The Value of Bone Marrow Assessment by FDG PET/CT, Biopsy and Aspirate in the Upfront Evaluation of Mantle Cell Lymphoma

Background: Assessment of bone marrow infiltration (BMI) is part of the initial staging of mantle cell lymphoma (MCL), although BMI evaluated by biopsy (BMB) is not considered significant in the MIPI scales, and standardized recommendations remain lacking. Objectives: To evaluate the accuracy and pr...

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Authors: Ródenas-Quiñonero, Isabel|||0000-0002-2642-0914, Marco-Ayala, Javier, Chen-Liang, Tzu|||0000-0001-5969-8640, de la Cruz-Vicente, Fátima|||0000-0002-3866-8431, Baumann, Tycho|||0000-0003-4421-0088, Navarro Ferrando, José Tomás|||0000-0001-9101-6013, Martín García-Sancho, Alejandro|||0000-0001-6330-1028, Martin-Santos, Taida, Lopez-Jimenez, Javier|||0000-0002-2969-3002, Andreu, Rafael|||0000-0002-9220-3352, Parra, Ester, Usas, Andrea, Alonso, David, Fernández-González, Marta|||0000-0001-9949-8504, Palomo Rumschisky, Pablo, Frutos, Laura, Navarro, Jose Luis, Alvarez-Perez, Rosa Maria, Sarandeses Fernandez, Pilar|||0000-0002-1415-345X, Cortés, Montserrat, Tamayo Alonso, M. Pilar|||0000-0002-7466-514X, Uña-Gorospe, Jon Andoni|||0000-0002-0012-8819, Martínez-Lorca, Alberto, Ruiz, Cristina|||0009-0006-0100-382X, Lozano, María Luisa, Ortuño, Francisco José|||0000-0003-4450-9346
Format: article
Publication Date:2024
Country:España
Institution:Universitat Autònoma de Barcelona
Repository:Dipòsit Digital de Documents de la UAB
Language:English
OAI Identifier:oai:ddd.uab.cat:311569
Online Access:https://ddd.uab.cat/record/311569
https://dx.doi.org/urn:doi:10.3390/cancers16244189
Access Level:Open access
Keyword:Mantle cell lymphoma
PET/CT
Bone marrow biopsy
Description
Summary:Background: Assessment of bone marrow infiltration (BMI) is part of the initial staging of mantle cell lymphoma (MCL), although BMI evaluated by biopsy (BMB) is not considered significant in the MIPI scales, and standardized recommendations remain lacking. Objectives: To evaluate the accuracy and prognostic impact of BMI assessed by PET/CT and BMB in a large series of MCL patients. Methods: We deconstructed the IPI-NCCN, MIPI, and MIPI-c indices and considered BMI as positive if indicated by a BMB, PET/CT scan, or a combination of both. Results: In the total cohort (n = 148), 110 patients had BMI detected by BMB and 33 by PET/CT. The sensitivity of BMB was higher than that of PET/CT (94.8% vs. 28.4%), as were its negative predictive value (84.2% vs. 27.8%) and accuracy (95.9% vs. 43.9%). In the total cohort, BMI detected by PET/CT showed a significant predictive value for PFS (p = 0.027), while BMB demonstrated independent prognostic value only in combination with PET/CT (p = 0.025). Among intensively treated patients (n = 128), PET/CT had significant clinical impact on PFS (p = 0.030), and when combined with BMB, it provided independent prognostic value for both PFS and OS (p = 0.026 and p = 0.033, respectively). Based on these findings, we propose a prognostic model (MCL-PET-I) that incorporates BMI by PET/CT, allowing for the identification of three groups with distinct clinical outcomes (p < 0.0001 for PFS and p = 0.00025 for OS). Conclusions: In the upfront work of MCL, PET/CT-based BMI has greater prognostic impact, while BMB remains essential for staging. We propose the MCL-PET-I prognostic index, which effectively differentiates between clinical risk groups.

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