18F-FDG PET Response of Skeletal (Bone Marrow and Bone) Involvement After Induction Chemotherapy in Pediatric Hodgkin Lymphoma: Are Specific Response Criteria Required?

Georgi, Thomas W; Kluge, Regine; Kurch, Lars; Chavdarova, Lidia; Hasenclever, Dirk; Stoevesandt, Dietrich; Pelz, Tanja; Landman-Parker, Judith; Wallace, W. Hamish; Karlen, Jonas; Fernandez-Teijeiro, Ana; Cepelova, Michaela; Fossa, Alexander; Balwierz, Walentyna; Attarbaschi, Andishe; Ammann, Roland; Pears, Jane; Hraskova, Andrea; Uyttebroeck, Anna; Beishuizen, Auke; ... (2018). 18F-FDG PET Response of Skeletal (Bone Marrow and Bone) Involvement After Induction Chemotherapy in Pediatric Hodgkin Lymphoma: Are Specific Response Criteria Required? Journal of nuclear medicine, 59(10), pp. 1524-1530. Society of Nuclear Medicine 10.2967/jnumed.117.205633

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To determine whether the current 18F-FDG PET response criterion for
skeletal involvement in Hodgkin lymphoma (HL) is suitable, we performed
a systematic evaluation of the different types of skeletal involvement
and their response on PET after 2 cycles of chemotherapy
(PET-2). A secondary objective was to observe the influence of the
initial uptake intensity (measured as qPET) and initial metabolic tumor
volume (MTV) of skeletal lesions on the PET-2 response. Methods:
The initial PET scans of 1,068 pediatric HL patients from the EuroNet-
PHL-C1 trial were evaluated for skeletal involvement by central review.
Three types of skeletal lesions were distinguished: PET-only
lesions (those detected on PET only), bone marrow (BM) lesions (as
confirmed by MRI or BM biopsy), and bone lesions. qPET and MTV
were calculated for each skeletal lesion. All PET-2 scans were
assessed for residual tumor activity. The rates of complete metabolic
response for skeletal and nodal involvement on PET-2 were compared.
Results: Of the 1,068 patients, 139 (13%) showed skeletal
involvement (44 PET-only, 32 BM, and 63 bone). Of the 139 patients
with skeletal involvement, 101 (73%) became PET-2–negative in the
skeleton and 94 (68%) became PET-2–negative in the lymph nodes.
The highest number of PET-2–negative scans in the skeleton was 42 (95%) in the 44 PET-only patients, followed by 22 skeletal lesions
(69%) in the 32 BM patients and 37 (59%) in the 63 bone patients.
Lesions that became PET-2–negative showed a lower initial median
qPET (2.74) and MTV (2 cm3) than lesions that remained PET-2–
positive (3.84 and 7 cm3, respectively). Conclusion: In this study with
pediatric HL patients, the complete response rate for skeletal involvement
on PET-2 was similar to that for nodal involvement. Bone flare
seemed to be irrelevant. Overall, the current skeletal PET response
criterion—comparison with the local skeletal background—is well
suited. The initial qPET and MTV of skeletal lesions were predictive
of the PET-2 result. Higher values for both parameters were associated
with a worse PET-2 response.

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