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Extramedullary disease in patients with acute myeloid leukemia assessed by 18F-FDG PET
Anne-Sofie Weindel Ibar Cribe1, Maria Steenhof, Claus Werenberg Marcher
1Department of Haematology, Odense University Hospital, Odense, Denmark.
Background:
Prevalence of extramedullary disease (EMD) in acute myeloid leukemia (AML) at the time of diagnosis is unknown. Previous estimates range from 2.5% to 30.5% and are usually based on clinical examination. This may cause an under diagnosis of EMD as not all extramedullary manifestations are easily detectable. Few recent studies have used positron emission tomography (PET) scans for diagnosing EMD in patients AML.
Method:
During a 9-month period, newly diagnosed patients with AML who were candidates for intensive chemotherapy were 18F-Fluoro-deoxy-glucose (FDG) PET-scanned prior to induction treatment. We compared the prevalence of EMD diagnosed by PET scans and by clinical examination. Subsequent PET scans following induction chemotherapy were performed for response evaluation of EMD.
Results:
Twenty-six patients were included in the study. 18-F-FDG PET scans revealed more than twice as many patients with EMD than found by clinical examination (65% vs. 31%). PET demonstrated 55 EMD lesions compared with 15 diagnosed by clinical examination. In general, the responses of EMD detected by PET scans were concordant with the bone marrow responses assessed by pathology examination.
Conclusion:
18-F-FDG PET is a useful tool for diagnosing EMD in AML and for assessing treatment responses of EMD in AML.
Insights
Positron emission tomography (PET) scans significantly improve the detection of extramedullary disease (EMD) in acute myeloid leukemia (AML) compared to clinical exams. This imaging technique is valuable for both initial diagnosis and monitoring treatment response in AML patients.
Area of Science:
- Hematology
- Oncology
- Nuclear Medicine
Background:
- The prevalence of extramedullary disease (EMD) in acute myeloid leukemia (AML) at diagnosis is not well-established.
- Previous estimates of EMD prevalence vary widely and often rely on clinical examination, potentially leading to underdiagnosis.
- Recent advancements suggest positron emission tomography (PET) scans may offer improved detection of EMD in AML.
Purpose of the Study:
- To compare the diagnostic accuracy of 18F-Fluoro-deoxy-glucose (FDG) PET scans versus clinical examination for detecting EMD in newly diagnosed AML patients.
- To evaluate the utility of PET scans in assessing treatment response of EMD following induction chemotherapy.
Main Methods:
- Newly diagnosed AML patients eligible for intensive chemotherapy underwent 18F-FDG PET scans before induction treatment.
- EMD prevalence was compared between PET scans and clinical examinations.
- Follow-up PET scans were performed post-chemotherapy to assess EMD response.
Main Results:
- 18F-FDG PET scans identified EMD in 65% of patients, more than double the 31% detected by clinical examination.
- PET scans revealed 55 EMD lesions, compared to only 15 identified through clinical examination.
- Responses of EMD to treatment, as seen on PET, generally correlated with bone marrow response assessments.
Conclusions:
- 18F-FDG PET is a valuable tool for diagnosing extramedullary disease in AML.
- PET imaging aids in assessing treatment efficacy for EMD in AML patients.
- This imaging modality enhances the comprehensive evaluation of AML patients with EMD.
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