Journal of Hematology & Oncology
Tools
Share this article

Email updates

Keep up to date with the latest news and content from Journal of Hematology & Oncology and BioMed Central.

Open Access Letter to the Editor

The significance of 18F-FDG PET/CT in secondary hemophagocytic lymphohistiocytosis

Li-Juan Zhang12†, Ji Xu1†, Peng Liu1, Chong-Yang Ding3, Jian-Yong Li1, Hong-Xia Qiu1* and Su-Jiang Zhang1*

Author Affiliations

1 Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, 300 Guangzhou Road, Nanjing, China

2 Department of Hematology, Huai’an First People’s Hospital, Nanjing Medical University, Huai’an, China

3 Department of PET/CT Center, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China

For all author emails, please log on.

Journal of Hematology & Oncology 2012, 5:40  doi:10.1186/1756-8722-5-40


The electronic version of this article is the complete one and can be found online at: http://www.jhoonline.org/content/5/1/40


Received: 8 July 2012
Accepted: 23 July 2012
Published: 23 July 2012

© 2012 Zhang et al.; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This study was aimed to investigate the significance of 18F-FDG PET/CT in secondary hemophagocytic lymphohistiocytosis (sHLH) patients. A total of 18 patients received 18F-FDG PET/CT scan at initial diagnosis. All patients (18/18) had at least 3 organs involved, with increased FDG metabolism in different degrees. Fifteen cases (15/18) had definite underlying diseases, including infections (IAHLH), rheumatosis (RAHLH), or malignancy (MAHLH). The SUVmax of patients in MAHLH group was significantly higher than patients in IAHLH group or RAHLH group (P = 0.015, P = 0.045). Furthermore, the SUVmax of patients in IAHLH group was significantly higher than patients of RAHLH group (P = 0.043). Therefore, we concluded that 18F-FDG PET/CT may especially play important role in differential diagnosis of sHLH.

To the Editor

Secondary hemophagocytic lymphohistiocytosis (sHLH) is a hyper-inflammatory clinical syndrome mainly caused by severe infections, autoimmune inflammatory disorders and malignancies, especially lymphoma [1-3]. Up to date, very few data from the literature are available regarding the role of 18F-FDG PET/CT in sHLH. In this study, 18 of 50 patients with sHLH who were admitted into our hospital between May 2007 and December 2010 underwent the examination (Table 1). The male-to-female ratio was 1:1, and the median age was 35 years (15-73). The diagnosis of HLH was made according to HLH-2004 diagnostic guidelines [4,5], and the underlying diseases were confirmed by a series of pathogenesis examinations including pathology, immunology, bacterial culture and virus detection et al. The maximum standardized uptake values (SUVmax) used to measure the level of FDG uptake were determined in all lesions [6]. All of the 18 patients had at least 3 organs involved, with increased FDG uptake at different level, including 18 cases showing splenomegaly, 16 cases serous effusions, 16 cases lymphadenopathy, 13 cases bone lesions, 12 cases pneumonia, 8 cases hepatomegaly, 5 cases brain parenchymal or cerebroventricular lesions, 5 cases cholecystitis, 4 cases myocardium lesions, and 2 cases kidney calculi. There were also other organs involved, such as larynx, muscles and adnexauteri. Fifteen patients (15/18) had definite underlying diseases, and were divided into three groups.,including Infection Associated HLH (IAHLH, including EBV-HLH, n = 8), Rheumatosis Associated HLH (RAHLH, n = 2), and Malignancy Associated HLH (MAHLH, n = 5). The SUVmax of patients in MAHLH group was significantly higher than those of patients with IAHLH (Mean 12.0 vs. 6.8, P = 0.015), and RAHLH (Mean 12.0 vs. 2.7, P = 0.045). Furthermore, the SUVmax of patients with IAHLH was significantly higher than that of patients with RAHLH (Mean 6.8 vs. 2.7, P = 0.043). However, no significant difference in survival time was found between the three different sHLH subtype according to Kaplan-Meier analysis (P >0.05). In conclusion, 18F-FDG PET/CT may play important role in differential diagnosis of sHLH, with high SUV pointing toward underlying malignancy.

Table 1. Characteristics of 18 sHLH patients

Acknowledgments

This study was supported by the National Natural Science Foundation of China (81070456, 81170490), ‘Liu Da Ren Cai Gao Feng’ of Jiangsu Province (2010-WS-019), and A Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions.

References

  1. Janka G, Imashuku S, Elinder G, et al.: Infection- and malignancy-associated hemophagocytic syndromes. Secondary hemophagocytic lymphohistiocytosis.

    Hematol Oncol Clin North Am 1998, 12:435-444. PubMed Abstract | Publisher Full Text OpenURL

  2. Fisman DN: Hemophagocytic syndromes and infection.

    Emerg Infect Dis 2000, 6:601-608. PubMed Abstract | Publisher Full Text | PubMed Central Full Text OpenURL

  3. Dhote R, Simon J, Papo T, et al.: Reactive hemophagocytic syndrome in adult systemic disease: report of twenty-six cases and literature review.

    Arthritis Rheum 2003, 49:633-639. PubMed Abstract | Publisher Full Text OpenURL

  4. Henter JI, Horne A, Aricó M, et al.: HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis.

    Pediatr Blood Cancer 2007, 48:124-131. PubMed Abstract | Publisher Full Text OpenURL

  5. Filipovich AH: Hemophagocytic lymphohistiocytosis (HLH) and related disorders.

    Hematology Am Soc Hematol Educ Program 2009, :127-131. OpenURL

  6. Huang SC: Anatomy of SUV.

    Nucl Med Biol 2000, 27:643-646. PubMed Abstract | Publisher Full Text OpenURL