SpringerLink
Log in

Early detection value of 18F-FDG-PET/CT for drug-induced lung injury in lymphoma

  • Original Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

Recent studies have not only shown better prognosis of lymphoma with the advancement of therapeutic drug development, but also suggested more attention should be paid to drug-induced lung injury. Early diagnosis is critical for treatment of drug-induced lung injury. 18F-FDG-PET/CT, the standard imaging method for prognosis evaluation of Hodgkin’s lymphoma and some non-Hodgkin’s lymphoma, has also shown the potential for early detection of drug-induced lung injury in our study. A total of 579 lymphoma patients evaluated by 18F-FDG-PET/CT between June 2016 and March 2018 are studied retrospectively. Clinical and imaging characteristics are described in 32 patients (average age of 55), who were diagnosed with drug-induced lung injury. The incidence of drug-induced lung injury was 5.53% (32/579); most of the chemotherapy regimens include rituximab (90.63%, 29/32). Twelve patients demonstrated fever, cough, and dyspnea, and the other 20 had no significant symptoms. 18F-FDG-PET/CT showed multiple or diffused distribution of ground glass and patchy shadows, with increased FDG uptake in both lungs (SUVmax 2.28 ± 1.13, standardized uptake ratio-blood pool, SUR-BP = 0.59–4.07, median SUR-BP 1.32). SUVmax and SUR-BP in patients with symptoms (SUVmax 3.03 ± 1.33 and SUR-BP 2.12 ± 1.06) were significantly higher than in those without symptoms (SUVmax 1.84 ± 0.70 and SUR-BP 1.18 ± 0.48) (P = 0.002 for both SUVmax and SUR-BP). After temporary drug withdrawal, changing chemotherapy regimens, and corticosteroid usage, the pulmonary lesions in all patients were relieved, confirmed with chest CT. Drug-induced lung injury can be a co-finding during 18F-FDG-PET/CT assessment of lymphoma. With positive correlation between FDG uptake and symptoms, 18F-FDG-PET/CT provided value in early detection of lung injury in asymptomatic patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Zhou T, Shen Q, Peng H, Chao T, Zhang L, Huang L, Yang K, Thapa S, Yu S, Jiang Y (2018) Incidence of interstitial pneumonitis in non-Hodgkin’s lymphoma patients receiving immunochemotherapy with pegylated liposomal doxorubicin and rituximab. Ann Hematol 97:141–147. https://doi.org/10.1007/s00277-017-3160-1

    Article  CAS  PubMed  Google Scholar 

  2. Madabhavi I, Modi G, Patel A, Anand A, Panchal H, Parikh S (2017) Pulmonary toxicity following bleomycin use: a single-center experience. J Cancer Res Ther 13:466–470. https://doi.org/10.4103/0973-1482.204887

    Article  PubMed  Google Scholar 

  3. Salmasi G, Li M, Sivabalasundaram V, Panzarella T, Tsang R, Kukreti V, Crump M, Kuruvilla J (2015) Incidence of pneumonitis in patients with non-Hodgkin lymphoma receiving chemoimmunotherapy with rituximab. Leuk Lymphoma 56:1659–1664. https://doi.org/10.3109/10428194.2014.963075

    Article  CAS  PubMed  Google Scholar 

  4. Cella L, Liuzzi R, D'Avino V, Conson M, Di BA, Picardi M, Pugliese N, Solla R, Salvatore M, Pacelli R (2014) Pulmonary damage in Hodgkin’s lymphoma patients treated with sequential chemo-radiotherapy: predictors of radiation-induced lung injury. Acta Oncol 53:613–619. https://doi.org/10.3109/0284186X.2013.850739

    Article  CAS  PubMed  Google Scholar 

  5. Ghesquieres H (2005) Severe interstitial pneumonitis following rituximab and bleomycin-containing combination chemotherapy. Ann Oncol 16:1399. https://doi.org/10.1093/annonc/mdi232

    Article  CAS  PubMed  Google Scholar 

  6. Buchler T, Bomanji J, Lee SM (2007) FDG-PET in bleomycin-induced pneumonitis following ABVD chemotherapy for Hodgkin’s disease--a useful tool for monitoring pulmonary toxicity and disease activity. Haematologica 92:e120–e121. https://doi.org/10.3324/haematol.11856

    Article  CAS  PubMed  Google Scholar 

  7. Dimopoulou I, Bamias A, Lyberopoulos P, Dimopoulos MA (2006) Pulmonary toxicity from novel antineoplastic agents. Ann Oncol 17:372–379. https://doi.org/10.1093/annonc/mdj057

    Article  CAS  PubMed  Google Scholar 

  8. Matsuno O (2012) Drug-induced interstitial lung disease: mechanisms and best diagnostic approaches. Respir Res 13:39. https://doi.org/10.1186/1465-9921-13-39

    Article  PubMed  PubMed Central  Google Scholar 

  9. Burton C, Kaczmarski R, Jan-Mohamed R (2003) Interstitial pneumonitis related to rituximab therapy. N Engl J Med 348:2690–2691; discussion 2690-2691. https://doi.org/10.1056/NEJM200306263482619

