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Journal of Cancer Research and Therapeutics, Vol. 7, No. 2, April-June, 2011, pp. 228-229 Letter to the Editor Intense FDG uptake in the spleen due to recent granulocyte-macrophage colony-stimulating factor administration: Follow-up scan clarifying the situation Sandip Basu, Nawab S Baghel Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Jerbai Wadia Road, Parel, Mumbai-400 012, Maharashtra, India Code Number: cr11058 PMID: 21768724 Sir, Intense fluorodeoxyglucose (FDG) uptake is observed at times in the spleen in patients receiving marrow stimulants along with chemotherapy. Such uptake can be confounding to the positron emission tomography (PET) -interpreting physicians, as traditionally in practice, only bone marrow FDG uptake is the usually described [1],[2],[3],[4],[5],[6] observation in this situation. Hence a diffuse and intense FDG uptake in the spleen in the setting of recent administration of bone marrow stimulants without any obvious focal lesions in the anatomical modalities should be considered to be due to the effect of the aforementioned therapy. The case vignette is presented as an educative primer to the practicing oncologists to recognize this phenomenon that they might come across in the routine clinics. We herein describe a 39-year-old female, a diagnosed case of Non-Hodgkin′s Lymphoma involving the left upper zone of the lung with mediastinal adenopathy. FDG-PET after six cycles of chemotherapy with cyclophosphamide, hydroxydaunorubicin, Oncovin and prednisolone CHOP regimen demonstrated diffuse intense FDG uptake in the bone marrow and spleen in addition to the residual disease in the suprahilar region and upper zone of the left lung. There was history of granulocyte-macrophage colony-stimulating factor (GM-CSF) administration three days prior to the FDG-PET study [Figure - 1]: upper panel]. She was administered four cycles of salvage chemotherapy with R-DHAP (rituximab-dexametasone, cytarabine, cisplatinum), the last cycle being administered around three weeks back with GM-CSF . The FDG-PET, this time [Figure - 1]: lower panel], showed evidence of progressive disease in the neck and mediastinum; however, the bone marrow and splenic uptake of FDG was low, being substantially reduced compared to the previous study. This was likely due to the fact that three weeks had elapsed since the last administration of the marrow stimulants during the follow-up study. In patients treated with conventional-dose chemotherapy and marrow stimulants such as granulocyte colony-stimulating factor (G-CSF) or GM-CSF, increased marrow uptake is a prominent observation in the FDG-PET. [1],[2],[3],[4],[5],[6] The pattern of uptake is usually diffuse in nature and the increased FDG accumulation is more regular in this situation. However, at times, it is difficult to distinguish the diffuse bone marrow FDG uptake attributable to the hematopoietic cytokines from that of bone marrow involvement by malignancy. It is predicted that such bone marrow uptake returns to the pretreatment value approximately one month after discontinuation of CSF and hence a follow-up scan can be of importance in resolving this issue in difficult situations. While bone marrow FDG uptake has been described in several reports, intense uptake in the spleen due to the effect of cytokines has been rarely described in the literature and is relatively less recognized by the interpreting physicians. The present report demonstrates that similar diffuse intense FDG uptake in the spleen also can be observed in certain individuals in the setting of very recent administration of GM-CSF, which gradually reduces with time and should not be construed as disease involvement in the present FDG-PET study. The importance of recognizing the pattern cannot be overemphasized nor can be the value of a follow-up study and careful correlation in this setting. References
Copyright 2011 - Journal of Cancer Research and Therapeutics The following images related to this document are available:Photo images[cr11058f1.jpg] |
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