The Pattern of Use of PET/CT Scans in the Clinical Management of Chronic Lymphocytic Leukemia

• Published in: Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2021-08, Vol.21 (8), p.558-563
• Main Authors: Hod, Keren, Tova, Yonina, Gold, Oded, Harari, Shira Fertig, Guindy, Michal, Shpilberg, Ofer, Groshar, David, Tavor, Sigal
• Format: Article
• Language: English
• Subjects: Aged; Biomarkers - blood; Chronic lymphocytic leukemia; Clinical Decision-Making; Clinical management; Disease Progression; Female; Fluorodeoxyglucose F18 - pharmacokinetics; Humans; Israel; L-Lactate Dehydrogenase - blood; Leukemia, Lymphocytic, Chronic, B-Cell - diagnostic imaging; Leukemia, Lymphocytic, Chronic, B-Cell - metabolism; Leukemia, Lymphocytic, Chronic, B-Cell - pathology; Leukemia, Lymphocytic, Chronic, B-Cell - therapy; Liver - metabolism; Lymphocyte Count; Male; Middle Aged; PET/CT; Positron Emission Tomography Computed Tomography - statistics & numerical data; Radiopharmaceuticals - pharmacokinetics; Retrospective Studies; Survival Analysis; SUVmax; SUVmax/SUVliver mean ratio
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/j.clml.2021.04.003

The study aimed to evaluate the utilization patterns of positron emission tomography/computed tomography (PET/CT) in chronic lymphocytic leukemia (CLL) patients and to investigate whether the results of these scans influenced treatment decisions. and Methods: In this observational study, we analyzed patients with CLL or small lymphocytic leukemia (SLL) who underwent at least one PET/CT scan from 2007 to 2018. Patients were divided into two groups: (1) patients who had at least one fluorodeoxyglucose-avid PET/CT scan, and (2) patients who had all negative scans. PET/CT results were retrieved from patients’ medical files and were revised by an expert radiologist according to visual score scale, SUVmax/SUVliver mean ratio, and the SUVmax. Of the 524 patients, 160 patients (30.5%) had PET/CT scans, and 120 patients met the inclusion criteria. A total of 219 eligible scans were analyzed; 62 of these scans (28.3%) were reported as positive, and 167 of these scans (76.3%) were performed for staging. There was a significant association between PET/CT results and change of therapy (P < .001); however, 62.9% of the positive PET/CT scans were not followed by a change of treatment. Survival time was not different between the two groups. The SUVmax/SUVliver mean ratio was negatively significantly associated with lymphocytes percent (r = –0.237, P = .042) and positively associated with lactate dehydrogenase levels (r = 0.338, P = .008) among CLL patients. Despite the fact that the use of surveillance PET/CT for patients with CLL/SLL is not in the guidelines and that it is not useful for disease management, in practice the test is in frequent use in Israel. A retrospective study of the use of PET/CT on 120 patients with chronic lymphocytic leukemia found that it is widely used and did not commonly result in therapy changes. The routine use of PET/CT for surveillance is limited, and its results were not associated with survival. Our observations suggest the need to raise awareness of the improper use of PET/CT in these patients.