Exploring the role of bone marrow increased FDG uptake on PET/CT in patients with lymphoma-associated hemophagocytic lymphohistiocytosis: a reflection of bone marrow involvement or cytokine storm?

Abstract

The role of 18F-2-fluoro-2-deoxy-D-glucose (FDG) uptake of bone marrow (BM) on positron emission tomography/computed tomography (PET/CT) in patients with lymphoma-associated hemophagocytic lymphohistiocytosis (LA-HLH) remains uncertain. This retrospective study included 34 LA-HLH patients who underwent both PET/CT and comprehensive BM examinations prior to treatment. Comparison between PET/CT and BM examinations for the assessment of bone marrow involvement (BMI) indicated statistical difference (p = 0.039). The specificity of PET/CT in detecting BMI was 11.1% compared to BM examinations. However, a significant correlation was found between PET parameters of BM and laboratory parameters associated with HLH, such as C-reactive protein, ferritin, fibrinogen and soluble CD25. By multivariate analysis, PET parameters of marrow were significantly associated with overall survival. The findings suggest that FDG uptake of marrow might fail to detect lymphomatous BMI, but reflected the level of cytokine storm to a certain extent and might be a prognostic factor in patients with LA-HLH.

Keywords::

• FDG
• PET
• bone marrow
• lymphoma
• hemophagocytic lymphohistiocytosis

Acknowledgments

This study was supported by the National Natural Science Foundation of China (30971296, 81170485, 81170488, 81370657, 81470328), Key Projects of Health Department of Jiangsu Province (K201108), Jiangsu Province's Medical Elite Program (RC2011169), National Public Health Grand Research Foundation (201202017), Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institute (JX10231801), Program for Development of Innovative Research Teams in the First Affiliated Hospital of Nanjing Medical University, Project of National Key Clinical Specialty. National Science & Technology Pillar Program (2014BAI09B12) and Project funded by Jiangsu Provincial Special Program of Medical Science (BL2014086).

Potential conflict of interest

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Supplementary material available online

Supplementary Table I showing further results