A prospective study on early PET/CT scans during the first cycle of salvage chemotherapy for relapsed or refractory diffuse large B-cell lymphoma

Abstract Abstract 3127 Background: Circulating nucleic acids have been explored as tumor markers in several malignancies. Lymphoma offers a special opportunity to develop tumor DNA markers. Normal B cells undergo Ig rearrangements to generate antibody diversity. In B cell malignancies, the Ig gene rearrangements are monoclonal. Molecular diagnostic tests are widely employed in tumor specimens to detect these clone-specific Ig rearrangements when histology and immunohistochemistry are ambiguous. While long-lived plasma cells can secrete Ig over years, a B cell can only release its unique clone once. In order to sustain the presence of Ig DNA, ongoing cellular proliferation and death is required, suggesting that detection in the plasma may be a specific marker for presence of lymphoma. We previously reported our experience in screening plasma from patients (pts) with AIDS-related lymphomas (Blood 110(11):1579, 2007). The feasibility of this approach and promising results led to a pilot study evaluating clonal Ig DNA in pts with newly diagnosed diffuse large B cell lymphoma (DLBCL) without HIV. Methods: Plasma is screened for clonal Ig DNA using standardized fluorescently-labeled multiplex primers (InVivoScribe) targeting IgH rearrangements. Rearranged Ig DNA is amplified by polymerase chain reaction (PCR), and the amplified products are separated by size using capillary electrophoresis. International prognostic index (IPI) scores and results of baseline PET/CT scans, including standardized uptake value (SUV)max scores are collected from pts to determine the impact of these findings on the ability to detect clonal Ig DNA. Results: Of 36 plasma specimens evaluated to date, 28 (78%) had clonal IgH rearrangements. Clonal and polyclonal controls yielded appropriate results. Tumor specimens are available from 22 patients, including 19 formalin-fixed paraffin-embedded (FFPE) and 5 fresh frozen tissue (FFT) specimens (2 pts have both FFPE and FFT). Eight FFPE tumor specimens have been evaluated; monoclonal IgH rearrangements were present in 5 (63%), 2 had polyclonal rearrangements, and 1 had no detectable IgH rearrangements. The median IPI scores were 1.5 (75% of pts had scores of 0–2) for the group without detectable plasma clonal Ig DNA and 2 (67% of pts had scores of 0–2) for the group with detectable plasma clonal Ig DNA. Wilcoxon 2-sample test demonstrated no difference between the 2 groups with respect to IPI scores (p= 0.50). Pre-treatment PET/CT scans were interpreted as positive in 30 of 33 pts. Two pts with negative PET/CT and corresponding IPI scores of 0 and 1 respectively, did not have detectable plasma clonal Ig DNA. One pt with a negative PET/CT had an IPI score of 0 and had detectable clonal Ig DNA in the plasma. In a T-test comparison, there was no evidence for a difference in SUVmax among pts with and without detectable clonal Ig DNA (p = 0.31). Conclusions: Circulating clonal Ig DNA is detectable in pts with newly diagnosed DLBCL even with low IPI scores and negative PET/CT scans. Relatively small pt numbers limit the interpretation of the IPI/FDG-PET findings with respect to the detection of clonal Ig DNA in the plasma, and larger studies are needed to better appreciate if there is any correlation. Studies are ongoing to determine whether clonal Ig plasma DNA persists after the initiation of therapy, and whether the presence of clonal Ig DNA in plasma might complement information obtained from early interim FDG-PET in identifying patients likely to fail conventional therapy. Continued analysis of paired tumor/plasma specimens will clarify if plasma clonal Ig DNA is tumor derived. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

Comparing radioactive tracers 18F-FDG and 18F-FLT in the staging of diffuse large B-cell lymphoma by PET/CT examination: A single-center prospective study

Advances in Clinical and Experimental Medicine ◽

10.17219/acem/104558 ◽

2019 ◽

Vol 28 (8) ◽

pp. 1095-1099

Author(s):

Justyna Rybka ◽

Bogdan Małkowski ◽

Monika Olejniczak ◽

Ewa Chmielowska ◽

Ewelina Sokołowska ◽

...

