18F-FDG PET in Patients with Primary Systemic Anaplastic Large Cell Lymphoma: Differential Features According to Expression of Anaplastic Lymphoma Kinase

Abstract

Purpose Primary systemic anaplastic large cell lymphoma (ALCL) is divided into two entities according to the expression of anaplastic lymphoma kinase (ALK). We investigated 18 F-fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET) findings in primary systemic ALCL according to ALK expression. Methods Thirty-seven patients who had baseline PET before CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone)-based chemotherapy were enrolled. Among them, patients who underwent interim and/or post-therapy PET were further investigated for the treatment response and survival analysis. Baseline PET was analyzed visually and semiquantitatively using peakSUV, and interim and post-therapy PETs were visually analyzed. Results All cases were 18 F-FDG-avid on baseline PET. The peakSUV of ALK-positive ALCL (n =16, 18.7±10.5) was higher than that of ALK-negative ALCL (n =21, 10.0±4.9) (P =0.006). In ALK-negative ALCL, complete response (CR) rate in negative-interim PET was higher than positive-interim PET (100 % vs 37.5 %, P =0.02); however, there was no such difference in ALK-positive ALCL (100 % vs 75 %, P =0.19). The 3-year progression-free survival (PFS) was not significantly different between ALK-positive and ALK-negative ALCL (72.7 % vs 47.6 %, P =0.34). In ALK-negative ALCL, negative interim and post-therapy PET patients had better 3-year PFS than positive interim (83.3 % vs 25.0 %, P =0.06) and post-therapy PET patients (70.0 % vs 20.0 %, P =0.04). In contrast, ALK-positive ALCL had no such differences between PFS and PET results. Conclusions On baseline PET, all cases showed 18 F-FDGavidity, and ALK expression was related to higher 18 F-FDG uptake. ALK-positive patients tend to have better PFS than ALK-negative patients. Negative-interim PET was a good indicator of CR, and interim or post-therapy PET was helpful for predicting the prognosis only in the ALK-negative group.

18F-FDG PET/CT imaging findings in anaplastic large cell lymphoma, a rare subtype of lymphoma

“…Subsequently, ALK translocations were also found in other cancers, such as lung cancers [26]. The present study found that ALK-positive ALCL had a higher 18 F-FDG uptake than that of ALK-negative ALCL (SUVmax: 22.1 ± 14.3 vs. 15.1 ± 6.6, t = 2.354, P = 0.023), which was consistent with the results reported by Lee DY [9]. Similarly, ALK-positive lung cancers were also observed to have a higher SUVmax than ALK-negative [27,28] lung cancers.…”

“…The present study revealed that ALCL had intense uptake of 18 F-FDG in tumours with a mean SUVmax of 19.5 ± 12.6. Due to the high 18 F-FDG uptake, PET/CT had a very high sensitivity for the detection of ALCL (98.0%), which was consistent with the results reported by Lee DY, et al [9]. High uptake of 18 F-FDG in the lesions implies that PET/CT is a perfect modality for staging and treatment response evaluation for ALCL.…”

“…18 F-FDG PET/CT can also show the tumour distribution in each individual and reflect the growth patterns of the tumours [17]. However, although 18 F-FDG PET/CT has been extensively applied for diagnosing lymphoma [13], only a few papers have investigated the utility of this modality in ALCL [9,18] and the imaging manifestations of 18 F-FDG PET/CT for this disease have been rarely described.…”

“…18 F-FDG positron emission tomography/computed tomography (PET/CT) is an important functional imaging technique that has become a standard imaging modality in staging, treatment response evaluation and prognostic prediction for FDG-avid lymphomas, according to the updated guidelines for imaging in lymphoma [8]. However, the imaging characteristics of ALCL on 18 F-FDG PET/CT have rarely been described, and the role of 18 F-FDG PET/ CT in evaluating this disease has not been well established, possibly due to the low incidence rate of the disease [9]. In the present study, 18 F-FDG PET/CT images of 50 patients with ALCL were retrospectively reviewed to describe the ALCL imaging manifestation.…”

T-Cell Non-Hodgkin Lymphomas: Spectrum of Disease and the Role of Imaging in the Management of Common Subtypes

“…One study has shown differences in extra-nodal sites involved in ALK-positive and ALK-negative ALCLs: bone marrow, bone, subcutaneous tissue, and splenic involvement were seen at more commonly in ALK-positive patients, whereas skin, liver, and gastrointestinal involvement was more frequent in ALK-negative ALCL (43). The degree of 18 FDG uptake is higher in ALK-positive ALCL than in ALK-negative ALCL, suggesting that PET may be useful in distinguishing between the two groups (45). …”