Page 94 - Haematologica - Vol. 105 n. 6 - June 2020

Acute Myeloid Leukemia
Ferrata Storti Foundation
Haematologica 2020 Volume 105(6):1552-1558
The prevalence of extramedullary acute myeloid leukemia detected by 18FDG-PET/CT: final results from the prospective
PETAML trial
Friedrich Stölzel,1 Tors Lüer,1 Steffen Löck,2 Stefani Parmentier,3 Friederike Kuithan,4 Michael Kramer,1 Nael S. Alakel,1 Katja Sockel,1 Franziska Taube,1 Jan M. Middeke,1 Johannes Schetelig,1 Christoph Röllig,1 Tobias Paulus,5 Jörg Kotzerke,6 Gerhard Ehninger,1 Martin Bornhäuser,1,7,8 Markus Schaich3# and Klaus Zoephel6#
1Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany; 2OncoRay - National Center for Radiation Research in Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz Zentrum, Dresden Rossendorf, Germany; 3Department of Haematology and Oncology, Rems-Murr-Hospital, Winnenden, Germany; 4Department of Pathology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany; 5Department of Radiology, Städtisches Klinikum Dresden, Dresden, Germany; 6Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; 7National Center for Tumor Diseases NCT, Partner site Dresden, Dresden, Germany; 8Department of Haematological Medicine, The Rayne Institute, King's College London, London, UK
#MS and KZ contributed equally as co-senior authors.
ABSTRACT
Extramedullary (EM) disease in patients with acute myeloid leukemia (AML) is a known phenomenon. Since the prevalence of EM AML has so far only been clinically determined on examination, we performed a prospective study in patients with AML. The aim of the study was to determine the prevalence of metabolically active EM AML using total body 18Fluorodesoxy-glucose positron emission tomography / computed tomog- raphy (18FDG-PET/CT) imaging at diagnosis prior to initiation of therapy. In order to define the dynamics of EM AML throughout treatment, PET- positive patients underwent a second 18FDG-PET/CT imaging series during follow up by the time of remission assessment. A total of 93 patients with AML underwent 18FDG-PET/CT scans at diagnosis.The prevalence of PET- positive EM AML was 19% with a total of 65 EM AML manifestations and a median number of two EM manifestations per patient (range, 1-12), with a median maximum standardized uptake value of 6.1 (range, 2-51.4). When adding those three patients with histologically confirmed EM AML who were 18FDG-PET/CT negative in the 18FDG-PET/CT at diagnosis, the com- bined prevalence for EM AML was 22%, resulting in 77% sensitivity and 97% specificity. Importantly, 60% (6 of 10) patients with histologically con- firmed EM AML still had active EM disease in their follow up 18FDG- PET/CT. 18FDG-PET/CT reveals a high prevalence of metabolically active EM disease in AML patients. Metabolic activity in EM AML may persist even beyond the time point of hematologic remission, a finding that merits further prospective investigation to explore its prognostic relevance. (Trial registered at clinicaltrials.gov identifier: 01278069.)
Introduction
Acute myeloid leukemia (AML) may present with either concomitant or isolat- ed extramedullary (EM) AML, also termed myeloid sarcoma (MS). EM AML is defined by infiltrating AML blasts effacing normal tissue as demonstrated by his- tological evaluation.1 Data on the prevalence of EM AML are based on retrospec- tive or clinical analyses, and they possibly under-estimate the true prevalence,
Correspondence:
FRIEDRICH STÖLZEL
friedrich.stoelzel@uniklinikum-dresden.de
Received: March 31, 2019. Accepted: August 27, 2019. Pre-published: August 29, 2019.
doi:10.3324/haematol.2019.223032
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