The prevalence of extramedullary acute myeloid leukemia detected by <sup>18</sup>FDG-PET/CT: final results from the prospective PETAML trial

Stölzel, Friedrich; Lüer, Tors; Löck, Steffen; Parmentier, Stefani; Kuithan, Friederike; Kramer, Michael; Alakel, Nael; Sockel, Katja; Taube, Franziska; Middeke, Jan Moritz; Schetelig, Johannes; Röllig, Christoph; Paulus, Tobias; Kotzerke, Jörg; Ehninger, Gerhard; Bornhäuser, Martin; Schaich, Markus; Zoephel, Klaus

doi:10.3324/haematol.2019.223032

Cited by 43 publications

(45 citation statements)

References 21 publications

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“…In addition, for the right selection of therapeutic modalities, bone marrow biopsy should be performed to exclude medullary involvement [10,11]. Moreover, additionally performed Positron Emission Tomography and Computer Tomography allows for the evaluation of treatment response, reveals previously unnoticed manifestations, and increases diagnostic accuracy [12].…”

Section: Introductionmentioning

confidence: 99%

Extra-medullary recurrence of myeloid leukemia as myeloid sarcoma after allogeneic stem cell transplantation: impact of conditioning intensity

Frietsch

Hunstig

Wittke

et al. 2020

Bone Marrow Transplant

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Myeloid sarcoma (MS) as a solid extra-medullary (EM) manifestation of acute myeloid leukemia (AML), myeloproliferative or myelodysplastic syndromes is a rare presentation of relapse after allogeneic hematopoietic stem cell transplantation (HSCT). The databases of the Departments of Hematology and Oncology of the University Hospitals of Jena and Rostock were screened for patients aged 18 years or older for onset of MS after HSCT for myeloid malignancies between 2002 and 2019. Nineteen patients with MS were identified, the majority of whom had received reduced-intensity conditioning (RIC). The median onset of MS was 425 days after HSCT and the median overall survival since MS was 234 days. Although MS is associated with a poor prognosis, three patients survived more than two years and one more than 11 years after MS onset. These results indicate that RIC protocols may be associated with a higher risk of EM relapse. Since EM relapse occurred in the presence of Graft-versus-host-disease, these observations also demonstrate the limitations of graft-versus-tumor effects after HSCT. In conclusion, occurrence of MS after HSCT is associated with a poor prognosis, as multimodal curative concepts including intensive chemotherapy and another HSCT are often not viable.

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Section: Introductionmentioning

confidence: 99%

Extra-medullary recurrence of myeloid leukemia as myeloid sarcoma after allogeneic stem cell transplantation: impact of conditioning intensity

Frietsch

Hunstig

Wittke

et al. 2020

Bone Marrow Transplant

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“…In previous studies, PET-CT was reported to be useful as a diagnostic tool for extramedullary disease in patients with leukemia. In a recent prospective study, PET-CT had 77% sensitivity and 97% speci city for detecting extramedullary disease in AML patients [14]. In the present study, although the correlation between the SUVmax response and recurrence was di cult to analyze due to the lack of recurrence cases and the number of samples, we analyzed the factors affecting the recurrence and PMD showing treatment failure.…”

Section: Discussionmentioning

confidence: 89%

Analysis of PET Parameters Predicting Response to Radiotherapy for Myeloid Sarcoma

Choi¹,

Song²,

Kwak

et al. 2020

Preprint

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Background: Positron-emission tomography (PET)-CT has recently been used for diagnostic imaging and radiotherapy for myeloid sarcoma, but there is little research on predicting the response of radiotherapy. The aim of this study was to analyze the association between PET-CT variables and the response to radiotherapy in patients with myeloid sarcoma.Methods: This study was conducted in myeloid sarcoma patients who received radiotherapy and PET-CT before and after radiotherapy. The response to radiotherapy was evaluated based on the European Organization for Research and Treatment of Cancer PET response criteria, and binary regression analysis was performed to assess the factors predicting reductions in the SUVmax.Results: Twenty-seven sites in 12 patients were included in the study. The 27 irradiated sites included 14 soft tissues, 11 bones, and two organs. Complete metabolic responses were seen in 24 patients after radiotherapy, a partial metabolic response in one, and progressive metabolic disease in two patients. The prescribed dose of more than 3000 cGy10 was significantly greater in the treatment control group (P = 0.024). In binary logistic regression analysis predicting reductions in the SUVmax of more than 70% after radiotherapy, the pretreatment SUVmax (≥ 7.5) and further chemotherapy after radiotherapy showed significant differences in univariate and multivariate analyses.Conclusions: Good metabolic responses (complete or partial) to radiotherapy were achieved in 92.6% of the myeloid sarcoma patients. Radiation doses < 3000 cGy10 and increased SUVmax were related to treatment failure and high SUVmax before radiotherapy was a factor influencing SUVmax reduction. Further large-scale studies are needed.

