycles is the best MRD detection timepoint.

Clinical and molecular characteristics of paediatric mature B‐cell acute lymphocytic leukaemia and non‐Hodgkin lymphoma with bone marrow involvement: A joint study between the CCCG leukaemia and lymphoma groups

SummaryMature B‐cell acute lymphocytic leukaemia (B‐ALL) is distinguished from B‐cell non‐Hodgkin lymphoma (B‐NHL) by the arbitrariness of the 25% cut‐off, and given that the percentage of bone marrow (BM) blasts can vary according to site of aspirate, we refrained from differentiating mature B‐ALL from B‐NHL with BM infiltration. A total of 156 patients from the Chinese Children Cancer Group with BM blasts of more than 5% and consistent with immunophenotypic features of mature B cells were included in this study. The 2‐year progression‐free survival, 2‐year event‐free survival and 2‐year overall survival were 76.6 ± 3.6%, 69.7 ± 3.7% and 80.1 ± 3.3% respectively. Central nervous system (CNS) involvement, serum ferritin levels higher than four times normal and rituximab no more than two doses were associated with lower PFS. Male, bulky disease and head/neck region involvement were associated with higher rate of CNS invasion. We performed an integrative transcriptomic characterization of 36 cases. Structure variant included IG::MYC, IGH::CACS11, MEF2D::BCL9, IGH::VPS53 and ACIN1::NUTM1. SNV analysis uncovered driver variations affecting 10 recurrently mutated genes including ID3, TP53, MYC, ARID1A, SMARCA4, DDX3X, CCND3, RHOA, SMARCB1, FOXO1 and GNA13. Mature B‐ALL/B‐NHL with BM involvement was a heterogeneous group of malignancies in both clinical features and genetic alternations. Genetics analysis was helpful for making accurate diagnoses and guiding appropriate therapeutic strategies.

Young bone marrow transplantation delays bone aging in old mice.

Young bone marrow transplantation delays bone aging in old mice.

Bone marrow involvement by breast carcinoma mimicking blast cells: the utility of CD326.

Bone marrow involvement by breast carcinoma mimicking blast cells: the utility of CD326.

Outcome of adult acute myeloid leukemia patients with extramedullary disease and treatment with venetoclax/ hypomethylating agents.

We evaluated response to venetoclax/hypomethylating agents (HMA) in 46 patients with acute myeloid leukemia (AML) characterized by extramedullary disease. The median age of these patients was 65 years (range, 19-81). The patients had a median of two sites of extramedullary disease (range, 1-5) and 35 (76%) had concurrent bone marrow involvement. Twenty (43%) patients had high-risk genetic features according to the European LeukemiaNet 2022 classification. Twenty-nine (63%) had relapsed or were refractory after intensive chemotherapy, including 13 (28%) who had undergone prior allogeneic hematopoietic cell transplantation. Patients received a median of two cycles of venetoclax/HMA (range, 1-31). Twenty (43%) patients achieved complete remission (CR) or CR with incomplete hematologic recovery (CRi) after venetoclax/HMA and five (11%) achieved a partial remission (PR). Six patients were subsequently consolidated with allogeneic hematopoietic cell transplantation (CR/CRi, N=4; PR, N=2). The median follow-up was 49.1 months (95% confidence interval [95% CI]: 26.1 months - not reached) and the median overall survival was 6.4 months (95% CI: 5.1-11 months). One-year and 2-year overall survival rates were 29.3% (95% CI: 18.6-46.2%) and 12.3% (95% CI: 5.5-27.6%), respectively. Age, with a cutoff of 60 years, did not have an impact on overall survival (P=0.90). Relapse occurred in 12 of 20 (60%) patients who achieved CR/CRi after venetoclax/ HMA treatment. Of those, all except one succumbed to their disease. Six (30%) patients were in CR/CRi at last follow-up and two (10%) died in CR. In our cohort of patients with AML with extramedullary disease with high-risk features, treatment with venetoclax/HMA resulted in an encouraging overall response rate of 54% with a CR/CRi rate of 43.5%. However, venetoclax/ HMA alone may not be effective in maintaining disease control.

Hepatosplenic T-cell lymphoma in children and adolescents.

Hepatosplenic T-cell lymphoma in children and adolescents.

Long-Term Safety and Survival Outcomes of [225Ac]Ac-PSMA (Prostate-Specific Membrane Antigen) and [225Ac]Ac-/[177Lu]Lu-PSMA (TANDEM) Radioligand Therapy (PRLT) in Metastatic Castration-Resistant Prostate Cancer.

