The significance of pre-therapeutic F-18-FDG PET-CT in lymphoma-associated hemophagocytic lymphohistiocytosis when pathological evidence is unavailable.
The significance of pre-therapeutic F-18-FDG PET-CT in lymphoma-associated hemophagocytic lymphohistiocytosis when pathological evidence is unavailable.
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当病理证据不可用时，治疗前 F-18-FDG PET-CT 在淋巴瘤相关噬血细胞性淋巴组织细胞增多症中的意义
DOI：
10.1007/s00432-015-2094-z
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发表时间：
2016-04
影响因子：
3.6
通讯作者：
Qiu H
中科院分区：
文献类型：
--
作者：
Wang J;Wang D;Zhang Q;Duan L;Tian T;Zhang X;Li J;Qiu H
当病理证据不可用时，正电子发射断层扫描/计算机断层扫描（PET-CT）在识别淋巴瘤相关噬血细胞性淋巴组织细胞增生症（LAHLH）患者中的意义仍不确定。在这项回顾性研究中，入组了44例在临床治疗前接受PET-CT检查的HLH患者，其中18例通过PET-CT高度怀疑为LAHLH。我们比较了确诊LAHLH和非LAHLH患者的PET-CT参数。对高度怀疑LAHLH患者的初始治疗的疗效进行了分析。 我们发现LAHLH组的SUVSp、SUVBM、SUVLN、SUVmax、SUVLN/Li和SUVmax/Li显著高于非LAHLH组（分别为p = 0.003、p = 0.034、p = 0.003、p < 0.001、p = 0.039和p = 0.035）。SUVmax值>5.5、SUVLN值>3.3和SUVSp值>4.8的HLH患者更可能是LAHLH（分别为p < 0.001、p = 0.003和p = 0.003）。LAHLH患者FDG摄取增加的多发性淋巴结病或多发性骨病变的发生率显著高于非LAHLH组（分别为92.9 vs. 35.7%，p = 0.004; 42.9 vs. 0%，p = 0.016）。此外，通过比较高度怀疑LAHLH患者（n = 18）的初始治疗的疗效，我们表明淋巴瘤化疗组的CR率显著高于免疫抑制治疗组（分别为90%和25%; p = 0.013）。OS分析显示，高度怀疑LAHLH患者接受淋巴瘤化疗的预后（264天）优于接受免疫抑制剂治疗的患者（15天）（p < 0.0001）。当病理证据缺乏时，PET-CT可能在识别HLH患者的潜在淋巴瘤中发挥重要作用。一旦PET-CT高度怀疑为LAHLH，直接治疗基础淋巴瘤的淋巴瘤化疗可能比免疫抑制治疗具有相对有利的效果和更好的临床结局。
The significance of positron emission tomography/computed tomography (PET–CT) in identifying patients with lymphoma-associated hemophagocytic lymphohistiocytosis (LAHLH) when pathological evidence is unavailable remains uncertain. In this retrospective study, 44 HLH patients who underwent PET–CT before clinical treatment were enrolled, and 18 of them were highly suspected as LAHLH by PET–CT. We compared the PET–CT parameters between confirmed LAHLH and non-LAHLH patients. The efficacy of initial therapies for highly suspected LAHLH patients was analyzed as well. We found that the SUVSp, SUVBM, SUVLN, SUVmax, SUVLN/Li, and SUVmax/Li in LAHLH group were significantly higher than those in non-LAHLH group (p = 0.003, p = 0.034, p = 0.003, p < 0.001, p = 0.039, and p = 0.035, respectively). HLH patients with an SUVmax value >5.5, an SUVLN value >3.3, and an SUVSp value >4.8 were more likely to be LAHLH (p < 0.001, p = 0.003, and p = 0.003, respectively). And the incidence of multiple lymphadenopathy with increased FDG uptake or the incidence of multiple bone lesions in LAHLH patients was significantly higher than those in non-LAHLH group (92.9 vs. 35.7 %, p = 0.004; 42.9 vs. 0 %, p = 0.016, respectively). Furthermore, by comparing the efficacy of initial therapies for highly suspected LAHLH patients (n = 18), we indicated that the CR rate was significantly higher in lymphoma-chemotherapy group than in immunosuppressive therapy group (90 and 25 %, respectively; p = 0.013). OS analysis revealed that highly suspected LAHLH patients treated with lymphoma-chemotherapy had better prognosis (264 days) than those treated with immunosuppressive therapy (15 days) (p < 0.0001). When pathological evidence is absent, PET–CT may play an important role in identifying HLH patients underlying lymphoma. Once highly suspected as LAHLH by PET–CT, lymphoma-chemotherapies that directly treat the underling lymphoma may have a relatively favorable effect and better clinical outcomes than immunosuppressive therapy.