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Focal skeletal FDG uptake indicates poor prognosis in cHL regardless of extent and first-line chemotherapy

Focal skeletal FDG uptake indicates poor prognosis in cHL regardless of extent and first-line chemotherapy
Focal skeletal FDG uptake indicates poor prognosis in cHL regardless of extent and first-line chemotherapy

18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) is used for staging classical Hodgkin lymphoma (cHL) with high sensitivity for skeletal involvement. However, it is unclear whether a single bone lesion carries the same adverse prognosis as multifocal lesions and if this is affected by type of chemotherapy [ABVD (adriamycin, bleomycin, vincristine, dacarbazine) versus BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone)]. We reviewed the clinico-pathological and outcome data from 209 patients with newly diagnosed cHL staged by FDG-PET/CT. Patterns of skeletal/bone marrow uptake (BMU) were divided into ‘low’ and ‘high’ diffuse BMU (i.e. without focal lesions), and unifocal or multifocal lesions. Additional separate survival analysis was performed, taking type of chemotherapy into account. Forty patients (19·2%) had skeletal lesions (20 unifocal, 20 multifocal). The 3-year progression-free-survival (PFS) was 80% for patients with ‘low BMU’, 87% for ‘high BMU’, 69% for ‘unifocal’ and 51% for ‘multifocal’ lesions; median follow-up was 38 months. The presence of bone lesions, both uni- and multifocal, was associated with significantly inferior PFS (log rank P = 0·0001), independent of chemotherapy type. Thus, increased diffuse BMU should not be considered as a risk factor in cHL, whereas unifocal or multifocal bone lesions should be regarded as important predictors of adverse outcome, irrespective of the chemotherapy regimen used.

F-FDG PET/CT, bone marrow uptake, chemotherapy, classical Hodgkin lymphoma, focal bone lesions
0007-1048
431-439
Pedersen, Mette A.
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Gormsen, Lars C.
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Kamper, Peter
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Wassberg, Cecilia
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Andersen, Maja D.
3b202328-c75c-4162-85db-031284623cc8
d'Amore, Alexander L.
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Barrington, Sally F.
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Johnson, Peter
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Hamilton-Dutoit, Stephen
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Amini, Rose Marie
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Enblad, Gunilla
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Molin, Daniel
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d'Amore, Francesco
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Pedersen, Mette A.
4568f028-3140-433b-bda9-4f10a709952f
Gormsen, Lars C.
393ded4d-edfa-4345-85ae-ca5c0b1a18ca
Kamper, Peter
4004d037-920c-4678-9dae-30f4a8c8361f
Wassberg, Cecilia
3a71b9d2-cf59-4308-8295-6da4ff654cf7
Andersen, Maja D.
3b202328-c75c-4162-85db-031284623cc8
d'Amore, Alexander L.
4f356bab-af32-4fcf-abd2-7eb74cab3d99
Barrington, Sally F.
fb047bda-27e7-4082-b741-c41ef52aa53c
Johnson, Peter
3f6068ce-171e-4c2c-aca9-dc9b6a37413f
Hamilton-Dutoit, Stephen
a658ab59-43c2-477d-b3a7-9ae92d0dc4d2
Amini, Rose Marie
8f835136-c36c-4926-834c-aad3374c06f2
Enblad, Gunilla
9652040d-7a58-4f45-a597-f6af377c0b08
Molin, Daniel
c6e8436c-0f1f-482f-8eea-7ee1267f3572
d'Amore, Francesco
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Pedersen, Mette A., Gormsen, Lars C., Kamper, Peter, Wassberg, Cecilia, Andersen, Maja D., d'Amore, Alexander L., Barrington, Sally F., Johnson, Peter, Hamilton-Dutoit, Stephen, Amini, Rose Marie, Enblad, Gunilla, Molin, Daniel and d'Amore, Francesco (2019) Focal skeletal FDG uptake indicates poor prognosis in cHL regardless of extent and first-line chemotherapy. British Journal of Haematology, 186 (3), 431-439. (doi:10.1111/bjh.15933).

Record type: Article

Abstract

18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) is used for staging classical Hodgkin lymphoma (cHL) with high sensitivity for skeletal involvement. However, it is unclear whether a single bone lesion carries the same adverse prognosis as multifocal lesions and if this is affected by type of chemotherapy [ABVD (adriamycin, bleomycin, vincristine, dacarbazine) versus BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone)]. We reviewed the clinico-pathological and outcome data from 209 patients with newly diagnosed cHL staged by FDG-PET/CT. Patterns of skeletal/bone marrow uptake (BMU) were divided into ‘low’ and ‘high’ diffuse BMU (i.e. without focal lesions), and unifocal or multifocal lesions. Additional separate survival analysis was performed, taking type of chemotherapy into account. Forty patients (19·2%) had skeletal lesions (20 unifocal, 20 multifocal). The 3-year progression-free-survival (PFS) was 80% for patients with ‘low BMU’, 87% for ‘high BMU’, 69% for ‘unifocal’ and 51% for ‘multifocal’ lesions; median follow-up was 38 months. The presence of bone lesions, both uni- and multifocal, was associated with significantly inferior PFS (log rank P = 0·0001), independent of chemotherapy type. Thus, increased diffuse BMU should not be considered as a risk factor in cHL, whereas unifocal or multifocal bone lesions should be regarded as important predictors of adverse outcome, irrespective of the chemotherapy regimen used.

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BJH-2018-02211-Bone HL - Accepted Manuscript
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Accepted/In Press date: 3 March 2019
e-pub ahead of print date: 22 May 2019
Published date: August 2019
Keywords: F-FDG PET/CT, bone marrow uptake, chemotherapy, classical Hodgkin lymphoma, focal bone lesions

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Local EPrints ID: 432586
URI: http://eprints.soton.ac.uk/id/eprint/432586
ISSN: 0007-1048
PURE UUID: af6055db-e4e2-43db-aafa-44f4c4a00cb7
ORCID for Peter Johnson: ORCID iD orcid.org/0000-0003-2306-4974

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Date deposited: 19 Jul 2019 16:31
Last modified: 07 Oct 2020 06:33

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Contributors

Author: Mette A. Pedersen
Author: Lars C. Gormsen
Author: Peter Kamper
Author: Cecilia Wassberg
Author: Maja D. Andersen
Author: Alexander L. d'Amore
Author: Sally F. Barrington
Author: Peter Johnson ORCID iD
Author: Stephen Hamilton-Dutoit
Author: Rose Marie Amini
Author: Gunilla Enblad
Author: Daniel Molin
Author: Francesco d'Amore

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