Prognostic role of baseline 18F-FDG PET/CT metabolic parameters in mantle cell lymphoma

  • Domenico AlbanoEmail author
  • Giovanni Bosio
  • Nicola Bianchetti
  • Chiara Pagani
  • Alessandro Re
  • Alessandra Tucci
  • Raffaele Giubbini
  • Francesco Bertagna
Original Article



Mantle cell lymphoma (MCL) is an aggressive lymphoma sub-type with poor prognosis and high 18F-FDG avidity at PET/CT; nowadays, no validated criteria for PET/CT in treatment response evaluation and prediction of outcome are present. The aim of study was to investigate whether the metabolic PET/CT features may predict treatment evaluation and prognosis in MCL.


We retrospectively enrolled 87 patients who underwent baseline 18F-FDG PET/CT and 85 end-of-treatment (eot) PET/CT. The baseline PET images were analyzed visually and semi-quantitatively by measuring the maximum standardized uptake value body weight (SUVbw), lean body mass (SUVlbm), body surface area (SUVbsa), lesion-to-liver SUVmax ratio (L-L SUV R), lesion-to-blood pool SUVmax ratio (L-BP SUV R), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). EotPET/CT was visually interpreted according to the criteria of the Deauville 5-point scale (DC). Survival curves were plotted according to the Kaplan–Meier method.


At a median follow-up of 40 months, relapse/progression occurred in 47 and death in 23 patients. Median PFS and OS were 30 and 41 months. Baseline MTV and TLG were significantly higher in patients with progressive metabolic response compared to complete/partial response group. EotPET/CT results using DC significantly correlated with PFS, not with OS. MTV and TLG were demonstrated to be independent prognostic factors for PFS; instead the other metabolic parameters were not related to outcome survival. Considering OS, no variable was significantly associated.


EotPET/CT results (using DC), MTV and TLG were significantly correlated with response to treatment and PFS.


Mantle cell lymphoma 18F-FDG PET/CT MTV TLG Prognosis 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all the individual participants included in the study.


