The prevalence of extramedullary acute myeloid leukemia detected by 18FDG-PET/CT: final results from the prospective PETAML trial
Friedrich Stölzel,
Tors Lüer,
Steffen Löck,
Stefani Parmentier,
Friederike Kuithan,
Michael Kramer,
Nael S. Alakel,
Katja Sockel,
Franziska Taube,
Jan M. Middeke,
Johannes Schetelig,
Christoph Röllig,
Tobias Paulus,
Jörg Kotzerke,
Gerhard Ehninger,
Martin Bornhäuser,
Markus Schaich,
Klaus Zoephel
Affiliations
Friedrich Stölzel
Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
Tors Lüer
Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
Steffen Löck
OncoRay -National Center for Radiation Research in Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz Zentrum, Dresden Rossendorf, Germany
Stefani Parmentier
Department of Haematology and Oncology, Rems-Murr-Hospital, Winnenden, Germany
Friederike Kuithan
Department of Pathology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
Michael Kramer
Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
Nael S. Alakel
Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
Katja Sockel
Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
Franziska Taube
Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
Jan M. Middeke
Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
Johannes Schetelig
Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
Christoph Röllig
Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
Tobias Paulus
Department of Radiology, Städtisches Klinikum Dresden, Dresden, Germany
Jörg Kotzerke
Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
Gerhard Ehninger
Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
Martin Bornhäuser
Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany;National Center for Tumor Diseases NCT, Partner site Dresden, Dresden, Germany;Department of Haematological Medicine, The Rayne Institute, King’s College London, London, UK
Markus Schaich
Department of Haematology and Oncology, Rems-Murr-Hospital, Winnenden, Germany
Klaus Zoephel
Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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 tomography (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 combined prevalence for EM AML was 22%, resulting in 77% sensitivity and 97% specificity. Importantly, 60% (6 of 10) patients with histologically confirmed 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.)
