EXTRANODAL AND SPLEEN DISEASE DETECTED BY FDG-PET/CT IS ASSOCIATED WITH EARLY CLINICAL FAILURE IN UNTREATED FOLLICULAR LYMPHOMA
Author(s): ,
Frederique St-Pierre
Affiliations:
Internal Medicine,Mayo Clinic,Rochester,United States
,
Stephen Broski
Affiliations:
Radiology,Mayo Clinic,Rochester,United States
,
Betsy Laplant
Affiliations:
Department of Health Sciences Research, Division of Biomedical Statistics and Informatics,Mayo Clinic,Rochester,United States
,
Kay Ristow
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
,
Matthew Maurer
Affiliations:
Department of Health Sciences Research, Division of Biomedical Statistics and Informatics,Mayo Clinic,Rochester,United States
,
William Macon
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
,
Thomas Habermann
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
,
Stephen Ansell
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
,
Carrie Thompson
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
,
Ivana Micallef
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
,
Grzegorz Nowakowski
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
Thomas Witzig
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
EHA Library. St-Pierre F. Jun 15, 2019; 266866; PS1249
Dr. Frederique St-Pierre
Dr. Frederique St-Pierre
Contributions
Abstract

Abstract: PS1249

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Background
Predicting early clinical failure in patients with untreated follicular lymphoma (FL) is important but difficult. Lymphoma involvement of extranodal (EN) sites is better detected by FDG-PET/CT than CT alone, but PET parameters are not part of the usual predictive indices. 

Aims
We aimed to determine the incidence and patterns of EN and spleen disease, and learn if they were useful in predicting early clinical failure.

Methods
PET/CT images from 613 cases of newly diagnosed FL between 2003 – 2016 were retrospectively reviewed for EN and spleen involvement. The location, number, and pattern of EN sites, as well as splenic involvement, were recorded.  Associations with outcomes were assessed using event-free survival (EFS), overall survival (OS), and early clinical failure at 24 months (EFS24).

Results
49% (301/613) of patients had PET/CT-detected EN involvement, and 28% (171/613) had spleen involvement. Presence of ≥2 EN sites, spleen, bone or soft tissue involvement all predicted failure to achieve EFS24. These factors, as well as pattern of bone involvement by imaging, were predictors of EFS on univariate analysis; presence of ≥2 EN sites and bone involvement pattern were also predictive of OS.  In a multivariate analysis with FLIPI-2 factors, spleen involvement, pattern of bone involvement, and soft tissue involvement independently predicted a lower EFS (Table 1). When the multivariate analysis was performed using PRIMA-PI factors (marrow and B2M), the presence of ≥2 EN sites was an adverse independent prognostic factor for OS (HR 2.28; 95% CI 1.01-5.18; p=0.05).

Table 1: Extranodal and spleen involvement by PET/CT as predictors of event-free survival

Variable

Multivariate analysis for EFS

HR

P value

Bone involvement (n=204)

1.20 (0.90-1.60)

0.21

# of EN sites (≥2 vs. 0-1) (n=69)

1.43 (0.99-2.07)

0.06

Multifocal on diffuse pattern of bone involvement (n=41)

1.71 (1.10-2.65)

0.02

Spleen involvement (n=171)

1.49 (1.11-2.00)

<0.01

Soft tissue involvement (n=43)

1.67 (1.06-2.62)

0.02

Conclusion
Baseline PET/CT identifies EN and spleen sites of disease that can predict early clinical failure in FL. These results, when combined with other factors, may better identify high-risk patients and guide appropriate therapy.

Session topic: 18. Indolent and mantle-cell non-Hodgkin lymphoma - Clinical

Keyword(s): Extranodal lymphoma, Follicular lymphoma, Spleen, Survival prediction

By continuing to browse or by clicking “Accept Terms & all Cookies”, you agree to the storing of third-party cookies on your device to enhance your user experience and agree to the user terms and conditions of this learning management system (LMS).

Cookie Settings
Accept Terms & all Cookies