Positron emission tomography in mantle cell lymphoma

Area of Science:

• Oncology
• Nuclear Medicine
• Radiology

Background:

• Mantle Cell Lymphoma (MCL) is an aggressive non-Hodgkin lymphoma with a high relapse rate.
• Traditional response assessment relies on Computed Tomography (CT), but [(18)F]Fluorine-Deoxyglucose Positron Emission Tomography (PET) has transformed response evaluation in other aggressive lymphomas.
• The utility of PET in MCL response assessment remained uninvestigated.

Purpose of the Study:

• To investigate the value of PET and CT findings in evaluating treatment response in Mantle Cell Lymphoma.
• To compare the prognostic value of CT-based, PET-based, and combined PET/CT-based response criteria in MCL.

Main Methods:

• Retrospective analysis of PET and CT scans from 37 MCL patients (239 scans).
• Categorization of findings using standardized criteria: International Workshop Criteria (IWC) for CT, European Organisation for Research and Treatment of Cancer (EORTC) for PET, and combined IWC + PET.
• Correlation of imaging findings with patient prognosis.

Main Results:

• FDG-PET demonstrated high sensitivity for MCL detection and higher uptake in the blastoid variant compared to common MCL.
• CT- and PET-based response assessments showed equivalent prognostic value.
• PET/CT provided additional prognostic information only in a subset of highly FDG-avid MCL cases.
• PET enabled early detection of preclinical relapse during surveillance, though therapeutic implications are unclear.

Conclusions:

• Routine end-of-treatment response assessment using PET in MCL is not recommended due to equivalent prognostic value compared to CT.
• PET may offer additional insights in specific highly FDG-avid MCL subpopulations.
• PET's role in early relapse detection warrants further investigation regarding therapeutic consequences.