Introduction In malignant lymphoma, bone marrow involvement is considered as clinical stage IV which adversely affects International Prognostic Index resulting in poor outcome. Detecting bone marrow lesion is therefore important in staging of newly diagnosed malignant lymphoma. Bone marrow biopsy (BMB) of unilateral or bilateral iliac crest has been a classical method to detect bone marrow infiltration. However, BMB in rare instance, induce some complications including excessive bleeding, infections, or lasting pain. Recently, positron emission tomography combined with computed tomography (PET-CT) became a routine tool in staging of malignant lymphoma. Although PET-CT shows high sensitivity of detecting viable nodal and extra-nodal lesions in aggressive lymphoma, its role in low-grade, indolent lymphoma such as follicular lymphoma (FL) remains controversial. The aim of this study is to retrospectively evaluate the diagnostic accuracy of PET-CT in detecting bone marrow infiltration in patients with newly diagnosed FL. Patients and Methods: We collected data of all patients who were newly diagnosed with FL from January 2005 to October 2015 at Yokohama City University Hospital and Yokohama City University Medical Center. Patients with FL who underwent both PET-CT and BMB prior to the initiation of treatments were finally included in the analysis. Results of unilateral or bilateral BMB of posterior iliac crest were collected from written reports. BMB specimens were evaluated by hemato-pathologists of each institution. The presence of lymphoma cells in the bone marrow was based on morphological and immune-histochemical findings. Written reports were used to collect PET-CT data. Interpretation of images was made by radiologists of each institution where PET-CT scans were performed. Bone marrow involvement in PET-CT was defined as greater intensity of FDG uptake in the bone marrow than those in liver or those in mediastinum. This study was approved by the Internal Review Board of Yokohama City University School of Medicine. Results: In total, 184 patients were newly diagnosed with FL from January 2005 to October 2015. Of 184 patients, 117 who underwent both PET-CT and BMB before treatment were evaluated in the further analysis. The patients included 53 males and 64 female with a median age at diagnosis of 53 years (range: 25 - 82). The distributions of histological FL grading were grade 1-2 in 3 patients, grade 1 in 41, grade 2 in 47, grade 3 in 7, grade 3a in 12, and grade unknown in 7. Bone marrow FDG uptake was elevated according to the defined criteria in 22 patients (19%), while the infiltration of lymphoma cells in the bone marrow was detected by BMB in 35 patients (30%). Of 22 patients with elevated FDG uptake in the bone marrow, 6 (32%) were diagnosed as negative for bone marrow infiltration by BMB. Among the 6 patients who were positive for PET-CT and negative for BMB, the pattern of bone marrow FDG uptake was focal in 2, diffuse in 3, and unknown in 1. Among the 35 patients positive for BMB, bone marrow FDG uptake was increased in 16 (65%). Of the16 patients positive for both BMB and PET-CT, the pattern of FDG uptake in the bone marrow was diffuse in 12, and focal in 4. The remaining 19 BMB positive patients were negative for PET-CT. Of these 19 patients positive for BMB and negative for PET-CT, the grading of FL was grade 1 or 2 in 16, and grade 3a in 3. Discussion In conclusion, our study revealed that significant number of patients showed discrepancy between the results of PET-CT and BMB in detecting bone marrow involvement of lymphoma. Although PET-CT is highly sensitive for detecting viable lymphoma cells and is commonly used for staging in routine practice, our data indicated that PET-CT still cannot replace BMB for identifying lymphoma cells in the bone marrow in patients with FL. Disclosures No relevant conflicts of interest to declare.
Background: The prevalence of obesity has more than doubled between 1980 and 2014, worldwide. In Japan, 25% of adults aged ≥20 years (29 % of males and 20% of females) were overweight in 2013. Body mass index (BMI) assesses the proportion of weight versus height, and is commonly used to stratify underweight, normal, overweight, and obesity in adults. However, the prognostic impact of BMI in acute myeloid leukemia (AML) is debatable. In this retrospective study, we aimed to assess whether BMI was associated with clinical outcomes in AML patients in Japan. Patients and Methods: We identified 374 patients with newly diagnosed AML who had been administered either daunorubicin or idarubicin in combination with cytarabine as induction chemotherapy at any of the seven Japanese hospitals that collaborate to form the Yokohama City University Hematology Group from January 2000 to March 2015. Patients with acute promyelocytic leukemia were excluded from this study. BMI is defined as a person's weight in kilograms divided by the square of his height in meters (kg/m2). All patients were categorized in one of two groups according to their BMI: underweight (BMI <18.5) and normal weight (BMI, 18.5-24.9) designed as NW, and overweight (BMI, 25.0-29.9) and obese (BMI ≥30.0) designed as OW. We analyzed complete remission (CR) rate, primary induction failure (PIF) which was defined as not achieving CR in two cycles of chemotherapy, and overall survival (OS) in each group. Results: This study included 227 males and 147 females, with median age at diagnosis of 49 years (range, 15-77 years). In BMI classification, 273 were NW (47, underweight; 226, normal weight), 101 were OW (83, overweight; 18, obese). Median BMI was 22.4 (range, 15.9-39). There were not significant differences in age, sex, Performance status (PS), cytogenetic risk, and comorbidities such as diabetes, hypertension, and ischemic heart disease requiring treatment on diagnosis of AML in the two BMI groups. In this cohort, 283 patients (75.7%) achieved CR and 81 (21.7%) experienced PIF, and 10 subjects (2.8%) had an early death (ED) as death occurring within 30 days of chemotherapy initiation. Only one patient received reduced intensity of chemotherapy ( ≥20%) because of obesity. Relapse during the first CR occurred in 173 subjects (46.3%), and death occurred in 139 patients (37.2%). There was no significant difference in CR rate between the NW and OW groups (73.3% and 82%, respectively, P = 0.079). All 10 patients who experienced ED were in NW (3.7%, P = 0.0068). Causes of ED were as follows: infection in 5 subjects; 3 from cerebral bleeding; and 2 deaths from alveolar bleeding. With a median follow-up of 42 months (1-176 months), OS was 52.4% and 64% at 3 years for the NW and OW groups, respectively (P = 0.022; Figure 1). There was no significant difference in PIF and adverse event between theNW and OW groups. Multivariate analysis showed that a better OS was associated with OW (HR 0.65, 95% CI 0.43-0.97, P = 0.033) and the other prognostic factors of age, sex, PS, and cytogenetic risk. Conclusions: The results of this study show that AML patients with BMI ≥25 had better survival. There was no difference in the toxicity of chemotherapy between the different BMI groups. Out study suggests that Increased BMI should not be a criterion for reducing the dose of chemotherapy administered to patients of newly diagnosed AML. Figure 1. Overall survival of patients with newly diagnosed acute myeloid leukemia according to BMI. Figure 1. Overall survival of patients with newly diagnosed acute myeloid leukemia according to BMI. Disclosures Fujita: Chugai Pharmaceutical CO.,LTD.: Honoraria.
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