Keyword(s):

Prospective Study ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Radioactive Tracers ◽

Single Center ◽

Large B Cell Lymphoma ◽

Pet Ct ◽

18F Fdg ◽

Large B Cell

Download Full-text

Consolidation Radiotherapy following Brief Chemotherapy for Localized Diffuse Large B-cell Lymphoma: A Prospective Study

Leukemia & Lymphoma ◽

10.3109/10428190309178776 ◽

2003 ◽

Vol 44 (9) ◽

pp. 1535-1539 ◽

Cited By ~ 2

Author(s):

Kouichi Isobe ◽

Hiroyuki Kawakami ◽

Jun-Ichi Tamaru ◽

Shigeo Yasuda ◽

Takashi Uno ◽

...

Keyword(s):

Prospective Study ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Consolidation Radiotherapy ◽

A Prospective Study ◽

Large B Cell

Download Full-text

Final Results of a Prospective Evaluation of the Predictive Value of Interim Positron Emission Tomography in Patients With Diffuse Large B-Cell Lymphoma Treated With R-CHOP-14 (SAKK 38/07)

Journal of Clinical Oncology ◽

10.1200/jco.2014.58.9846 ◽

2015 ◽

Vol 33 (23) ◽

pp. 2523-2529 ◽

Cited By ~ 78

Author(s):

Christoph Mamot ◽

Dirk Klingbiel ◽

Felicitas Hitz ◽

Christoph Renner ◽

Thomas Pabst ◽

...

Keyword(s):

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Ct Scans ◽

Interim Pet ◽

Large B Cell Lymphoma ◽

Positron Emission ◽

End Of Treatment ◽

Pet Ct ◽

Large B Cell

Purpose Our main objective was to prospectively determine the prognostic value of [18F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) after two cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone given every 14 days (R-CHOP-14) under standardized treatment and PET evaluation criteria. Patients and Methods Patients with any stage of diffuse large B-cell lymphoma were treated with six cycles of R-CHOP-14 followed by two cycles of rituximab. PET/CT examinations were performed at baseline, after two cycles (and after four cycles if the patient was PET-positive after two cycles), and at the end of treatment. PET/CT examinations were evaluated locally and by central review. The primary end point was event-free survival at 2 years (2-year EFS). Results Median age of the 138 evaluable patients was 58.5 years with a WHO performance status of 0, 1, or 2 in 56%, 36%, or 8% of the patients, respectively. By local assessment, 83 PET/CT scans (60%) were reported as positive and 55 (40%) as negative after two cycles of R-CHOP-14. Two-year EFS was significantly shorter for PET-positive compared with PET-negative patients (48% v 74%; P = .004). Overall survival at 2 years was not significantly different, with 88% for PET-positive versus 91% for PET-negative patients (P = .46). By using central review and the Deauville criteria, 2-year EFS was 41% versus 76% (P < .001) for patients who had interim PET/CT scans after two cycles of R-CHOP-14 and 24% versus 72% (P < .001) for patients who had PET/CT scans at the end of treatment. Conclusion Our results confirmed that an interim PET/CT scan has limited prognostic value in patients with diffuse large B-cell lymphoma homogeneously treated with six cycles of R-CHOP-14 in a large prospective trial. At this point, interim PET/CT scanning is not ready for clinical use to guide treatment decisions in individual patients.

Download Full-text

Primary gastrointestinal diffuse large B-cell lymphoma: A prospective study from South India

South Asian Journal of Cancer ◽

10.4103/sajc.sajc_52_18 ◽

2019 ◽

Vol 08 (01) ◽

pp. 57-59 ◽

Cited By ~ 3

Author(s):

Babu Suresh ◽

Vikas Asati ◽

K. C. Lakshmaiah ◽

Govind Babu ◽

D. Lokanatha ◽

...

