PET/CT bests gold standard bone marrow biopsy for diagnosis and prognosis of lymphoma patients

Main Category: Lymphoma / Leukemia / Myeloma
Also Included In: MRI / PET / Ultrasound
Article Date: 05 Aug 2013 - 1:00 PDT Current ratings for:
PET/CT bests gold standard bone marrow biopsy for diagnosis and prognosis of lymphoma patients

A more precise method for determining bone marrow involvement in patients with diffuse large B-cell lymphoma (DLBCL) - a key factor in tailoring patient management plans - has been identified by researchers in a study published in the August issue of The Journal of Nuclear Medicine. Imaging with 18F-FDG positron emission tomography/computed tomography (PET/CT), when compared to bone marrow biopsy, was more sensitive, showed a higher negative predictive value and was more accurate, changing treatment for 42 percent of patients with bone marrow involvement.

DLBCL is the most frequent subtype of high-grade non-Hodgkin lymphoma, accounting for nearly 30 percent of all newly diagnosed cases in the United States. In recent decades, there has been a 150 percent increase in incidence of DLBCL.

"In our study, we showed that in diffuse large B-cell lymphoma, 18F-FDG PET/CT has better diagnostic performance than bone marrow biopsy to detect bone marrow involvement and provides a better prognostic stratification. While bone marrow biopsy is considered the gold standard to evaluate bone marrow involvement by high-grade lymphomas, 18F-FDG PET/CT is in fact the best method to evaluate extension of the disease, as well as avoid invasive procedures," said Louis Berthet, MD, lead author of the study "In Newly Diagnosed Diffuse Large B-Cell Lymphoma, Determination of Bone Marrow Involvement with 18F-FDG PET/CT Provides Better Diagnostic Performance and Prognostic Stratification Than Dose Biopsy."

The retrospective study included 133 patients diagnosed with DLBCL. All patients received both a whole-body 18F-FDG PET/CT scan, as well as a bone marrow biopsy to determine bone marrow involvement. A final diagnosis of bone marrow involvement was made if the biopsy was positive, or if the positive PET/CT scan was confirmed by a guided biopsy, by targeted magnetic resonance imaging (MRI) or, after chemotherapy, by the concomitant disappearance of focal bone marrow uptake and uptake in other lymphoma lesions on 18F-FDG PET/CT reassessment. Progression-free survival and overall survival were then analyzed.

Thirty-three patients were considered to have bone marrow involvement. Of these, eight were positive according to the biopsy and 32 were positive according to the PET/CT scan.18FDG PET/CT was more sensitive (94 percent vs. 24 percent), showed a higher negative predictive value (98 percent vs. 80 percent) and was more accurate (98 percent vs. 81 percent) than bone marrow biopsy. Among the 26 patients with positive 18F-FDG PET/CT results and negative biopsy results, 11 were upstaged to stage IV by PET/CT, which changed their treatment plans.18F-FDG PET/CT was also determined to be an independent predictor of progression-free survival.

"Our findings add to the literature to prove the significance of 18F-FDG PET/CT in cancer evaluation and to democratize this imaging method," said Berthet. "Molecular imaging is the best method to adapt targeted therapies to each patient. The emergence of PET/MRI and novel radiotracers predicts an exciting new future for our field.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our lymphoma / leukemia / myeloma section for the latest news on this subject.

In Newly Diagnosed Diffuse Large B-Cell Lymphoma, Determination of Bone Marrow Involvement with 18F-FDG PET/CT Provides Better Diagnostic Performance and Prognostic Stratification Than Dose Biopsy“” Berthet L, Cochet A, Kanoun S, Berriolo-Riedinger A, Humbert O, Toubeau M, Dygai-Cochet I, Legouge C, Casasnovas O, Brunotte F, J Nucl Med. 2013 May 14. [Epub ahead of print].

Society of Nuclear Medicine

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PET/CT bests gold standard bone marrow biopsy for diagnosis and prognosis of lymphoma patients

Main Category: Lymphoma / Leukemia / Myeloma
Also Included In: MRI / PET / Ultrasound
Article Date: 05 Aug 2013 - 1:00 PDT Current ratings for:
PET/CT bests gold standard bone marrow biopsy for diagnosis and prognosis of lymphoma patients

A more precise method for determining bone marrow involvement in patients with diffuse large B-cell lymphoma (DLBCL) - a key factor in tailoring patient management plans - has been identified by researchers in a study published in the August issue of The Journal of Nuclear Medicine. Imaging with 18F-FDG positron emission tomography/computed tomography (PET/CT), when compared to bone marrow biopsy, was more sensitive, showed a higher negative predictive value and was more accurate, changing treatment for 42 percent of patients with bone marrow involvement.

DLBCL is the most frequent subtype of high-grade non-Hodgkin lymphoma, accounting for nearly 30 percent of all newly diagnosed cases in the United States. In recent decades, there has been a 150 percent increase in incidence of DLBCL.

