Journal Article

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

Hefzi, Nabila, Abdalla, Ahmed A. El-Hamid M., Hassan, Rania Mostafa, El-Azony, Ahmed, Zaitoun, Mohamed M. A., Amin, Mohamed I., Alnagar, Ahmed A., Aly, Sameh Abdelaziz, Nada, Mohamad Gamal, Ali, Susan Adil, Ali, Ismail Mohamed, Basha, Mohammad Abd Alkhalik, Abdelmaksoud, Bader, Yousef, Hala Y., Algazzar, Youssef H., Nasr, Ibrahim, Mahdey, Sheren, Dawoud, Tamer Mahmoud, Abdelhamed, Heba, Almalki, Yassir Edrees, Elsayed, Saeed Bakry

2024

Overview

Objective To determine prognostic value of bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) measured on baseline dual-phase 18 F-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 18 F-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 .

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: B-cell lymphoma / Bone marrow / Bone Marrow - diagnostic imaging / Bone Marrow - pathology / Chemotherapy / Computed tomography / Cyclophosphamide / Cyclophosphamide - therapeutic use / Diagnostic Radiology / Doxorubicin / Doxorubicin - therapeutic use / Fluorine isotopes / Fluorodeoxyglucose F18 / Humans / Imaging / Immunotherapy / Internal Medicine / Interventional Radiology / Liver / Liver - pathology / Lymphocytes B / Lymphoma / Lymphoma, Large B-Cell, Diffuse - diagnostic imaging / Lymphoma, Large B-Cell, Diffuse - drug therapy / Lymphoma, Large B-Cell, Diffuse - pathology / Medical prognosis / Medicine / Medicine & Public Health / Monoclonal antibodies / Neoplasm Recurrence, Local - pathology / Neuroradiology / Nuclear Medicine / Parameters / Patients / Positron emission / Positron emission tomography / Positron Emission Tomography Computed Tomography - methods / Prednisone / Prednisone - therapeutic use / Prognosis / Prospective Studies / Radiology / Radiopharmaceuticals - therapeutic use / Remission / Retention / Rituximab / Rituximab - therapeutic use / Survival / Targeted cancer therapy / Tomography / Ultrasound / Vincristine / Vincristine - therapeutic use