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“…Several papers reported that PET/CT incidentally detected acute lymphoblastic leukemia (ALL) (8)(9)(10)(11), and a few studies have reported the evaluation and predictive value of PET/CT in patients with leukemia (12,13). The prospective PETAML trial reported that the specificity of 18 F-FDG-PET/CT for diagnosis of extramedullary acute myeloid leukemia was 97%, despite hematological remission (14). In a retrospective study of 28 children suspected of leukemia progression or recurrence during / after chemotherapy or allo-HSCT, 14 cases with positive 18 F-FDG-PET/CT scans were associated with increased blasts in bone marrow biopsies, and the mean SUV max was significantly higher than what is seen with infectious diseases (15).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Asymmetric Bone Marrow Involvement in Patients With Acute Leukemia After Allogeneic Hematopoietic Stem Cell Transplantation

Yan

Zhou

et al. 2021

Front. Oncol.

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After allogeneic hematopoietic stem cell transplantation (allo-HSCT), acute leukemia relapse is common, and asymmetric bone marrow recurrence hasn't been reported. Because the anatomical distribution of acute leukemia clones in the bone marrow after allo-HSCT is presumed to be diffuse, bone marrow aspirations are performed in single site. The first case was a 20-year-old man who was diagnosed with acute myelomonocytic leukemia and received haploidentical allo-HSCT. Routine bone marrow biopsy of his left posterior iliac bone marrow showed 52% leukemia blasts, while the right side had 0% blasts 10 days later. The second case was a 23-year-old woman who was diagnosed with acute B lymphoblastic leukemia and received HLA-identical sibling allo-HSCT. Although 62% of blasts were found in her left iliac marrow on day +122, 0% of blasts were found on a sample obtained from the right iliac crest on day +128. Bilateral iliac bone marrow pathology and whole-body 18F-FDG PET/CT scans confirmed that the leukemic infiltration in her bone marrow was asymmetric. To our knowledge, these are the first case reports of asymmetric bone marrow infiltration of blasts in acute leukemia patients after allo-HSCT. Bilateral posterior iliac crest aspirations or 18F-FDG-PET/CT scans may help distinguish such involvement.

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The prevalence of extramedullary acute myeloid leukemia detected by ¹⁸FDG-PET/CT: final results from the prospective PETAML trial

Cited by 43 publications

References 21 publications

Extra-medullary recurrence of myeloid leukemia as myeloid sarcoma after allogeneic stem cell transplantation: impact of conditioning intensity

Extra-medullary recurrence of myeloid leukemia as myeloid sarcoma after allogeneic stem cell transplantation: impact of conditioning intensity

Analysis of PET Parameters Predicting Response to Radiotherapy for Myeloid Sarcoma

Case Report: Asymmetric Bone Marrow Involvement in Patients With Acute Leukemia After Allogeneic Hematopoietic Stem Cell Transplantation

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The prevalence of extramedullary acute myeloid leukemia detected by 18FDG-PET/CT: final results from the prospective PETAML trial

Cited by 43 publications

References 21 publications

Extra-medullary recurrence of myeloid leukemia as myeloid sarcoma after allogeneic stem cell transplantation: impact of conditioning intensity

Extra-medullary recurrence of myeloid leukemia as myeloid sarcoma after allogeneic stem cell transplantation: impact of conditioning intensity

Analysis of PET Parameters Predicting Response to Radiotherapy for Myeloid Sarcoma

Case Report: Asymmetric Bone Marrow Involvement in Patients With Acute Leukemia After Allogeneic Hematopoietic Stem Cell Transplantation

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The prevalence of extramedullary acute myeloid leukemia detected by ¹⁸FDG-PET/CT: final results from the prospective PETAML trial