Prognostic Value of Baseline Total Metabolic Tumor Volume Measured on FDG PET in Patients With Richter Syndrome

Abstract

Purpose We evaluated the prognostic value of baseline total metabolic tumor volume (TMTV) measured using pretreatment FDG PET for patients with transformation of chronic lymphocytic leukemia (CLL) into diffuse large B-cell lymphoma (DLBCL). Methods A total of 28 patients with transformation of CLL into DLBCL who had undergone FDG PET before treatment were retrospectively reviewed. Univariate and multivariate analysis of conventional clinicopathologic variables (sex, age, World Health Organization performance status score, International Prognostic Index score, Binet stage, lactate dehydrogenase serum level [LDH], platelet count, presence or not of prior therapies for CLL, the time from CLL to Richter syndrome, Ann Arbor stage, Bulky or not) and metabolic parameters (SUVmax, SUVmean, TMTV, and total lesion glycolysis) at the time of the transformation of CLL into DLBCL were tested for overall survival (OS). Results Of the 28 patients, 14 patients (50%) died during the follow-up period. Low platelet count, World Health Organization performance status score >1, high LDH, and high TMTV were found to be significant prognostic factors for OS on univariate analysis. The 5-year estimates of OS were 63% in the low metabolic burden group (TMTV ≤1200 cm3) and 0% in the high metabolic burden group (TMTV >1200 cm3). Multivariate analysis revealed that only high LDH was a significant predictor after adjustment for other variables of OS. Conclusions TMTV extracted from FDG PET at the time of the transformation of CLL into DLBCL is a predictor of OS.

The Role of 18F-FDG PET/CT in Guiding Precision Medicine for Invasive Bladder Carcinoma

“…The mainstream prognostic imaging biomarkers are baseline metabolic tumor burden (TMTV), baseline total lesion glycolysis (TLG), and SUVmax. All have been associated with overall survival in a wide range of cancers and treatments (38)(39)(40). With the paradigm shift of immunotherapy, authors have evaluated the potential role of appraising host metabolism in lymphoid tissues such as the bone marrow.…”

Value of total lesion glycolysis and cell-of-origin subtypes for prognostic stratification of diffuse large B-cell lymphoma patients

“…Baseline volume-based PET parameters, such as total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG), reflecting the tumor burden and metabolism, have been proposed as promising prognostic biomarkers in DLBCL. A growing body of literature shows that baseline TMTV or TLG can be used to risk-stratify patients with DLBCL (10)(11)(12)(13)(14). Furthermore, a recent study reported that TMTV could even allow for identifying a small group of high-risk NCCN-IPI of ≥4 patients with significantly different outcomes (15).…”

The Role of 2-[18F]-FDG PET/CT in Detecting Richter Transformation in Chronic Lymphocytic Leukemia: A Systematic Review

“…After the revision of the titles and abstracts, 90 records were eliminated because they were not within the field of interest of the research of this review and 44 records were eliminated because they were editorials, comments, case reports, small case series, reviews or conference proceedings. Finally, 13 studies (for a total of 1336 patients affected by CLL who performed 2-[ 18 F]-FDG PET or PET/CT) were screened in their full-text version and included in this systematic review [14][15][16][17][18][19][20][21][22][23][24][25][26] (Figure 1). No additional manuscripts were discovered while checking the references of the selected articles.…”

“…Tables 1-3 contain the main characteristics and results of the studies included. Of the 13 studies, 10 were of retrospective nature [14][15][16][19][20][21][23][24][25][26] and only 3 were prospective [17,18,22]. In two papers the scanner utilized was PET only [15,24], while in the other 10 cases the scanner used was hybrid PET/CT [14,[16][17][18][20][21][22][23]25,26]; only in one manuscript both techniques were considered [19].…”