[18F]-fluorodeoxyglucose positron emission tomography combined with computed tomography detection of asymptomatic late pulmonary toxicity in patients with non-Hodgkin lymphoma treated with rituximab-containing chemotherapy

Abstract

Rituximab is a chimeric anti-CD20 monoclonal antibody widely used in the treatment of B-cell non-Hodgkin lymphomas (NHL). Most adverse effects are due to infusion-related reactions, and severe respiratory complications are rare. We retrospectively reviewed clinical data and serial imaging studies of five patients with NHL treated with rituximab-containing chemotherapy who developed new pulmonary abnormalities on routine follow-up FDG-PET/CT imaging. None of the patients had pulmonary lymphoma or other pulmonary disease before therapy and all remained asymptomatic during follow-up. New pulmonary interstitial FDG-uptake was detected on follow-up FDG-PET/CT between 1 and 3 months post-treatment, preceded computed tomography abnormalities in one case, and persisted for several months. FDG uptake was linear, subpleural with maximum Standardized uptake value (SUV) from 2.0 to 5.84. Rituximab-containing chemotherapy for NHL may be associated with asymptomatic late pulmonary toxicity characterised by a distinct FDG uptake pattern. Awareness of this finding is important and should not be confused with lymphoma.

Hematologic neoplasms: Interpreting lung findings in chest computed tomography

“…18-FDG PET-CT is not only useful for the staging and follow up of metabolically-active lymphomas 69 but also a pathological uptake in the absence of pulmonary findings in the HRCT can raise early suspicion of drug toxicity 70,71 or leukemic infiltration and it can be useful to differentiate active lesion scarring (whether toxic, infectious or tumoral).…”

¹⁸F-FDG PET/CT Useful for the Early Detection of Rapidly Progressive Fatal Interstitial Lung Disease in Dermatomyositis

“…However, the usefulness of FDG-PET/CT for the early detection of ILD has not been proposed. A few studies suggest the possibility of predicting certain lung diseases such as radiation pneumonitis and chemotherapy-induced lung diseases (19,20). Thus, our observation is the first to describe the usefulness of FDG-PET/CT for the detection of early inflammation in interstitial lung disease that complicates DM.…”

Rituximab-induced subacute interstitial pneumonitis: A case report and review of literature

“…A high degree of suspicion, radiological monitoring between two doses of rituximab, timely withholding of rituximab and starting systemic steroids is highly recommended. [15,16] …”