"In our study, we showed that in diffuse large B-cell lymphoma, 18F-FDG PET/CT has better diagnostic performance than bone marrow biopsy to detect bone marrow involvement and provides a better prognostic stratification. While bone marrow biopsy is considered the gold standard to evaluate bone marrow involvement by high-grade lymphomas, 18F-FDG PET/CT is in fact the best method to evaluate extension of the disease, as well as avoid invasive procedures," said Louis Berthet, MD, lead author of the study "In Newly Diagnosed Diffuse Large B-Cell Lymphoma, Determination of Bone Marrow Involvement with 18F-FDG PET/CT Provides Better Diagnostic Performance and Prognostic Stratification Than Dose Biopsy."

The retrospective study included 133 patients diagnosed with DLBCL. All patients received both a whole-body 18F-FDG PET/CT scan, as well as a bone marrow biopsy to determine bone marrow involvement. A final diagnosis of bone marrow involvement was made if the biopsy was positive, or if the positive PET/CT scan was confirmed by a guided biopsy, by targeted magnetic resonance imaging (MRI) or, after chemotherapy, by the concomitant disappearance of focal bone marrow uptake and uptake in other lymphoma lesions on 18F-FDG PET/CT reassessment. Progression-free survival and overall survival were then analyzed.

Thirty-three patients were considered to have bone marrow involvement. Of these, eight were positive according to the biopsy and 32 were positive according to the PET/CT scan.18FDG PET/CT was more sensitive (94 percent vs. 24 percent), showed a higher negative predictive value (98 percent vs. 80 percent) and was more accurate (98 percent vs. 81 percent) than bone marrow biopsy. Among the 26 patients with positive 18F-FDG PET/CT results and negative biopsy results, 11 were upstaged to stage IV by PET/CT, which changed their treatment plans.18F-FDG PET/CT was also determined to be an independent predictor of progression-free survival.

"Our findings add to the literature to prove the significance of 18F-FDG PET/CT in cancer evaluation and to democratize this imaging method," said Berthet. "Molecular imaging is the best method to adapt targeted therapies to each patient. The emergence of PET/MRI and novel radiotracers predicts an exciting new future for our field.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our lymphoma / leukemia / myeloma section for the latest news on this subject.

In Newly Diagnosed Diffuse Large B-Cell Lymphoma, Determination of Bone Marrow Involvement with 18F-FDG PET/CT Provides Better Diagnostic Performance and Prognostic Stratification Than Dose Biopsy“” Berthet L, Cochet A, Kanoun S, Berriolo-Riedinger A, Humbert O, Toubeau M, Dygai-Cochet I, Legouge C, Casasnovas O, Brunotte F, J Nucl Med. 2013 May 14. [Epub ahead of print].

Society of Nuclear Medicine

Please use one of the following formats to cite this article in your essay, paper or report:

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Society of Nuclear Medicine. "PET/CT bests gold standard bone marrow biopsy for diagnosis and prognosis of lymphoma patients." Medical News Today. MediLexicon, Intl., 5 Aug. 2013. Web.
5 Aug. 2013. APA

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'PET/CT bests gold standard bone marrow biopsy for diagnosis and prognosis of lymphoma patients'

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UNMC study to test 'breakthrough' drug in mantle cell lymphoma patients - FDA expected to approve drug in 6 months

Main Category: Lymphoma / Leukemia / Myeloma
Also Included In: Clinical Trials / Drug Trials
Article Date: 31 Jul 2013 - 1:00 PDT Current ratings for:
UNMC study to test 'breakthrough' drug in mantle cell lymphoma patients - FDA expected to approve drug in 6 months

The University of Nebraska Medical Center is involved in testing a drug the Food and Drug Administration has fast-tracked towards approval because of its dramatic results in patients with mantle cell lymphoma and other cancers.

"This experimental drug, Ibruitinib, is so promising that the FDA gave it fast track designation which rarely happens," said Julie M. Vose, M.D., chief of the division of hematology and oncology and Neumann M. and Mildred E. Harris Professor at UNMC. "Patients who've been on the treatment have had remarkable results with limited side effects. We are able to offer this to patients through an expanded access program which occurs about six months before the FDA approves it."

The new study is targeted for patients age 18 and older with mantle cell lymphoma who've relapsed - meaning other treatments have failed. The study, which aims to enroll as many patients as possible, is being conducted in about 50 locations across the United States and in Puerto Rico. Those eligible for the study will be provided the drug at no cost.

The FDA designated Ibruitinib as a breakthrough therapy. The designation is intended to expedite the development and review of drugs for serious or life-threatening conditions that demonstrate the drug may have substantial improvement over available therapy. The study will remain open until the medication is FDA approved, which should be by the end of the year, Dr. Vose said.

Dr. Vose, who is principal investigator of the UNMC study, said Ibruitinib works differently than other drugs for this type of cancer. The drug, developed by Pharmacyclics, Inc and Johnson & Johnson's Janssen Pharmaceutical division, basically poisons one of the pathways that helps the cancer grow.

"It kills the lymphoma," she said. "It has fairly limited side effects. It's a pill rather than an intravenous delivery, and it also has potential to be used with other treatments due to the limited side effects."