This study aims to retrospectively assess the safety of [225Ac]Ac-PSMA-PRLT, both as monotherapy and in combination (TANDEM) with Lutetium-177, concerning tolerance after the radiopharmaceutical administration and long-term safety, its impact on salivary glands' function, overall survival (OS), and follow-up duration. Between December 2020 and September 2024, 89 patients received a total of 151 cycles of [225Ac]Ac-PSMA-PRLT. Patients with at least one follow-up (n = 71) were included in the analysis to evaluate xerostomia, as well as long-term hematological, renal, and hepatic toxicities, graded according to CTCAE v5.0. The most common adverse event after the radiopharmaceutical administration was flare pain (n = 16). As of the time of analysis, 68 patients had passed away (76.4%; range of survival 5 days to 39 months, median 7 months), while 21 patients were still alive (23.6%; follow-up duration: 1-33 months). Severe (G3/G4) long-term adverse events were rare, with 15 cases of G3 anemia (21.1%), 6 cases of G3 leukocytopenia (8.4%), and 14 cases of G3/G4 thrombocytopenia (19.7%). Hematological toxicity was primarily associated with severe bone marrow involvement or prior chemotherapy. Additionally, one case of G3 nephrotoxicity (1.4%) and six cases of G3 hepatotoxicity (8.4%) were observed. Only nine patients (12.7%) reported de novo xerostomia (G1/G2). In conclusion, this study demonstrates that [225Ac]Ac-PSMA PRLT, both as monotherapy and combined with [177Lu]Lu-PSMA as TANDEM PRLT, is generally safe in terms of both tolerance after the radiopharmaceutical administration and long-term toxicity.

Post-Marketing Safety of Temozolomide: A Pharmacovigilance Study Based on the Food and Drug Administration Adverse Event Reporting System

Introduction: Temozolomide (TMZ) is a widely used chemotherapy agent for the treatment of malignant gliomas and other brain tumors. Despite its established therapeutic benefits, there is an ongoing need to understand better its safety profile, particularly in real-world clinical settings. This study aimed to identify critical adverse drug reactions (ADRs) associated with TMZ by utilizing the FDA Adverse Event Reporting System (FAERS) database, thereby providing valuable safety insights for clinical practice. Methods: We utilized the reported odds ratio, proportional reporting ratio, Bayesian Confidence Propagation Neural Network, and Empirical Bayes Geometric Mean as primary algorithms for disproportionality analysis. Adverse events (AEs) were classified as ADRs only upon meeting the criteria set by all four algorithms. To ensure the accuracy of our results, we meticulously excluded any AEs deemed unrelated to TMZ. Results: From October 2003 to September 2023, a total of 10,502,538 case reports and 9,073 cases explicitly attributed to TMZ were retrieved from the FAERS database. After applying our filters, 116 ADRs, each with a corresponding Preferred Term (PT), were identified across 18 System Organ Classes (SOCs). The identified ADRs associated with TMZ primarily involved bone marrow suppression, hepatotoxicity, and various infections, notably Pneumocystis jirovecii pneumonia. Furthermore, our analysis identified valuable ADRs not listed in the drug label, including congenital, familial, and genetic disorders at the SOC level, as well as unexpected ADRs at the PT level, such as seizures, pulmonary embolism, and sepsis. Conclusion: This real-world pharmacovigilance study has identified significant and previously unreported ADRs associated with TMZ. Further research for validation and resolution is urgently needed to guide the clinical application of TMZ, ensuring the safety and efficacy of its use in treating brain tumors.

Relationship of Plasma Cell Infiltration Rates with 18F-FDG PET/CT Data and Hematological Parameters in Multiple Myeloma.

This study aimed to evaluate the relationship between the degree of bone marrow involvement, hematological parameters, and 18F-fluorodeoxyglucose (18F-FDG)-positron emission tomography/computed tomography (PET/CT) data in patients diagnosed with multiple myeloma. A total of 71 patients [19 females, 52 males, mean age 67 (36-83) years] who were diagnosed with multiple myeloma between 2014 and 2021, had not received any treatment yet, and underwent 18F-FDG-PET/CT for staging were included in the study. No significant correlation was observed between bone marrow standardized uptake value (SUV)max and plasma cell infiltration (p=0.07). However, we found that patients with visually increased bone marrow counts also had higher plasma cell infiltration rates (p=0.037). No significant correlation was found between plasma cell infiltration rates and bone marrow SUVmax and systemic inflammatory index (SII) (p=0.187 and p=0.446, respectively). However, there was a significant correlation between the SUVmax of lytic lesions showing increased 18F-FDG uptake in bone and SII (p=0.025, r=0.330). We believe that 18F-FDG PET/CT may be an advantage over bone marrow biopsy in the diagnosis and evaluation of multiple myeloma recurrence and may prevent repeated bone marrow biopsies.

