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. 2017 Sep 16;7(1):75.
doi: 10.1186/s13550-017-0326-8.

Early assessment of response to induction therapy in acute myeloid leukemia using 18F-FLT PET/CT

Eun Ji Han  1 , Bo-Hee Lee  2 , Jeong-A Kim  3 , Young Ha Park  4 , Woo Hee Choi  5
Affiliations

Early assessment of response to induction therapy in acute myeloid leukemia using 18F-FLT PET/CT

Eun Ji Han et al. EJNMMI Res. .

Abstract

Background: We evaluated the suitability of 18F-fluorodeoxythymidine (18F-FLT) positron emission tomography (PET)/computed tomography (CT) for assessment of the early response to induction therapy and its value for predicting clinical outcome in patients with acute myeloid leukemia (AML). Adult patients who had histologically confirmed AML and received induction therapy were enrolled. All patients underwent 18F-FLT PET/CT after completion of induction. PET/CT images were visually and quantitatively assessed. Cases with intensely increased bone marrow uptake in more than one third of the long bones and throughout the central skeleton were interpreted as PET-positive for resistant disease (RD). PET results were compared to the clinical response and outcome.

Results: In visual PET analysis of 10 eligible patients (7 male, 3 female; median age 58 years), 5 patients were interpreted as being PET-positive and 5 as PET-negative. Standardized uptake values were significantly different between PET-positive and PET-negative groups. Eight of 10 patients achieved clinical complete remission (CR)/CR with incomplete blood count recovery (CRi). Five CR/CRi patients had PET-negative findings, but 3 CR patients had PET-positive findings. Both of the RD patients had PET-positive findings. During follow-up, 2 CR patients with PET-positive findings relapsed, or were strongly suspected of relapse, 4 months after consolidation.

Conclusion: 18F-FLT PET/CT after induction therapy showed good sensitivity and negative-predictive value for evaluating RD in patients with AML. This preliminary study suggests that 18F-FLT PET/CT may be valuable as a noninvasive tool for early assessment of the response to treatment and may provide prognostic value for survival in patients with AML.

Keywords: 18F-FLT; Acute myeloid leukemia; Bone marrow; Induction therapy; PET; Response assessment.

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Conflict of interest statement

Ethics approval and consent to participate

This study was performed in accordance with the approved guidelines of St. Vincent’s Hospital’s institutional review board. Written consent was obtained from all participants included in the study.

Consent for publication

Informed consent was obtained from all individual participants included in the study.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
18F-FLT PET maximum intensity projection images after induction therapy in 10 patients with AML. Five PET cases (a) showed intensely increased BM uptake throughout the central skeleton and bilateral humeri and femurs and were interpreted as PET-positive. The other 5 PET cases (b) were interpreted as PET-negative. Of these, 2 (patients 1 and 3) had invisible BM uptake throughout the central skeleton and bilateral humeri and femurs. Three cases (patients 2, 5, and 10) demonstrated perceptible BM uptake along the central skeleton; however, the intensity of 18F-FLT uptake was markedly lower than that of the liver and no significant uptake was seen along bilateral humeri and femurs
See this image and copyright information in PMC

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