Steven "Robert" Whisnant of Morganton, N.C., and his wife, Quteen, came from North Carolina for the trial after his physicians told him there was nothing else they could do. Whisnant has had a dramatic response to the medication as have many other patients, Dr. Vose said.

"I'm thankful that there's somebody out there trying to find different things to help people because if I hadn't have gotten the medication, I'd have died," Whisnant said. "So far it seems to be working. All the tumors in my neck are gone and the ones in my stomach have shrunken. It gives us hope and I'm thankful for that."

Mantle cell lymphoma is a rare, B-cell non-Hodgkin lymphoma that most often affects men over the age of 60. The disease may be fast or slow growing. It comprises about five percent of all non-Hodgkin lymphomas.

Dr. Vose said results thus far have seen a 75 percent response rate in patients with mantle cell lymphoma whose disease has failed all other treatments.

"We have been involved in several of the first clinical trials with this particular medication," Dr. Vose said. "We don't think it's a cure but it's been found to be able to keep patients in remission longer to control their symptoms and allow them to have a good quality of life. These patients have very limited other options. This is a breakthrough and works very quickly."

Clinical trials began on Ibruitinib a few years ago. It also is being tested at other sites for other types of lymphoma, leukemia and multiple myeloma.

Other co-investigators in the study are UNMC physicians Jim Armitage, M.D., Phil Bierman, M.D., and Greg Bociek, M.D.

For more information about the study "An Open Label Treatment Use Protocol for Ibrutinib in Subjects With Relapsed or Refractory Mantle Cell Lymphoma", contact Maribeth at 402 559-9053 or mahohens@unmc.edu. For a complete list of other study locations go to clinicaltrials.gov and search "NCT01833039."

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University of Nebraska Medical Center

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University of Nebraska Medical Center

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No improvement seen in HIV-associated lymphoma survival during the antiretroviral therapy era

Main Category: Lymphoma / Leukemia / Myeloma
Also Included In: HIV / AIDS
Article Date: 30 Jul 2013 - 0:00 PDT Current ratings for:
No improvement seen in HIV-associated lymphoma survival during the antiretroviral therapy era

Stable survival rates were observed for HIV-associated lymphoma patients during the antiretroviral therapy (ART) era in the US, according to a new study published in the Journal of the National Cancer Institute.

Studies have shown that HIV infection increases the risk of non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) and that incidence for many lymphoma types has not decreased in the ART era. Furthermore, lymphoma is the most frequent cancer-related cause of death among HIV-infected persons. However, trends in presentation and survival have not been investigated among HIV-associated lymphoma patients in routine care since the beginning of the ART era.

Satish Gopal, M.D., M.P.H., from the Program in Global Oncology at the Lineberger Comprehensive Cancer Center of the University of North Carolina, and colleagues compared differences in presentation and survival, across histologic subtypes and diagnosis years, among HIV-infected lymphoma patients. They also examined predictors of death in this population. Data from 476 HIV-associated lymphoma patients living in the US who were diagnosed with various types of lymphoma including HL, diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma (BL), primary central nervous system lymphoma (PCNSL), and other types of NHL, between 1996 and 2010 were analyzed using various statistical methods.

Their results demonstrate that HIV-associated lymphoma is heterogeneous and changing since the ART era began. Clinical presentations across the different lymphoma subtypes was highly variable during the study period (79 HL, 201 DLBCL, 56 BL, 54 PCNSL, and 86 with other NHL). Histologic shifts in the proportion of BL vs other NHL subtypes is increasing consistent with other reports. Data showed that more recently diagnosed patients were older and more likely to be male, of nonwhite/nonblack ethnicity (primarily Latino patients), to be men who have sex with men, and to have prior AIDS-related illness. They were also more likely to be on ART at lymphoma diagnosis with higher CD4 counts and better HIV control. The authors also report that more recent diagnosis year was not associated with decreased mortality and that 61.6% of patients with HIV-associated HL were alive 5 years after lymphoma diagnosis, compared with 50.0% for BL, 44.1% for DLBCL, 43.3% for other NHL, and 22.8% for PCNSL. Of note, lymphomas occurring on ART were associated with a doubling of mortality, which may suggest important biologic differences between tumors developing on and off ART, although these results require confirmation.

Gopal and colleagues conclude, "These results highlight an ongoing need to elucidate lymphoma biology and optimize treatments for this challenging population to reduce deaths from one of the leading causes of mortality in the modern ART era."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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In an accompanying editorial, Kieron Dunleavy, M.D., and Wyndham H. Wilson, M.D., Ph.D., from the Metabolism Branch of the Center for Cancer Research at the National Cancer Institute, state the findings reflect the shifting demographics of the HIV epidemic in the US. However, the shift towards more biologically favorable and curable types of lymphoma has not resulted in improved survival over the study period. They assert, "In conclusion, because HIV-associated lymphomas are potentially as curable as those arising in HIV-negative patients, it is critical that they be approached with the same care as HIV negative cases."

Journal of the National Cancer Institute

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