Modified Endothelial Activation and Stress Index: A New Predictor for Survival Outcomes in Classical Hodgkin Lymphoma Treated with Doxorubicin-Bleomycin-Vinblastine-Dacarbazine-Based Therapy.

Background: Although the cure rates of classical Hodgkin Lymphoma (cHL) are as high as 90% using the current treatment protocols, the prognosis is poor for primary refractory patients. Thus, a biomarker that can predict patients with early progression at the time of diagnosis is an unmet clinical need. Endothelial activation and stress index (EASIX) and its variant modified EASIX (mEASIX) is a scoring system currently used for the prediction of prognosis in hematologic malignancies. This study aimed to investigate the prognostic value of the mEASIX score in newly diagnosed cHL patients. Methods: Data from 206 patients who underwent positron emission tomography (PET)-guided doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) therapy for cHL between January 2007 and November 2023 were retrospectively analyzed. The prognostic value of the mEASIX score was evaluated using the receiver operating characteristic (ROC) analysis, Cox regression analysis, and the Kaplan-Meier method, and then compared with standard risk assessment methods. Results: The median age at diagnosis was 33 years, and the rate of patients in the advanced stage was 67%. ROC analysis determined an optimal mEASIX score cut-off of 17.28, categorizing patients into mEASIXhigh (47%) and mEASIXlow (53%) groups. The 5-year progression-free survival (PFS) (60% vs. 84.3%) and overall survival (OS) (79.6% vs. 95.8%) were significantly lower in the mEASIXhigh group (p < 0.001). Additionally, multivariate analysis showed that the independent variables affecting PFS included the nodular sclerosing subtype (HR: 0.4), bone marrow involvement (HR: 2.6), and elevated mEASIX (HR: 3.1). Independent variables, which had an effect on OS included elevated mEASIX (HR:3.8) and higher IPS-3 scores (HR:1.9). Furthermore, a higher mEASIX score (≥17.28) was identified as an independent variable indicating primary refractory disease (OR: 6.5). Conclusions: mEASIX is a powerful and easy-to-access marker for the detection of primary refractory disease and prognosis in newly diagnosed cHL cases.

Clinical characteristics of lymphoma patients presenting with fever of unknown origin misdiagnosed with connective tissue diseases.

Recognizing and diagnosing lymphoma in patients with fever of unknown origin (FUO) can be challenging, and misdiagnosis is not uncommon. To improve understanding of the clinical characteristics of lymphoma patients presenting with FUO who were misdiagnosed with autoimmune diseases. A retrospective, observational study of 140 consecutive patients with FUO and lymphoma presenting to a tertiary center between January 2017 and December 2023. Patients were divided into those who were correctly diagnosed and those misdiagnosed as connective tissue diseases (CTD) and the clinical features compared. Of 140 lymphoma patients with FUO, 21 patients (15.0%) were misdiagnosed as CTD. The median time between symptom onset and diagnosis was significantly longer in the misdiagnosed group than in the non-misdiagnosed group (11.0 (IQR 6.0, 22.5) months vs. 4.0 (2.5, 9.0) months; p = 0.001). The misdiagnosed group had significantly less lymph node and bone marrow involvement and more skin rashes than the non-misdiagnosed group (47.6% vs. 70.6%, p = 0.039; 23.8% vs. 47.9%, p = 0.040; 47.6% vs. 25.2%, p = 0.036), as well as significantly lower ESR (p = 0.026) and hsCRP (p = 0.049). The misdiagnosed group had higher frequency of ANA/ANCA (57.1% vs. 27.7%; p = 0.008) and anti-phospholipid antibody (42.9% vs. 6.1%; p = 0.008) positivity. The distribution of lymphoma subtypes was different between groups (p = 0.058). Lymphoma patients with an atypical presentation and FUO suggesting inflammatory systemic disease are easily misdiagnosed. Autoantibody positivity is not rare in lymphoma patients with an atypical presentation and FUO, so close follow-up and repeated histopathological examination may be helpful to establishing a correct diagnosis.

