Use of positron emission tomography-computed tomography in the management of patients with chronic lymphocytic leukemia/small lymphocytic lymphoma.

Abstract

Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) cells typically have low 2-deoxy-2-[(18)F]fluoro-d-glucose (FDG) avidity, and patients with CLL have an increased risk of developing FDG-avid aggressive lymphomas, second malignancies and infections. We hypothesized that FDG positron emission tomography-computed tomography (PET-CT) of the trunk is a sensitive method of detecting these complications in patients with CLL. Of the of 2299 patients with CLL seen in the Division of Hematology at Mayo Clinic Rochester between 1 January 2006 and 31 December 2011, 272 (11.8%) had 526 PET-CT scans and 472 (89.7%) of these were reported as abnormal. Among the 293 (55.7%) PET-CT scans used for routine evaluation of CLL, the PET component was of clinical value in only one instance. In contrast, in 83 (30.5%) patients, PET-CT scans used to evaluate new clinical complications localized high FDG-avidity lesions for biopsies. This resulted in clinically relevant new diagnoses in 32 patients, including those with more aggressive lymphoma (n = 16), non-hematological malignancies (n = 8) and opportunistic infections (n = 3). Twenty-seven patients had high FDG-avidity CLL, which was associated with prominent lymph node proliferation centers, an increased frequency of poor prognostic factors (17p13 deletion, unmutated immunoglobulin heavy chain variable gene [IGHV], expression of ZAP-70 and CD38) and a shorter overall survival. We conclude that FDG PET scans should not be used for routine surveillance of patients with CLL. However PET-CT scans are sensitive, but not specific, for detection of aggressive lymphomas, other cancers and systemic infections in patients with CLL.

• Authors: Michael J Conte, Deborah A Bowen, Gregory A Wiseman, Kari G Rabe, Susan L Slager, Susan M Schwager, Timothy G Call, David S Viswanatha, Clive S Zent
• Journal: Leukemia & lymphoma (Leuk Lymphoma) Vol. 55 Issue 9 Pg. 2079-84 (Sep 2014) ISSN: 1029-2403 [Electronic] United States
• PMID: 24286263 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Immunoglobulin Heavy Chains
• Fluorodeoxyglucose F18

Topics

• Adult
• Aged
• Aged, 80 and over
• Biopsy
• Chromosome Aberrations
• Disease Management
• Female
• Fluorodeoxyglucose F18
• Humans
• Immunoglobulin Heavy Chains (genetics)
• Immunophenotyping
• Infections (diagnosis, etiology)
• Leukemia, Lymphocytic, Chronic, B-Cell (complications, diagnosis, genetics)
• Lymph Nodes (pathology)
• Male
• Middle Aged
• Mutation
• Neoplasm Staging
• Neoplasms, Second Primary (diagnosis, etiology)
• Positron-Emission Tomography
• Prognosis
• Tomography, X-Ray Computed
• Young Adult