Abstract
Abstract only
e18504
Background: Serologic positivity for HTLV and ATLL are endemic amongst Caribbean populations. Kings County and University Hospital of Brooklyn serve population with large number of immigrants from this region. ATLL in this population is mostly of aggressive (leukemia/lymphomatous) type. Responses to chemotherapy (CT) are brief, and 90% succumb to ATLLwithin 18 months (m) of presentation. Lactic dehydrogenase (LDH) levels are high, but PET is not used in routine staging. Methods: Records of all patients with ATLL presenting to these institutions between 2001-11 were reviewed. The results of PET, including maximum standard uptake value (SUVmx) were recorded for scans obtained before (12) and after (19) initial CT, and at relapse (13). Results: Of 95 T cell lymphoma patients, 73 had ATLL. PET was performed in 26 of the 73 patients; 20 of the 26 had ATLL, 5 had other T cell lymphomas. Infusional etoposide, vincristine, doxorubicin and prednisone (EPOCH) was the CT of 17 of the 20 ATLL patients; relapse occurred after a median of 9.5 m, often followed by salvage CT. Of the 6 male and 6 female patients scanned pre-CT, the median SUVmx was 9.9; range 2.9-33. Their initial median LDH level was 390 (321-683). The median overall survival (OS) was 11.5 (1-24 m). Thirteen patients had 19 post-CT scans, with a median SUVmx of 3.0; only one SUVmx was elevated (8.4); that patient had progressive disease, but the others variously displayed complete and partial remissions, or progression. Their median OS was 13 m (range 4-39 m). Their median LDH at presentation was 523. Eight patients had 13 scans at relapse, with a median SUVmx of 10.6, range 3.7-21. Their median OS was 17 m (range 12-21). OS and SUVmx were not correlated. Conclusions: Like Hodgkin’s and large B cell lymphomas, the pre-CT PET SUVmx levels of ATLL patients were significantly elevated; most fell to normal or slightly elevated levels after CT. PET is thus likely to have some value in staging ATTL. Our results suggest that PET response of ATLL patients to CT correlates poorly with durable relapse-free survival. The latter parameter is probably dependent on factors other than proliferative rate or control of aerobic glycolysis.