  1. 1.
    Swerdlow SH, Campo E, Harris NL, et al. World health organization classification of tumours of haematopoietic and lymphoid tissues. Lyon: IARC Press; 2008.Google Scholar
  2. 2.
    Maddocks K. Update on mantle cell lymphoma. Blood. 2018;132:1647–56.CrossRefGoogle Scholar
  3. 3.
    Hoster E, Dreyling M, Klapper W, et al. A new prognostic index (MIPI) for patients with advanced-stage mantle cell lymphoma. Blood. 2008;111:558–65.CrossRefGoogle Scholar
  4. 4.
    Shah JJ, Fayad L, Romaguera J. Mantle cell international prognostic index (MIPI) not prognostic after R-hyper-CVAD. Blood. 2008;112:2583 author reply 2583-2584.CrossRefGoogle Scholar
  5. 5.
    MatoAr Svodoba J, Feldman T, et al. Post-treatment (not interim) positron emission tomography-computed tomography scan status is highly predictive of outcome in mantle cell lymphoma patients treated with R-HyperCVAD. Cancer. 2012;118:3565–70.CrossRefGoogle Scholar
  6. 6.
    Katzenberger T, Petzoldt C, Holler S, et al. The Ki67 proliferation index is a quantitative indicator of clinical risk in mantle cell lymphoma. Blood. 2006;107:3407.CrossRefGoogle Scholar
  7. 7.
    Tiemann M, Schrader C, Klapper W, Dreyling MH, Campo E, Norton A, et al. Histopathology, cell proliferation indices and clinical outcome in 304 patients with mantle cell lymphoma (MCL): a clinicopathological study from the European MCL Network. Br J Haematol. 2005;131:29–38.CrossRefGoogle Scholar
  8. 8.
    Gill S, Wolf M, Miles Prince H, et al. 18F Fluorodeoxyglucose positron emission tomography scanning for staging, response assessment, and disease surveillance in patients with Mantle cell lymphoma. Clin Lymphoma Myeloma Leuk. 2008;8:158–65.Google Scholar
  9. 9.
    Alavi A, Shrikanthan S, Aydin A, et al. Fluorodeoxyglucose-positron-emission tomography findings in mantle cell lymphoma. Clin Lymphoma Myeloma Leuk. 2011;11:261–6.CrossRefGoogle Scholar
  10. 10.
    Brepoels L, Stroobants S, De Wever W, et al. Positron emission tomography in mantle cell lymphoma. Leuk Lymphoma. 2008;49:1693–701.CrossRefGoogle Scholar
  11. 11.
    Hosein PJ, Pastorini VH, Paes FM, et al. Utility of positron emission tomography scans in mantle cell lymphoma. Am J Hematol. 2011;86:841–5.CrossRefGoogle Scholar
  12. 12.
    Cohen JB, Hall NC, Ruppert AS, et al. Association of pre-transplantation positron emission tomography/computed tomography and outcome in mantle cell lymphoma. Bone Marrow Transplant. 2013;48:1212–7.CrossRefGoogle Scholar
  13. 13.
    Tateishi U, Tatsumi M, Terauchi T, et al. Relevance of monitoring metabolic reduction in patients with relapsed or refractory follicular and mantle cell lymphoma receiving bendamustine: a multicenter study. Cancer Sci. 2011;102:414–8.CrossRefGoogle Scholar
  14. 14.
    Kedmi M, Avivi I, Ribakovsky E, et al. Is there a role for therapy response assessment with 2-[fluorine-18] fluoro-2-deoxy-d-glucose-positron emission tomography/computed tomography in mantle cell lymphoma? Leuk Lymphoma. 2014;55:2484–9.CrossRefGoogle Scholar
  15. 15.
    Magnusson E, Cao Q, Linden MA, et al. Hematopoietic cell transplantation for mantle cell lymphoma: predictive value of pretransplant positron emission tomography/computed tomography and bone marrow evaluations for outcomes. Clin Lymphoma Myeloma Leuk. 2014;14:114–21.CrossRefGoogle Scholar
  16. 16.
    Mei MG, Cao TM, Chen L, et al. Long-term results of high-dose therapy and autologous stem cell transplantation for mantle cell lymphoma: effectiveness of maintenance rituximab. Biol Blood Marrow Transpl. 2017;23:1861–9.CrossRefGoogle Scholar
  17. 17.
    Guidot DM, Switchenko JM, Nastoupil LJ, et al. Surveillance imaging in mantle cell lymphoma in first remission lacks clinical utility. Leuk Lymphoma. 2018;59:888–95.CrossRefGoogle Scholar
  18. 18.
    Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014;32:3059–68.CrossRefGoogle Scholar
  19. 19.
    Bomben R, Ferrero S, D’Agaro T, et al. A B-cell receptor-related gene signature predicts survival in mantle cell lymphoma: results from the Fondazione Italiana Linfomi MCL-0208 trial. Hemtaologica. 2018;103:849–56.CrossRefGoogle Scholar
  20. 20.
    Boellaard R, Delgado-Bolton R, Oyen WJ, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42:328–54.CrossRefGoogle Scholar
  21. 21.
    Barrington SF, Mikhaeel NG, Kostakoglu L, et al. Role of imaging in the staging and response assessment of lymphoma: consensus of the international conference on malignant lymphomas imaging working group. J Clin Oncol. 2014;32:3048–58.CrossRefGoogle Scholar
  22. 22.
    Fernandez V, Hartmann E, Ott G, et al. Pathogenesis of mantle-cell lymphoma: all oncogenic roads lead to dysregulation of cell cycle and DNA damage response pathways. J Clin Oncol. 2005;23:6364–9.CrossRefGoogle Scholar
  23. 23.
    Leonard JP, Schattner EJ, Coleman M. Biology and management of mantle cell lymphoma. Curr Opin Oncol. 2001;13:342–7.CrossRefGoogle Scholar
  24. 24.
    Garcia M, Romaguera JE, Inamdar KV, et al. Proliferation predicts failure-free survival in mantle cell lymphoma patients treated with rituximab plus hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with rituximab plus high-dose methotrexate and cytarabine. Cancer. 2009;115:1041–8.CrossRefGoogle Scholar
