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

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DOI

  • Mette A Pedersen
  • Lars C Gormsen
  • Peter Kamper, Department of Haematology, Aarhus University Hospital, Aarhus, Denmark; Institute of Pathology, Aarhus University Hospital, Aarhus, Denmark.
  • ,
  • Cecilia Wassberg, Department of Nuclear Medicine, Uppsala University Hospital, Uppsala, Sweden.
  • ,
  • Maja D Andersen, Department of Haematology, Aarhus University Hospital, Aarhus, Denmark; Institute of Pathology, Aarhus University Hospital, Aarhus, Denmark.
  • ,
  • Alexander L d'Amore, Department of Haematology, Aarhus University Hospital, Aarhus, Denmark; Institute of Pathology, Aarhus University Hospital, Aarhus, Denmark.
  • ,
  • Sally F Barrington, King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
  • ,
  • Peter Johnson, Cancer Research UK Centre, University of Southampton, Southampton, UK.
  • ,
  • Stephen Hamilton-Dutoit
  • Rose-Marie Amini, Department of Immunology, Genetics and Pathology, Uppsala University Hospital, Uppsala, Sweden. Electronic address: henrik.lindman@igp.uu.se.
  • ,
  • Gunilla Enblad, n Department of Oncology , Uppsala University Hospital , Uppsala , Sweden.
  • ,
  • Daniel Molin, n Department of Oncology , Uppsala University Hospital , Uppsala , Sweden.
  • ,
  • Francesco d'Amore

18 F-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.

Original languageEnglish
JournalBritish Journal of Haematology
ISSN0007-1048
DOIs
Publication statusE-pub ahead of print - 22 May 2019
Externally publishedYes

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