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Gavrilina, O.1; Parovichnikova, E.1; Troitskaya, V.1; Baskhaeva, G.1; Zarubina, K.1; Galtseva, I.2; Savchenko, V.3

doi: 10.1097/
Publication Only: Acute lymphoblastic leukemia - Clinical

1Department of the chemotherapy haemoblastosis and haemopoesis depression

2Immunophenotyping laborotory

3director, National Research Center for Hematology, Moscow, Russian Federation

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Positron emission tomography/computed tomography (PET/CT) is emerging as an essential diagnostic tool in characterizing suspicious neoplastic lesions and staging malignant diseases. Most studies regarding the possible role of FDG-PET/CT in the management of acute lymphoblastic leukemia (ALL) patients are very limited. But one can suggest the high role of PET/CT in the assessment of residual lesions after chemotherapy in patients with lymphoblastic lymphoma (LBL) and ALL with extramedullary involvements.

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The aim of the study was to estimate the ability to accumulate 18F-FDG radiopharmaceuticals by tumor cells in PET/CT in patients with ALL/LBL and assess the prognostic value of the PET/CT after the consolidation therapy (with or without autologous stem cell transplantation (autoSCT)) in patients with Ph-negative ALL/LBL who received therapy according to the protocols of the Russian research group ALL-2009/ALL-2016.

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PET/CT was performed in 3 patients with different types of newly diagnosed ALL before the start of the therapy and after the end of induction. Characteristic of patients were: the first- male, 55 age, with BII type Ph-negative ALL, with t(6;11) with generalized bone involvement and ossalgia; the second - female, 33 age, with BII type Ph-positive ALL, p190type of transcript without extramedullary involvement; and the third- female, 28 age, with TIII type ALL, with TCR A/D rearrangement, with massive mediastinal lesion, bilateral renal and ovarium involvement.

PET/CT was applied in 10 patients with Ph-negative ALL/LBL after the end of consolidation by ALL-2009/ALL-2016 protocols. The characterization of patients (Table): 6/4 (60%/40%) M/F, 9/1 (90%/10%) B/T type Ph-negative ALL, 8/1/1 (80%/10%/10%) with mediastinum/lymph nodes/renal and ovarium involvements, 3/7 (30%/70%) with or without bone marrow involvement, nobody with CNS involvement, 5/5 (50%/50%) with or without autoSCT, 3/7 (30%/70%) with or without radiotherapy in consolidation.

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The results of PET/CT in three patients with different variants of newly diagnosed ALL/LBL were analyzed and it was shown that all patients had metabolic activity of 18F-FDG in all morphologically and immunohistochemically (immunophenotypically) confirmed lesions (SUV 3,9-8,7).

An analysis of the results of PET/CT after the consolidation therapy with/without autoSCT in patients with Ph-negative ALL was performed, and it has shown that all patients had PET-negative remission of the disease and MRD negative status in bone marrow by flow cytometry. With a median follow-up of 20.5 months (from 15 to 44 months), only one patient out of 10 patients had isolated CNS relapse after 10 months of remission. In another 9 patients, with a median CR duration of 19 months (from 14 to 43 months), complete clinical and hematological remission is maintained.



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The results demonstrated that all specific lesions in ALL/LBL patients, medullary and extramedullary, were capable to accumule 18F-FDG in PET. This fact provides opportunities for further studies of this method in assessing the completeness of remission in patients with extramedullary lesions. The value of PET/CT in ALL/LBL patients with central nervous system involvement remained unexplored. If the suggestions arising from this report are confirmed, FDG-PET/CT may be included in future clinical practice for disease staging, evaluating the response to the chemotherapy in identified lesions and in the restaging for recurrence of extramedullary disease.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health Inc., on behalf of the European Hematology Association.