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. 2023 Mar;12(6):6536-6546.
doi: 10.1002/cam4.5424. Epub 2022 Nov 13.

Accuracy and prognostic impact of FDG PET/CT and biopsy in bone marrow assessment of follicular lymphoma at diagnosis: A Nation-Wide cohort study

Isabel Ródenas-Quiñonero  1 , Tzu Chen-Liang  1 , Taida Martín-Santos  2 , Antonio Salar  3 , Marta Fernández-González  2 , Carolina Celades  4 , José-Tomás Navarro  4   5 , Ana Belén Martínez-Garcia  6 , Rafael Andreu  7 , Aitana Balaguer  7 , Alejandro Martin García-Sancho  8 , Mónica Baile  8 , Javier López-Jiménez  9 , Juan Marquet-Palomanes  9 , Ana Isabel Teruel  10 , María José Terol  10 , Carmen Benet  11 , Laura Frutos  12 , José Luis Navarro  12 , Jon Uña  13 , Marina Suarez  14 , Montserrat Cortes  15 , José Contreras  16 , Cristina Ruiz  17 , Pilar Tamayo  18 , Jorge Mucientes  19 , Pablo Sopena-Novales  20 , Laura Reguilón-Gallego  1 , José Javier Sánchez-Blanco  1 , Elena Pérez-Ceballos  1 , Andrés Jerez  1 , Francisco José Ortuño  1
Affiliations

Accuracy and prognostic impact of FDG PET/CT and biopsy in bone marrow assessment of follicular lymphoma at diagnosis: A Nation-Wide cohort study

Isabel Ródenas-Quiñonero et al. Cancer Med. 2023 Mar.

Abstract

Backgound: In the workup of follicular lymphoma (FL), bone marrow biopsy (BMB) assessment is a key component of FLIPI and FLIPI2, the most widely used outcome scores. During the previous decade, several studies explored the role of FDG-PET/CT for detecting nodal and extranodal disease, with only one large study comparing both techniques.

Methods: The aim of our study was to evaluate the diagnostic accuracy and the prognostic impact of both procedures in a retrospective cohort of 299 FL patients with both tests performed at diagnosis. In order to avoid a collinearity bias, FLIPI2 was deconstructed in its founding parameters, and the bone marrow involvement (BMI) parameter separately included as: a positive BMB, a positive PET/CT, the combined "PET/CT and BMB positive" or "PET/CT or BMB positive". These variables were also confronted independently with the POD24 in 233 patients treated with intensive regimens.

Results: In the total cohort, bone marrow was involved in 124 and 60 patients by BMB and PET/CT, respectively. In terms of overall survival, age > 60 y.o. and the combined "PET/CT or BMB positive" achieved statistical independence as a prognostic factor. In patients treated with an intensive regimen, only the combined "PET/CT or BMB positive" added prognostic value for a shorter overall survival, when confronted with the POD24.

Conclusion: Our results show that in FL both BMB and PET/CT should be considered at diagnosis, as their combined assessment provides independent prognostic value in the context of the most widely use clinical scores.

Keywords: PET/CT; bone marrow biopsy; follicular lymphoma.

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Conflict of interest statement

J.T.N. discloses honoraria from Novartis and Roche; consulting or advisory role in Novartis, Blueprint Medicines and EUSA Pharma; research funding from Gilead and EUSA Pharma. A.S: Roche (Research Funding, Speakers Bureau), Janssen (Consultancy, Speakers Bureau), Gilead (Research Funding), Celgene/BMS (Consultancy), EUSA Pharma (Consultancy), Beigene (Consultancy). A.J. reports a research grant from Gilead and consultancy honoraria from Novartis and Celgene, all outside of the submitted work. The rest of the authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier estimate curves of the two factors, within the FLIPI2 score, that remained significant in the multivariate Cox model for PFS. (A) LoDLIN over 6 cm, (B) B2M higher than ULN. B2M, B2‐microglobulin; FLIPI, Follicular Lymphomas International Prognostic Index; LoDLIN, longest diameter of the largest involved nodes; PFS, Progression‐free survival; ULN, upper limit of normal.
FIGURE 2
FIGURE 2
Kaplan–Meier estimate curves of the two factors, within the FLIPI2 score, that remained significant in the multivariate Cox model for OS. (A) Age older than 60 y.o., (B) The combined “PET/CT or BMB positive”. BMB, bone marrow biopsy; BMI, Bone marrow involvement; FLIPI, Follicular Lymphomas International Prognostic Index; OS, overall survival; PET/CT, PET/computed tomography; y.o, years old.
See this image and copyright information in PMC

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