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. 2014 May 1;123(18):2783-90.
doi: 10.1182/blood-2013-11-536169. Epub 2014 Mar 10.

Correlation between FDG/PET, histology, characteristics, and survival in 332 patients with chronic lymphoid leukemia

Lorenzo Falchi  1 , Michael J Keating, Edith M Marom, Mylene T Truong, Ellen J Schlette, Rachel L Sargent, Long Trinh, Xuemei Wang, Susan C Smith, Nitin Jain, Zeev Estrov, Susan O'Brien, William G Wierda, Susan Lerner, Alessandra Ferrajoli
Affiliations

Correlation between FDG/PET, histology, characteristics, and survival in 332 patients with chronic lymphoid leukemia

Lorenzo Falchi et al. Blood. .

Abstract

Richter syndrome (RS) is associated with poor outcome. The prognosis of patients with histologically aggressive chronic lymphocytic leukemia (CLL), or HAC, has not been studied. We aimed to correlate 2-deoxy-2-[(18)F]fluoroglucose/positron emission tomography (FDG/PET) data, histological diagnosis, clinical characteristics, and survival in patients with CLL. A total of 332 patients with CLL were histologically classified as: 95 RS, 117 HAC, and 120 histologically indolent CLL (HIC). HAC and RS patients had higher maximum standardized uptake value (SUVmax), more frequent constitutional symptoms, poorer performance status (PS), lower hemoglobin and platelets, and higher lactate dehydrogenase and β-2-microglobulin. An SUVmax ≥10 strongly correlated with mortality (overall survival [OS], 56.7 vs 6.9 months in patients with SUVmax <10 vs ≥10). Survival of patients with RS and HAC was similar among patients with SUVmax <10 or ≥10. SUVmax ≥10, PS ≥2, bulky disease, and age ≥65 were independently associated with shorter OS. In patients undergoing both fine-needle aspiration and biopsy, the former proved diagnostically inadequate in 23%, 29%, and 53% of HIC, HAC, and RS, respectively. FDG/PET is a useful diagnostic tool in patients with CLL and suspected transformation. Patients with HAC show different characteristics and worse prognosis compared with those with HIC. Patients with different CLL phases, but similar SUVmax have similar outcome. Tissue biopsy should be preferred for diagnosing RS.

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Figures

Figure 1
Figure 1
Study population selection process. The figure illustrates the 2-step process leading to the identification of patients with CLL and concurrent FDG/PET and tissue specimens.
Figure 2
Figure 2
OS according to SUVmax. OS of patients with SUVmax ≥10 or SUVmax <10 across CLL histologies.
Figure 3
Figure 3
OS according to histology and SUVmax. OS of patients with RS, HAC, or HIC among patients with SUVmax <10 (A) or ≥10 (B).
Figure 4
Figure 4
OS according to SUVmax and disease extent by FDG/PET. OS of patients with PET-lim disease and SUVmax <10, PET-ex disease and SUVmax <10, PET-lim disease and SUVmax ≥10, or PET-ex disease and SUVmax ≥10.
See this image and copyright information in PMC

Comment in

  • FDG/PET in CLL today.
    Molica S. Molica S. Blood. 2014 May 1;123(18):2749-50. doi: 10.1182/blood-2014-03-563700. Blood. 2014. PMID: 24786452

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