Prognostic Value of Bone Marrow Tracer Uptake Pattern in Baseline PET Scans in Hodgkin Lymphoma: Results from an International Collaborative Study

Colette Zwarthoed, Tarec Cristoffer El-Galaly, Maria Canepari, Matthieu John Ouvrier, Julien Viotti, Marc Ettaiche, Simonetta Viviani, Luigi Rigacci, Livio Trentin, Chiara Rusconi, Stefano Luminari, Maria Cantonetti, Silvia Bolis, Anna Borra, Jacques Darcourt, Flavia Salvi, Edyta Subocz, Joanna Tajer, Waldemar Kulikowski, Bogdan MalkowskiJan Maciej Zaucha, Andrea Gallamini

Research output: Contribution to journalArticlepeer-review


PET/CT-ascertained bone marrow involvement (BMI) constitutes the single most important reason for upstaging by PET/CT in Hodgkin lymphoma (HL). However, BMI assessment in PET/CT can be challenging. This study analyzed the clinicopathologic correlations and prognostic meaning of different patterns of bone marrow (BM) 18F-FDG uptake in HL. Methods: One hundred eighty newly diagnosed early unfavorable and advanced-stage HL patients, all scanned at baseline and after 2 adriamycin-bleomycin-vinblastine-dacarbazine (ABVD) courses with 18F-FDG PET, enrolled in 2 international studies aimed at assessing the role of interim PET scanning in HL, were retrospectively included. Patients were treated with ABVD × 4-6 cycles and involved-field radiation when needed, and no treatment adaptation on interim PET scanning was allowed. Two masked reviewers independently reported the scans. Results: Thirty-eight patients (21.1%) had focal lesions (fPET+), 10 of them with a single (unifocal) and 28 with multiple (multifocal) BM lesions. Fifty-three patients (29.4%) had pure strong (>liver) diffuse uptake (dPET+) and 89 (48.4%) showed no or faint (≤liver) BM uptake (nPET+). BM biopsy was positive in 6 of 38 patients (15.7%) for fPET+, in 1 of 53 (1.9%) for dPET+, and in 5 of 89 (5.6%) for nPET+ dPET+ was correlated with younger age, higher frequency of bulky disease, lower hemoglobin levels, higher leukocyte counts, and similar diffuse uptake in the spleen. Patients with pure dPET+ had a 3-y progression-free survival identical to patients without any 18F-FDG uptake (82.9% and 82.2%, respectively, P = 0.918). However, patients with fPET+ (either unifocal or multifocal) had a 3-y progression-free survival significantly inferior to patients with dPET+ and nPET+ (66.7% and 82.5%, respectively, P = 0.03). The κ values for interobserver agreement were 0.84 for focal uptake and 0.78 for diffuse uptake. Conclusion: We confirmed that 18F-FDG PET scanning is a reliable tool for BMI assessment in HL, and BM biopsy is no longer needed for routine staging. Moreover, the interobserver agreement for BMI in this study proved excellent and only focal 18F-FDG BM uptake should be considered as a harbinger of HL.

Original languageEnglish
Pages (from-to)1249-1254
Number of pages6
JournalJournal of Nuclear Medicine
Issue number8
Publication statusPublished - Aug 2017


  • Adult
  • Aged
  • Aged, 80 and over
  • Biological Transport
  • Bone Marrow
  • Female
  • Fluorodeoxyglucose F18
  • Hodgkin Disease
  • Humans
  • Internationality
  • Male
  • Middle Aged
  • Positron-Emission Tomography
  • Prognosis
  • Radioactive Tracers
  • Retrospective Studies
  • Young Adult
  • Journal Article


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