  25. 25.
    Martin P, Chadburn A, Christos P, et al. Outcome of deferred initial therapy in mantle-cell lymphoma. J Clin Oncol. 2009;27:1209–13.CrossRefGoogle Scholar
  26. 26.
    Weiler-Sagie M, Bushelev O, Epelbaum R, et al. (18)F-FDG avidity in lymphoma readdressed: a study of 766 patients. J Nucl Med. 2010;51:25–30.CrossRefGoogle Scholar
  27. 27.
    Meignan M, Gallamini A, Haioun C, Polliack A. Report on the second international workshop on interim positron emission tomography in lymphoma held in Menton, France, 8–9 April 2010. Leuk Lymphoma. 2010;51:2171–80.CrossRefGoogle Scholar
  28. 28.
    Albano D, Bosio G, Re A, et al. Metabolic behaviour and prognostic value of early and end of treatment 18F-FDG PET/CT in adult Burkitt lymphoma: role of Deauville and IHP criteria. Leuk Lymphoma. 2018;3:1–8.CrossRefGoogle Scholar
  29. 29.
    Klener P, Fronkova E, Belada D, et al. Alternating R-CHOP and R-cytarabine is a safe and effective regimen for transplant-ineligible patients with a newly diagnosed mantle cell lymphoma. HematolOncol. 2018;36:110–5.Google Scholar
  30. 30.
    Lamonica D, Graf DA, Munteanu MC, Czuczman MS. 18F-FDG PET for measurement of response and prediction of outcome to relapsed or refractory mantle cell lymphoma therapy with bendamustine-rituximab. J Nucl Med. 2017;58:62–8.CrossRefGoogle Scholar
  31. 31.
    Czuczman MS, Goy A, Lamonica D, et al. Phase II study of bendamustine combined with rituximab in relapsed/refractory mantle cell lymphoma: efficacy, tolerability, and safety findings. Ann Hematol. 2015;94:2025–32.CrossRefGoogle Scholar
  32. 32.
    Kostakoglu L, Chauvie S. Metabolic tumour volume metrics in lymphoma. Semin Nucl Med. 2018;48:50–66.CrossRefGoogle Scholar
  33. 33.
    Xie M, Wu K, Liu Y, et al. Predictive value of F-18 FDG PET/CT quantization parameters in diffuse large B cell lymphoma: a meta-analysis with 702 participants. Med Oncol. 2015;32:446.CrossRefGoogle Scholar
  34. 34.
    Albano D, Bertoli M, Battistotti M, et al. Prognostic role of pretreatment 18F-FDG PET/CT in primary brain lymphoma. Ann Nucl Med. 2018;32:532–41.CrossRefGoogle Scholar
  35. 35.
    Procházka V, Klugar M, Bachanova V, et al. Comparing the accuracy of quantitative versus qualitative analyses of interim PET to prognosticate Hodgkin lymphoma: a systematic review protocol of diagnostic test accuracy. BMJ Open. 2016;5:6.Google Scholar
  36. 36.
    Albano D, Bosio G, Pagani C, et al. Prognostic role of baseline 18F-FDG PET/CT metabolic parameters in Burkitt lymphoma. Eur J Nucl Med Mol Imaging. 2019;46:87–96.CrossRefGoogle Scholar
  37. 37.
    Karam M, Ata A, Irish K, et al. DG positron emission tomography/computed tomography scan may identify mantle cell lymphoma patients with unusually favorable outcome. Nucl Med Comm. 2009;30:770–8.CrossRefGoogle Scholar
  38. 38.
    Bodet-Milin C, Touzeau C, Leux C, et al. Prognostic impact of 18F-fluorodeoxyglucose positron emission tomography in untreated mantle cell lymphoma: a retrospective study from GOELAMS group. Eur J Nucl Med Mol Imaging. 2010;37:1633–42.CrossRefGoogle Scholar
  39. 39.
    Meignan M, Cottereau AS, Versari A, et al. Baseline metabolic tumor volume predicts outcome in high–tumor-burden follicular lymphoma: a pooled analysis of three multicenter studies. J ClinOncol. 2016;34:3618–26.CrossRefGoogle Scholar
  40. 40.
    Kanoun S, Rossi C, Berriolo-Riedinger A, et al. Baseline metabolic tumour volume is an independent prognostic factor in Hodgkin lymphoma. Eur J Nucl Med Mol Imaging. 2014;41:1735–43.CrossRefGoogle Scholar
  41. 41.
    Moskowitz AJ, Schoder H, Gavane S, et al. Prognostic significance of baseline metabolic tumor volume in relapsed and refractory Hodgkin lymphoma. Blood. 2017;130:2196–203.CrossRefGoogle Scholar
  42. 42.
    Sasanelli M, Meignan M, Haioun C, et al. Pretherapy metabolic tumour volume is an independent predictor of outcome in patients with diffuse large B-cell lymphoma. Eur J Nucl Med Mol Imaging. 2014;41:2017–22.CrossRefGoogle Scholar
  43. 43.
    Mikhaeel NG, Smith D, Dunn JT, et al. Combination of baseline metabolic tumour volume and early response on PET/CT improves progression-free survival prediction in DLBCL. Eur J Nucl Med Mol Imaging. 2016;43:1209–19.CrossRefGoogle Scholar
  44. 44.
    Albano D, Bosio G, Camoni L, et al. Prognostic role of baseline 18F-FDG PET/CT parameters in MALT lymphoma. Hematol Oncol. 2019;37:39–46. Scholar
  45. 45.
    Bernard M, Gressin R, Lefrère F, et al. Blastic variant of mantle cell lymphoma: a rare but highly aggressive subtype. Leukemia. 2001;15:1785–91.CrossRefGoogle Scholar
  46. 46.
    Weigert O, Unterhalt M, Hiddemann W, Dreyling M. Current management of mantle cell lymphoma. Drugs. 2007;67:1689–702.CrossRefGoogle Scholar

Copyright information

© The Japanese Society of Nuclear Medicine 2019

Authors and Affiliations

  1. 1.Nuclear MedicineUniversity of Brescia and Spedali Civili BresciaBresciaItaly
  2. 2.Nuclear MedicineSpedali Civili BresciaBresciaItaly
  3. 3.Division of Hematology, Spedali CiviliBresciaItaly

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