Use of positron emission tomography-computed tomography in the management of patients with chronic lymphocytic leukemia/small lymphocytic lymphoma

Michael J. Conte, Deborah A. Bowen, Gregory A. Wiseman, Kari G. Rabe, Susan L. Slager, Susan M. Schwager, Timothy G. Call, David S. Viswanatha, Clive S. Zent

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) cells typically have low 2-deoxy-2-[18F]fluoro-d-glucose (FDG) avidity, and patients with CLL have an increased risk of developing FDG-avid aggressive lymphomas, second malignancies and infections. We hypothesized that FDG positron emission tomography-computed tomography (PET-CT) of the trunk is a sensitive method of detecting these complications in patients with CLL. Of the of 2299 patients with CLL seen in the Division of Hematology at Mayo Clinic Rochester between 1 January 2006 and 31 December 2011, 272 (11.8%) had 526 PET-CT scans and 472 (89.7%) of these were reported as abnormal. Among the 293 (55.7%) PET-CT scans used for routine evaluation of CLL, the PET component was of clinical value in only one instance. In contrast, in 83 (30.5%) patients, PET-CT scans used to evaluate new clinical complications localized high FDG-avidity lesions for biopsies. This resulted in clinically relevant new diagnoses in 32 patients, including those with more aggressive lymphoma (n = 16), non-hematological malignancies (n = 8) and opportunistic infections (n = 3). Twenty-seven patients had high FDG-avidity CLL, which was associated with prominent lymph node proliferation centers, an increased frequency of poor prognostic factors (17p13 deletion, unmutated immunoglobulin heavy chain variable gene [IGHV], expression of ZAP-70 and CD38) and a shorter overall survival. We conclude that FDG PET scans should not be used for routine surveillance of patients with CLL. However PET-CT scans are sensitive, but not specific, for detection of aggressive lymphomas, other cancers and systemic infections in patients with CLL.

Original languageEnglish (US)
Pages (from-to)2079-2084
Number of pages6
JournalLeukemia and Lymphoma
Volume55
Issue number9
DOIs
StatePublished - Sep 2014

Keywords

  • CT
  • Chronic lymphocytic leukemia
  • Imaging
  • PET
  • Small lymphocytic lymphoma

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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