    Article  PubMed  Google Scholar 

  10. Sakai F, Johkoh T, Kusumoto M, Arakawa H, Takahashi M (2012) Drug-induced interstitial lung disease in molecular targeted therapies: high-resolution CT findings. Int J Clin Oncol 17:542–550. https://doi.org/10.1007/s10147-012-0489-2

    Article  PubMed  Google Scholar 

  11. Mei-xin Z, Wei-fang Z (2017) 18F-FDG-PET/CT in diagnosis of chemotherapy-induced lung injury in patients with lymphoma. Chin J Med Imaging Technol 33:40–43

    Google Scholar 

  12. Adams HJ, Kwee TC (2016) Interim PET-CT scan in advanced Hodgkin’s lymphoma. N Engl J Med 375:999–1000. https://doi.org/10.1056/NEJMc1609333

    Article  PubMed  Google Scholar 

  13. Kazama T, Faria SC, Uchida Y, Ito H, Macapinlac HA (2008) Pulmonary drug toxicity: FDG-PET findings in patients with lymphoma. Ann Nucl Med 22:111–114. https://doi.org/10.1007/s12149-007-0089-9

    Article  PubMed  Google Scholar 

  14. Falay O, Öztürk E, Bölükbaşı Y, Gümüş T, Örnek S, Özbalak M, Çetiner M, Demirkol O, Ferhanoğlu B (2017) Use of fluorodeoxyglucose positron emission tomography for diagnosis of bleomycin-induced pneumonitis in Hodgkin lymphoma. Leuk Lymphoma 58:1114–1122. https://doi.org/10.1080/10428194.2016.1236379

    Article  CAS  PubMed  Google Scholar 

  15. Liu X, Hong XN, Gu YJ, Wang BY, Luo ZG, Cao J (2008) Interstitial pneumonitis during rituximab-containing chemotherapy for non-Hodgkin lymphoma. Leuk Lymphoma 49:1778–1783. https://doi.org/10.1080/10428190802270886

    Article  CAS  PubMed  Google Scholar 

  16. Barber NA, Ganti AK (2011) Pulmonary toxicities from targeted therapies: a review. Target Oncol 6:235–243. https://doi.org/10.1007/s11523-011-0199-0

    Article  PubMed  Google Scholar 

  17. Bonanni A, Calatroni M, D'Alessandro M, Signa S, Bertelli E, Cioni M, Di ME, Biassoni R, Caridi G, Ingrasciotta G, Bertelli R, Di DA, Bruschi M, Canepa A, Piaggio G, Ravani P, Ghiggeri GM (2018) Adverse events linked with the use of chimeric and humanized anti-CD20 antibodies in children with idiopathic nephrotic syndrome. Br J Clin Pharmacol 84:1238–1249. https://doi.org/10.1111/bcp.13548

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Franzen D, Ciurea A, Bratton DJ, Clarenbach CF, Latshang TD, Russi EW, Kyburz D, Kohler M (2016) Effect of rituximab on pulmonary function in patients with rheumatoid arthritis. Pulm Pharmacol Ther 37:24–29. https://doi.org/10.1016/j.pupt.2016.02.002

    Article  CAS  PubMed  Google Scholar 

  19. Kim KM, Kim HC, Jeon KN, Kim HG, Kang JH, Hahm JR, Lee GW (2008) Rituximab-CHOP induced interstitial pneumonitis in patients with disseminated extranodal marginal zone B cell lymphoma. Yonsei Med J 49:155–158. https://doi.org/10.3349/ymj.2008.49.1.155

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Zhang X, Guo X, Pan J (2015) Increased levels of tumor necrosis factor-α involved in rituximab-related acute pulmonary fibrosis in diffuse large B-cell lymphoma. Am J Clin Pathol 143:725–727

    Article  CAS  PubMed  Google Scholar 

  21. Akira M, Suganuma N (2014) Acute and subacute chemical-induced lung injuries: HRCT findings. Eur J Radiol 83:1461–1469. https://doi.org/10.1016/j.ejrad.2014.04.024

    Article  PubMed  Google Scholar 

  22. Yamane T, Daimaru O, Ito S, Nagata T, Yoshiya K, Fukaya N, Ito S, Imai T, Uchida H (2008) Drug-induced pneumonitis detected earlier by 18F-FDG-PET than by high-resolution CT: a case report with non-Hodgkin’s lymphoma. Ann Nucl Med 22:719–722. https://doi.org/10.1007/s12149-008-0183-7

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Bei**g, 100191, People’s Republic of China

    Meixin Zhao & Weifang Zhang

Authors
  1. Meixin Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Weifang Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Weifang Zhang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All 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.

Informed consent

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhao, M., Zhang, W. Early detection value of 18F-FDG-PET/CT for drug-induced lung injury in lymphoma. Ann Hematol 98, 909–914 (2019). https://doi.org/10.1007/s00277-018-3558-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-018-3558-4

Keywords

Search

Navigation