From the Guidelines
Bone Marrow Activity on PET Scan in Relapsed Hodgkin Lymphoma
Bone marrow activity on a PET scan can indeed indicate relapsed Hodgkin lymphoma, even without other detectable disease activity.
- This phenomenon is supported by studies such as 1, which highlights the sensitivity of PET-CT for bone marrow involvement, suggesting that it can be an indicator of disease relapse.
- The use of PET scans in evaluating residual masses and assessing response to treatment is also emphasized by 1, indicating its utility in monitoring disease progression or recurrence.
- However, it's crucial to consider the potential for false-positive findings due to inflammation, infection, or other non-malignant conditions, as noted in 1.
- In cases where increased fluorodeoxyglucose (FDG) uptake in the bone marrow is observed, biopsy confirmation is often necessary to confirm the presence of lymphoma cells.
- Treatment approaches may include salvage chemotherapy regimens, such as ICE (ifosfamide, carboplatin, and etoposide), followed by high-dose therapy and autologous stem cell transplantation if a complete response is achieved, as guided by 1.
- The NCCN guidelines 1 support the use of PET scans for initial staging and evaluating residual masses, underscoring their importance in managing Hodgkin lymphoma.
- It's also important to note that bone marrow biopsy may not always be required if the PET scan is negative or shows a homogeneous pattern of bone marrow uptake, as stated in 1.
From the Research
Bone Marrow Activity on PET Scans
- Increased bone marrow activity on a Positron Emission Tomography (PET) scan can be an indicator of relapsed Hodgkin lymphoma, even in the absence of other detectable disease activity 2, 3.
- A study published in the European journal of haematology found that diffusely increased bone marrow FDG uptake was more common in Hodgkin lymphoma than in non-Hodgkin lymphoma, with an incidence of 9.3% in Hodgkin lymphoma patients 2.
- Another study published in the Indian journal of cancer found that FDG-PET was a useful adjuvant to bone marrow biopsy for evaluating bone marrow involvement in lymphoma patients, with a disease metabolic index of > 2.5 indicating bone marrow involvement 3.
Relapsed or Refractory Hodgkin Lymphoma
- PET-adapted sequential salvage therapy with brentuximab vedotin followed by augmented ifosfamide, carboplatin, and etoposide has been shown to be effective in treating relapsed or refractory Hodgkin lymphoma, with a high proportion of patients achieving PET-negativity 4.
- A study published in The Lancet. Haematology found that dose-dense brentuximab vedotin plus ifosfamide, carboplatin, and etoposide was a rapidly administered and active salvage regimen for patients with relapsed or refractory classical Hodgkin lymphoma 5.
- Pre-transplantation FDG-PET scans have been shown to predict event-free survival and overall survival in patients with relapsed classical Hodgkin lymphoma treated with standard salvage chemotherapy and autologous stem cell transplantation 6.
PET Scans and Disease Activity
- FDG-PET scans can detect disease activity in the bone marrow, even in the absence of other detectable disease activity 3, 6.
- A study published in Biology of blood and marrow transplantation found that pre-transplantation FDG-PET response significantly predicted event-free survival in patients with relapsed classical Hodgkin lymphoma 6.