The Role of [18F]FDG PET and Clinicopathologic Factors in Detecting and Predicting Bone Marrow Involvement in Non-Hodgkin Lymphoma.

Background/Objectives: This study evaluates the diagnostic accuracy of [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) using bone marrow biopsy (BMB) and clinical follow-up as reference standards. It further identifies predictive factors for bone marrow involvement (BMI) in non-Hodgkin lymphoma (NHL) patients. Methods: NHL patients who underwent [18F]FDG PET and BMB at diagnosis in a tertiary cancer center were included in this study. Diagnostic accuracy was analyzed, and logistic regression was performed to identify BMI predictors using Stata software version 17. A retrospective analysis of 262 NHL patients was conducted. Results: Concordance rates between [18F]FDG PET and BMB and between [18F]FDG PET and clinical follow-up were 75.6% and 88.1%, respectively. The primary cause of discordance between [18F]FDG PET and BMB was the detection of extra-iliac focal hypermetabolic bone marrow lesions by [18F]FDG PET, which were negative on BMB. The sensitivity, specificity, and accuracy of [18F]FDG PET were 62.9%, 80%, and 75.6%, respectively, with BMB as a reference, and 74.1%, 97.5%, and 88.2%, respectively, with clinical follow-up as a reference. The focal bone marrow [18F]FDG pattern was the most reliable indicator of BMI. Univariate logistic regression showed that advanced NHL stage, elevated alkaline phosphatase, thrombocytopenia, leukopenia, and elevated lactate dehydrogenase were significant predictors of BMI. Multivariate analysis revealed advanced NHL stage and thrombocytopenia as clinical predictors. Conclusions: [18F]FDG PET is a reliable tool for assessing BMI, providing comprehensive total-body evaluation and identifying extra-iliac involvement beyond the scope of BMB. The collective interpretation of molecular imaging, clinical, and biochemical factors is crucial for predicting BMI.

Clinical Characteristics and Outcomes of Pediatric Systemic Anaplastic Large Cell Lymphoma.

Anaplastic large cell lymphomas (ALCLs) present unique challenges due to their clinical and genetic heterogeneity. This study investigated the clinical characteristics of children diagnosed with systemic ALCL. Retrospective data from 14 pediatric patients diagnosed with systemic ALCL at Valme University Hospital were studied. Demographic, clinical, and treatment data were collected and statistically analyzed. The mean age at diagnosis was 8.5 years, with a male predominance (78.6%). Cutaneous presentation occurred in 35.7% of cases, with characteristic rapidly growing subcutaneous nodules. B symptoms were present in 57.1% of patients, while 100% exhibited nodal involvement. Visceral and bone marrow involvement was observed in 71.4% and 7.1% of patients, respectively. Central nervous system (CNS) involvement was absent. Anaplastic lymphoma kinase (ALK) rearrangement was positive in all cases. Anthracycline-based chemotherapy resulted in 100% 5- and 10-year overall survival rates. Systemic ALCL in children often presents with advanced-stage disease, with cutaneous involvement in a significant proportion of cases. Prompt recognition of skin lesions is vital to expedite diagnosis and treatment initiation, ultimately improving patient outcomes. This study underscores the importance of vigilance and early intervention in managing pediatric ALCL.

A Unique Case of Extramedullary Relapse in Acute Lymphoblastic Leukemia: Testicular to Ocular, Cardiac, and Colonic Involvement and the Role of Sperm Phenotyping in Diagnosis-Case Report and Literature Review.

Acute lymphoblastic leukemia (ALL) is a malignant condition of lymphoid progenitor cells that primarily affects the pediatric population, but also adults. The 5-year survival rate is 90% in children and approximately 40% in adults, with survival increasing through the use of peripheral stem cell allotransplantation (SCT). The relapse rate after stem cell transplantation (SCT) in adult acute lymphoblastic leukemia (ALL) patients ranges from 35% to 45%, making relapse a major cause of death in this population. Background: We present an atypical case of late testicular involvement in ALL in a 50-year-old man diagnosed with ALL pro-T in remission post-chemotherapy (GMALL 2003 protocol) and allogeneic stem cell transplantation (alloSCT) from a related donor. Methods: This case describes a 50-year-old male with ALL pro-T who experienced three rare extramedullary relapses post-chemotherapy and alloSCT. Five years after remission, he had a unilateral testicular relapse confirmed by immunophenotyping of spermatic fluid. Results: Despite no bone marrow involvement, he was treated with chemotherapy, intrathecal therapy, and bilateral testicular radiotherapy. He later relapsed in the orbit, controlled by radiotherapy, followed by a third relapse in the heart and colon. Conclusions: This case highlights the unusual sites and consecutive nature of extramedullary relapses in adult ALL.

