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- Title
The prognostic value of bone marrow retention index and bone marrow-to-liver ratio of baseline 18F-FDG PET/CT in diffuse large B-cell lymphoma.
- Authors
El-Azony, Ahmed; Basha, Mohammad Abd Alkhalik; Almalki, Yassir Edrees; Abdelmaksoud, Bader; Hefzi, Nabila; Alnagar, Ahmed A.; Mahdey, Sheren; Ali, Ismail Mohamed; Nasr, Ibrahim; Abdalla, Ahmed A. El-Hamid M.; Yousef, Hala Y.; Zaitoun, Mohamed M. A.; Elsayed, Saeed Bakry; Nada, Mohamad Gamal; Amin, Mohamed I.; Hassan, Rania Mostafa; Ali, Susan Adil; Dawoud, Tamer Mahmoud; Aly, Sameh Abdelaziz; Algazzar, Youssef H.
- Abstract
Objective: To determine prognostic value of bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) measured on baseline dual-phase 18F-FDG PET/CT in a series of newly diagnosed patients with diffuse large B-cell lymphoma (DLBCL) treated homogeneously with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy. Patients and methods: This prospective study enrolled 135 patients with newly diagnosed DLBCL. All patients underwent dual-phase 18F-FDG PET/CT. The following PET parameters were calculated for both tumor and bone marrow: maximum standardized uptake value (SUVmax) at both time points (SUVmax early and SUVmax delayed), SUVmax increment (SUVinc), RI, and BLR. Patients were treated with R-CHOP regimen and response at end of treatment was assessed. Results: The final analysis included 98 patients with complete remission. At a median follow-up of 22 months, 57 patients showed no relapse, 74 survived, and 24 died. The 2-year relapse-free survival (RFS) values for patients with higher and lower RI-bm were 20% and 65.1%, respectively (p < 0.001), and for patients with higher and lower BLR were 30.2% and 69.6%, respectively (p < 0.001). The 2-year overall survival (OS) values for patients with higher and lower RI-bm were 60% and 76.3%, respectively (p = 0.023), and for patients with higher and lower BLR were 57.3% and 78.6%, respectively (p = 0.035). Univariate analysis revealed that RI-bm and BLR were independent significant prognostic factors for both RFS and OS (hazard ratio [HR] = 4.02, p < 0.001, and HR = 3.23, p < 0.001, respectively) and (HR = 2.83, p = 0.030 and HR = 2.38, p = 0.041, respectively). Conclusion: Baseline RI-bm and BLR were strong independent prognostic factors in DLBCL patients. Clinical relevance statement: Bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) could represent suitable and noninvasive positron emission tomography/computed tomography (PET/CT) parameters for predicting pretreatment risk in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy. Key Points: • Bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) are powerful prognostic variables in diffuse large B-cell lymphoma (DLBCL) patients. • High BLR and RI-bm are significantly associated with poor overall survival (OS) and relapse-free survival (RFS). • RI-bm and BLR represent suitable and noninvasive risk indicators in DLBCL patients.
- Subjects
DIFFUSE large B-cell lymphomas; BONE marrow; PROGNOSIS; BONE marrow cancer; POSITRON emission tomography; END of treatment
- Publication
European Radiology, 2024, Vol 34, Issue 4, p2500
- ISSN
0938-7994
- Publication type
Article
- DOI
10.1007/s00330-023-10150-z