Evaluation of bone mineral density with PET/CT in hodgkin and non-hodgkin lymphoma patients and investigation of the relationship between an anti-apoptotic protein BCL-2 and osteoporosis

Introductıon and Purpose: With the advances in treatment, osteoporosis becomes an important morbidity and mortality problem in lymphoma patients. Identification of opportunistic osteoporosis screening without the need for additional examination and identification of effective factors in the development of osteoporosis will provide an advantage in complication management. In our study, we evaluate the guidance of routine PET/CT in the diagnosis of osteoporosis, which is one of the chemotherapy-related complications in NHL and HL patients, with a time-and cost-effective understanding, without requiring additional examination and it was intended to investigate the possible relationship between BCL-2, an antiapoptotic protein, and osteoporosis in NHL patients with bone marrow involvement. Material and methods: A total of 108 patients, 55 of whom were HL and 53 were NHL, who were treated with the diagnosis of HL and NHL at the Hematology clinic of Gaziantep University Faculty of Medicine, were followed up. Demographic data such as age, gender, stage, laboratory parameters, BCL-2 results and PET/CT images were analyzed retrospectively. Three PET/CT scans were selected; at the time of diagnosis PET/BT1, in the mid-response evaluation of chemotherapy PET/BT2, and taken at least six months after the completion of chemotherapy PET/BT3. In the evaluation of the presence of osteoporosis by PET/CT, Hounsfield Unit (HU) measurement was used in the lumbar spine (L1-L4) and CT imaging of trabecular bones. HU threshold value was determined as 160 based on previous studies. Results: Bone mineral density in PET/BT2 was significantly decreased in all patients diagnosed with HL and NHL compared to PET/BT1 (p = 0.001, p = 0.001). In patients diagnosed with early stage HL and in patients diagnosed with early stage NHL, bone mineral density in PET/CT 3 increased significantly compared to PET/BT2 (respectively; p = 0.001, p = 0.017). Bone mineral density in PET/BT3 was significantly reduced in all patients with NHL and in patients with advanced NHL diagnosis compared to PET/BT2 (respectively; p=0.001 and p=0.002). In all patients with HL, in patients with early stage HL, in all patients with NHL, in patients with early-advanced stage NHL, it was found that bone mineral density in PET/BT3 decreased significantly compared to PET/BT1 (respectively p = 0.004, p = 0.049, p = 0.001, p= 0.005, p= 0.001). Bone mineral density in female gender PET/BT1 and PET/BT2 was significantly lower in the NHL patient group (p = 0.004, p = 0.001, respectively). Conclusion: In our study; A significant decrease in bone mineral density was found at the time of diagnosis and treatment of HL and NHL patients. In posttreatment follow-up, it was determined that negative effects on bone disappear earlier in patients with early stage HL and NHL. Study results; shows that PET/CT used in diagnosis and follow-up can be safely used in opportunistic osteoporosis screening with a cost-effective approach without using additional examination. Key Words: Hodgkin Lymphoma, Non-hodgkin lymphoma, osteoporosis, opportunistic osteoporosis screening