Aim/Introduction: The present study aimed to verify whether metabolic response of active bone marrow (BM) to chemotherapy is correlated with treatment effect in patients with Hodgkin lymphoma. Materials and Methods: We studied 33 patients (10 female and 23 male, median age 42, range 19- 78 years) with Hodgkin lymphoma. All patients underwent PET/CT imaging at baseline, after 2 cycles (interim) of ABVD (Adriamycin, Bleomycin, Vinblastine and Dacarbazine) and one month after treatment completion (EoT). Ten non-responders patients showed a positive interim scan (Deauville score >=4) and were moved to BEACOPP scheme (Bleomycin, Etoposide, Adriamycin, Cyclophosphamide, Oncovin, Procarbazine and Prednisone). Patients with suspected BM involvement were excluded from the analysis. All PET/CT scans were analyzed to identify the intraosseous volume (IV) of all vertebral bodies at all time points. As previously described, an iterative optimization scheme was applied to each CT slice to identify the external bone border and thus to extract the IV and its metabolic activity from co-registered PET images. According to our previously validated procedure, inactive BM was defined by IV voxels with a SUV <1.1, while voxels over this cutoff identified active BM. Volume of both BM components was estimated and expressed as % of total IV. Results: No differences in age, prevalence of male gender or disease extension were observed at baseline examination. Similarly, before treatment initiation, mean SUV of intraosseous voxels (1.83±0.34 vs 1.72±0.28, in responders and non-responders, respectively, p=ns) and extension of inactive BM (15±8% and 18±7%, respectively, p=ns) were not significantly different between the two groups. However, at the interim PET after the same two ABVD cycles, responders showed significantly lower extension of inactive BM with respect to non-responders (11±10% vs 26±15%, respectively, p<0.01). This difference even increased at EoT scan (18±10% vs 35±20%, respectively, p<0.01). By contrast, average SUV of either active and inactive BM did not show any significant difference at any study point between the two groups. Conclusion: ABVD failure is associated with a peculiar metabolic response by normal BM to chemotherapy characterized by a more evident loss of active BM in favor of its inactive counterpart. References: None.
Metabolic response of normal bone marrow in nonresponders patients with Hodgkin Lymphoma: a FDG-PET/ CT study
C Marini;
2019
Abstract
Aim/Introduction: The present study aimed to verify whether metabolic response of active bone marrow (BM) to chemotherapy is correlated with treatment effect in patients with Hodgkin lymphoma. Materials and Methods: We studied 33 patients (10 female and 23 male, median age 42, range 19- 78 years) with Hodgkin lymphoma. All patients underwent PET/CT imaging at baseline, after 2 cycles (interim) of ABVD (Adriamycin, Bleomycin, Vinblastine and Dacarbazine) and one month after treatment completion (EoT). Ten non-responders patients showed a positive interim scan (Deauville score >=4) and were moved to BEACOPP scheme (Bleomycin, Etoposide, Adriamycin, Cyclophosphamide, Oncovin, Procarbazine and Prednisone). Patients with suspected BM involvement were excluded from the analysis. All PET/CT scans were analyzed to identify the intraosseous volume (IV) of all vertebral bodies at all time points. As previously described, an iterative optimization scheme was applied to each CT slice to identify the external bone border and thus to extract the IV and its metabolic activity from co-registered PET images. According to our previously validated procedure, inactive BM was defined by IV voxels with a SUV <1.1, while voxels over this cutoff identified active BM. Volume of both BM components was estimated and expressed as % of total IV. Results: No differences in age, prevalence of male gender or disease extension were observed at baseline examination. Similarly, before treatment initiation, mean SUV of intraosseous voxels (1.83±0.34 vs 1.72±0.28, in responders and non-responders, respectively, p=ns) and extension of inactive BM (15±8% and 18±7%, respectively, p=ns) were not significantly different between the two groups. However, at the interim PET after the same two ABVD cycles, responders showed significantly lower extension of inactive BM with respect to non-responders (11±10% vs 26±15%, respectively, p<0.01). This difference even increased at EoT scan (18±10% vs 35±20%, respectively, p<0.01). By contrast, average SUV of either active and inactive BM did not show any significant difference at any study point between the two groups. Conclusion: ABVD failure is associated with a peculiar metabolic response by normal BM to chemotherapy characterized by a more evident loss of active BM in favor of its inactive counterpart. References: None.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
