In a 61-year-old patient affected from follicular lymphoma, end-of-treatment [18F]FDG-PET/CT (panel B) revealed bilateral pneumonia suggestive for COVID-19, subsequently confirmed by a nasal swab. Simultaneously, images showed the shrinkage of a para-aortic lymph nodal lesion compared to baseline (arrows), consistent with a partial response to R-bendamustine (panels B–F vs A–E). Re-staging [18F]FDG-PET/CT, obtained after SARS-CoV-2 recovery, showed an increase in size and in [18F]FDG avidity of the para-aortic lesion, suggestive for progressive disease (panels C-G-I). During COVID-19 infection and after, he did not experience any symptoms . Surprisingly, malignancy was excluded by CT-guided biopsy performed twice, and this finding was confirmed by a second follow-up scan showing a complete metabolic response (panels D–H).
The SARS-CoV-2 infection has proved to trigger an immune response. In this patient, the virus may have firstly induced a local “flare phenomenon” (panels C-G-I)—as typically observed in patients receiving immunotherapy—finally resulting in an “abscopal effect” (panels D–H). This report suggests a close interplay among COVID-19 infection, inflammation, and tumour biology.
The manuscript represents valid work. Arturo Chiti had full access to all the data and takes responsibility for the data integrity and the accuracy of the data analysis.
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Prof. Chiti reports a fellowship grant from Sanofi and personal fees from AAA, Blue Earth Diagnostics, and General Electric Healthcare, outside the submitted work. The other authors do not report any conflict of interest.
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Sollini, M., Gelardi, F., Carlo-Stella, C. et al. Complete remission of follicular lymphoma after SARS-CoV-2 infection: from the “flare phenomenon” to the “abscopal effect”. Eur J Nucl Med Mol Imaging (2021). https://doi.org/10.1007/s00259-021-05275-6