ALK-positive large B-cell lymphoma: A study of six cases from an oncopathology center in North India.

ALK-positive large B-cell lymphoma (ALK+ LBCL) is a rare neoplasm with an aggressive course and poor therapeutic response to the standard R-CHOP regimen. Owing to its negativity for usual B- and T-cell markers and immunopositivity for epithelial markers, it can be easily misdiagnosed if it is not contemplated. To study the clinicopathological parameters of cases of ALK+ LBCL diagnosed at our institution. A retrospective observational study of ALK+ LBCL was conducted at a tertiary cancer center of North India with cases diagnosed over a period of 3 years. Six cases of ALK+ LBCL were identified. The clinical findings at presentation included mean age of 38.8 years, male-to-female ratio of 5:1, extranodal presentation (1/6 cases), concurrent extranodal and nodal involvement (3/6), nodal presentation (2/6), high serum LDH (5/5), and bone marrow involvement (1/5). Histomorphology of diffuse (100%), alveolar/nested (16.6%), and sinusoidal pattern (1 case upon relapse) and immunoblastic and plasmablastic morphology (100%) and immunopositivity in all cases for ALK-1 protein (100%), CD138 (100%), MUM1 (100%), LCA (100%) along with negativity for EBER-ISH/EBV-LMP1 immunohistochemistry clinched the diagnosis. Fluorescence in situ hybridization analysis for ALK gene rearrangement was detected in 4/4 cases. Four patients received chemotherapy demonstrating relapse in 2 cases: residual disease and no response in one case each, along with death in 2 cases. A high degree of diagnostic suspicion is required for accurate recognition of ALK+ LBCL. Awareness of its histology, immunohistochemistry, and cytogenetics is pivotal for precise identification of this rare entity.

The Value of Positron Emission Tomography Scan in Staging of Lymphoma in a Sample of Iraqi Patients

Abstract Background: A diverse range of illnesses known as lymphomas are caused by immune system constituent cells or their progenitors.18F-Fluorodeoxyglucose positron emission tomography (PET)/computerized tomography has been routine practice to improve the characterization and prognosis of both Hodgkin and non-Hodgkin lymphomas (NHLs). Objectives: The objective of the study was to assess the role of positron emission tomography (PET) scan in clinical evaluation of lymphoma and its ability to identify the correct stage of lymphoma. Patients and Methods: cross-sectional follow-up study was conducted on 50 patients with pathologically proven lymphoma in 2021 who were admitted to the hospital. All patients included in the study performed computed tomography (CT) and PET scan for initial staging. Results: In NHL, PET scan staging differed significantly from clinical in two stages; there were 7 patients versus none with Stage II according to clinical and PET scan staging, respectively. Furthermore, only five patients had Stage IV according to clinical staging versus 17 patients in PET scan staging. Accordingly, there was no agreement between the two modalities (κ = 0.085, 95% = 0.045–0.123, P = 0.394). In Hodgkin lymphoma (HL), the two modalities differ significantly in the appraisal of Stage IV, in which there were 2 patients based on clinical staging and 11 patients according to PET scan staging. Thus, there was a poor agreement between the two modalities (κ = 0.314, 95% confidence interval = 0.283–0.376, P = 0.002). PET scan upstaged 50% and 61.54% of the patients with HL and NHL, respectively, with a highly significant difference, whereas there was no change in staging for 50% and 34.62%, respectively, with a highly significant difference. In NHL, PET scan demonstrated higher positive bone marrow (BM) involvement than biopsy (34.62% vs. 19.23%) with a highly significant difference. Similarly, in HL, PET scan revealed far more positive BM involvement than biopsy (45.83% vs. 8.33%) with a highly significant difference. Conclusions: There is poor or no agreement between PET scan and clinical staging of lymphoma, with high detection with PET scan for BM involvement compared with CT scan, which leads to the identification of additional involved sites of patients with lymphoma.