The significance of pre-therapeutic F-18-FDG PET–CT in lymphoma-associated hemophagocytic lymphohistiocytosis when pathological evidence is unavailable

• Published in: Journal of cancer research and clinical oncology Vol. 142; no. 4; pp. 859 - 871
• Main Authors: Wang, Jujuan, Wang, Dongjiao, Zhang, Qingbo, Duan, Limin, Tian, Tian, Zhang, Xiaoyan, Li, Jianyong, Qiu, Hongxia
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2016; Springer Nature B.V
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cancer Research; Chemotherapy; Cyclophosphamide - administration & dosage; Doxorubicin - administration & dosage; Etoposide - administration & dosage; Female; Fluorodeoxyglucose F18 - administration & dosage; Hematology; Humans; Immunoglobulins, Intravenous - therapeutic use; Immunosuppressive Agents - therapeutic use; Internal Medicine; Kaplan-Meier Estimate; Lymphohistiocytosis, Hemophagocytic - diagnosis; Lymphohistiocytosis, Hemophagocytic - drug therapy; Lymphohistiocytosis, Hemophagocytic - etiology; Lymphohistiocytosis, Hemophagocytic - immunology; Lymphoma; Lymphoma - complications; Lymphoma - diagnosis; Lymphoma - drug therapy; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Multimodal Imaging - methods; Oncology; Original Article – Clinical Oncology; Original – Clinical Oncology; Positron-Emission Tomography - methods; Prednisone - administration & dosage; Radiopharmaceuticals - administration & dosage; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Tomography; Tomography, X-Ray Computed; Treatment Outcome; Vincristine - administration & dosage; Chemotherapy; Lymphoma-associated hemophagocytic lymphohistiocytosis (LAHLH); Differential diagnosis; Prognosis; PET–CT
• ISSN: 0171-5216; 1432-1335
• DOI: 10.1007/s00432-015-2094-z

Purpose The significance of positron emission tomography/computed tomography (PET–CT) in identifying patients with lymphoma-associated hemophagocytic lymphohistiocytosis (LAHLH) when pathological evidence is unavailable remains uncertain. Methods In this retrospective study, 44 HLH patients who underwent PET–CT before clinical treatment were enrolled, and 18 of them were highly suspected as LAHLH by PET–CT. We compared the PET–CT parameters between confirmed LAHLH and non-LAHLH patients. The efficacy of initial therapies for highly suspected LAHLH patients was analyzed as well. Results We found that the SUV Sp , SUV BM , SUV LN , SUV max , SUV LN/Li , and SUV max/Li in LAHLH group were significantly higher than those in non-LAHLH group ( p  = 0.003, p  = 0.034, p  = 0.003, p  < 0.001, p  = 0.039, and p  = 0.035, respectively). HLH patients with an SUV max value >5.5, an SUV LN value >3.3, and an SUV Sp value >4.8 were more likely to be LAHLH ( p  < 0.001, p  = 0.003, and p  = 0.003, respectively). And the incidence of multiple lymphadenopathy with increased FDG uptake or the incidence of multiple bone lesions in LAHLH patients was significantly higher than those in non-LAHLH group (92.9 vs. 35.7 %, p  = 0.004; 42.9 vs. 0 %, p  = 0.016, respectively). Furthermore, by comparing the efficacy of initial therapies for highly suspected LAHLH patients ( n  = 18), we indicated that the CR rate was significantly higher in lymphoma-chemotherapy group than in immunosuppressive therapy group (90 and 25 %, respectively; p  = 0.013). OS analysis revealed that highly suspected LAHLH patients treated with lymphoma-chemotherapy had better prognosis (264 days) than those treated with immunosuppressive therapy (15 days) ( p  < 0.0001). Conclusions When pathological evidence is absent, PET–CT may play an important role in identifying HLH patients underlying lymphoma. Once highly suspected as LAHLH by PET–CT, lymphoma-chemotherapies that directly treat the underling lymphoma may have a relatively favorable effect and better clinical outcomes than immunosuppressive therapy.