Keyword(s):

Prospective Study ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Disease Stage ◽

Common Site ◽

Large B Cell Lymphoma ◽

Localized Disease ◽

A Prospective Study ◽

Large B Cell

Abstract Background: Gastrointestinal tract (GIT) is the most common extranodal site for non-Hodgkin's lymphoma (NHL) and constitutes about 10%-15% of all NHL. This was a prospective study to evaluate the epidemiological, clinicopathological characteristics, and treatment outcome of primary GIT diffuse large B-cell lymphoma (PGIL). Materials and Methods: Newly diagnosed patients of PGIL with DLBCL histology were eligible. Lugano staging system was used. All patients were treated with prephase treatment (1 mg vincristine and 100 mg prednisolone) followed by CHOP-based chemotherapy (with or without rituximab) as definitive treatment. Results: A total of 21 patients of PGIL were diagnosed. The median age was 46 years (range: 27–69 years) with male:female ratio of 2:1. Dull aching abdominal pain was the most common presenting complaint. Stomach was the most common site involved (52.4%, n = 11) followed by the colon (23.8%, n = 5). The estimated median survival in patients with Stage IV disease was significantly lower as compared to patients with localized disease (Stage I and II) (6.23 months vs. 23.4 months; P = 0.04). Patients, who did not achieve complete response (CR), had 15.5 times higher risk of death, as compared to those who achieved CR (P = 0.01). Conclusions: Stomach was the most common site for PGIL. Localized disease and CR after first-line chemotherapy were associated with better survival. A higher cost of rituximab was the prohibitive factor for cure in these patients.

Download Full-text

Consolidation Radiotherapy Following Brief Chemotherapy for Localized Diffuse Large B-cell Lymphoma: A Prospective Study

Leukemia & Lymphoma ◽

10.1080/1042819031000097357 ◽

2003 ◽

Vol 44 (9) ◽

pp. 1535-1539 ◽

Cited By ~ 4

Author(s):

Kazuo Hatano ◽

Toshiyuki Takagi ◽

Atsuo Mikata ◽

Hisao Ito ◽

Tetsuya Kawata ◽

...

Keyword(s):

Prospective Study ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Consolidation Radiotherapy ◽

A Prospective Study ◽

Large B Cell

Download Full-text

Prognostic Value of Pre-Autologous Stem Cell Transplantation PET/CT in Diffuse Large B-Cell Lymphoma: The Deauville Score Is Prognostically Superior to ΔSUVmax

Acta Haematologica ◽

10.1159/000500512 ◽

2019 ◽

Vol 143 (2) ◽

pp. 124-130

Author(s):

Xi-Yuan Zhang ◽

Li Song ◽

Pei-Jun Wang ◽

Ling Wang ◽

Ying Li ◽

...

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Ct Scans ◽

Large B Cell Lymphoma ◽

Deauville Score ◽

Pet Ct ◽

Large B Cell

Objective: The predictive value of pre-autologous stem cell transplantation (pre-ASCT) positron emission tomography/computed tomography (PET/CT) scans according to different criteria remains elusive in patients with diffuse large B-cell lymphoma (DLBCL). Methods: A total of 46 DLBCL patients treated with pre-ASCT were enrolled in the present study, and two methods, Deauville score and maximal standardized uptake value reduction (ΔSUVmax), were used to evaluate the PET/CT scans before transplantation. Results:In patients with Deauville 1–3 and ≥4, the 2-year progression-free survival (PFS) rates were 82.8 and 11.8% (p < 0.001), respectively, while the 2-year overall survival (OS) rates were 89.7 and 41.2%, respectively (p < 0.001). When using the ΔSUVmax cut-off of 66% criterion, in patients with a ΔSUVmax of >66 and ≤66%, the 2-year PFS rates were 78.1 and 7.1%, respectively (p < 0.001), while the 2-year OS rates were 87.5 and 35.7%, respectively (p < 0.001). In the univariate analysis, the ΔSUVmax, Deauville score, NCCN-IPI and serum lactate dehydrogenase levels were significantly correlated with the 2-year PFS/OS. Furthermore, the multivariate analysis revealed that the Deauville score was an independent prognostic factor for 2-year PFS. Conclusion: The present results indicate that PET/CT scans at pre-ASCT can predict the survival of DLBCL patients, and the Deauville score is better than ΔSUVmax in prognostic prediction.

Download Full-text