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Detection of extra-medullary relapse of acute lymphoblastic leukemia by radiographic imaging following allogeneic hematopoietic SCT

Bone Marrow Transplantation volume 44, pages 827–828 (2009)Cite this article

PET scanning with the tracer fluorine-18 fluorodeoxyglucose (FDG), called FDG-PET, has been widely used in clinical oncology. FDG is taken up by metabolically active, glucose-utilizing cells and phosphorylated by hexokinase. The mitochondrial form is greatly elevated in rapidly growing malignant tumors. In this report, FDG-PET was used to detect EMR of leukemia involving multiple hypermetabolic lesions, which was confirmed subsequently during biopsy. Imaging techniques such as CT scanning or MRI cannot distinguish metabolically active tumor lesions. Although PET is inferior to CT and MRI for anatomic resolution, intense tumor accumulation of FDG due to a high metabolic rate allows identification of very small foci of malignancy that are not easily detected by anatomic imaging methods. Previous reports have shown the ability of PET to detect tumor foci in various neoplasms, including cancers of the thyroid, breast, lung, head and neck, colon, ovary, muscle, bone and lymph node (lymphoma).1, 2, 3 PET imaging for acute leukemia has been described to have been useful only in two acute myeloid leukemia (AML) cases: (1) detection of extramedullary infiltrates and (2) detection of lytic bone lesions.4, 5, 6 There are no reported cases of EMR of ALL detected by FDG-PET scan. In summary, FDG-PET scan may prove to be of value in the future in detecting and monitoring EMR of ALL following allogeneic HSCT.

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Authors and Affiliations

  1. Department of Medicine, State University of New York at Buffalo, Buffalo, NY, USA

    J Francis

  2. Department of Medicine, Blood and Marrow Transplant Program, Roswell Park Cancer Institute, Buffalo, NY, USA

    S Smiley, M Battiwalla, P Paplham, K Brown, M Syta & P McCarthy

  3. Department of Medicine, Leukemia Program, Roswell Park Cancer Institute, Buffalo, NY, USA

    M Wetzler

  4. Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY, USA

    M Barcos & W Bshara

  5. Department of Nuclear Medicine and Radiology, Roswell Park Cancer Institute, Buffalo, NY, USA

    D Lamonica & P Loud

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  1. J Francis
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  12. P McCarthy
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Correspondence to P McCarthy.

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Francis, J., Smiley, S., Battiwalla, M. et al. Detection of extra-medullary relapse of acute lymphoblastic leukemia by radiographic imaging following allogeneic hematopoietic SCT. Bone Marrow Transplant 44, 827–828 (2009). https://doi.org/10.1038/bmt.2009.183

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