DLBCL pacientka

Dobrý den,

protože jsem sám tento případ zasílal, svoji odpověď přidávat nebudu, zasílám ale dle mého názoru velmi zajímavé odpovědi tří zahraničních key-opinion leaderů v této oblasti, které jsem včera také s tímto dotazem oslovil a od kterých jsem již obratem obdržel tyto odpovědi:

Prof.Gilles Salles (MSK, NY, USA):

It is hard to make a recommendation based in reports without looking at the images and knowing the initial and final SUV. However, my 2 cents:

We never go for CAR without a biopsy-proven recurrence. So hold before you make this decision
I am not fan of radiation on the spleen, this is an heamatopoietic / lymphoid organ, if active tumor is here, it will be eslswhere.
We have seen a few patients with delayed metabolic and imaging response in the spleen. If a biopsy is not possible today (see PMID: 36049840), and assuming blood counts and patient’s status is good, I would repeat a PET ~ 2 months.
Hope this helps, Best regards, Gilles

Prof.Greg Nowakowski: Mayo Clinic, Rochester, USA

We actually typically do diagnostic/therapeutic splenectomy in these patients – it helps with next step decision plus provide removal of residual disease. Our surgeons usually do it laparoscopically, recovery very quick. Typically we would not treat with CART without histological proof of disease since granulomas in spleen can have high SUV without active disease. Other centers use radiation or monitoring.

Hope this is helpful, Greg

prof.Laurie Sehn: BCancer Institute, Austrálie

This is a challenging case, indeed. I must say that we have had numerous cases of DLBCL with false positive findings on PET scan in the spleen, post completion. Given the subtle findings of what is described, I personally would not be proceeding onto a next systemic therapy without clarity that this represents true disease. Have you performed a dedicated contrast enhanced CT scan to assess whether there is objective growth at any site? If no growth, I would consider repeating the PET scan in approximately 6 weeks To see whether this area resolves or expands. If this is true lymphoma, it will inevitably declare itself, and then you can move forward with more certainty. However, I personally would require proof by way of true progression, versus biopsy proven persistence. We have actually recommended splenectomy in some patients to clarify the situation. And if you think this could be easily done by laparoscopy, it would not be unreasonable.
In general, we have not been radiating the spleen With consolidated radiation, as I think, it is hard to believe that any involvement would, in fact be focal, and therefore radiation would require a wide field with fair long-term morbidity.

Tak je videt, ze se ma vcerejsi odpoved pres mobil neprotlacila :-)
- tak opakuji aniz bych cetl odpovedi
- chybi mi rada udaju z diagnosy: IPI? LDH? Typ DLBCL? diagnosa z uzliny na krku?
- asi bych volil kontrolu PET/CT za 6-8 tydnu
- v pripade nejasnosti bych zvazil splenektomii - jiz jsme videli po lecbe granulomatosni postizeni PET + bez pritomnosti lymfomu, dalsi rozhodnuti podle vysledku

marek trneny

PS ted si rad prectu odpovedi kolegu: -)

Díky moc, doplňuji jen vstupní údaje: IPI 2 (LDH, stadium III), dg.byla z biopsie sleziny. DLBCL byl non GC, to jsem tam již uváděl. Vstupní hodnota LDH byla 6,36 (norma 3,75 ukat/l).

Díky:)