Lack of Prognostic Significance of Pre-Treatment Total Metabolic Tumor Volume (TMTV) in Diffuse Large B-Cell Lymphoma (DLBCL)

Abstract Background DLBCL is the most common non-Hodgkin lymphoma (NHL), making up about 30%-40% of NHL in the U.S. PET-CT is recommended as the most accurate imaging technique in DLBCL for staging and response assessment. Pretreatment assessment of PET-CT scan derived metrics such as TMTV has been shown to correlate with PFS and/or overall survival (OS) in DLBCL (Sasanelli 2014) We attempted to replicate this finding using EFS at 24 months as a primary endpoint and compare it with pre-treatment TMTV, TLG and cell of origin (COO). Methods 47 pts with newly diagnosed DLBCL and treated with R-CHOP at our institution between 2014 to 2018 were identified from our electronic medical record system for retrospective analysis after IRB approval. All pts had a pretreatment PET-CT scan available for TMTV measurement. All pts had a pretreatment biopsy which were reviewed along with their clinical information regarding treatment outcome and follow up. Patients were classified as to germinal center B cell (GCB) and non-GCB based on immunochemistry using the Hahn's algorithm. PET-CT scans were reviewed by two nuclear medicine physicians using synovia software, and measurements for TMTV and TLG were recorded. TMTV was calculated using a threshold of 41% of the max pixel value (based on prior studies) to draw the volume of interest (VOI) for a lesion. Pooled t-test was performed to compare TMTV, TLG and COO with EFS at 24 mos. Chi-Square test compared TMTV with COO Results Median age of pts was 58 years, with a median duration of follow up of 26 months. There were 33% with limited stage (Stage I or II) and 67% were advanced stage (Stage III or IV). The mean pretreatment TMTV and pretreatment TLG was 295cm3 and 4519 units. 49% were GCB subtype and 47 % non-GCB. Amongst all patients 19.2 % had an event within 24 mos. When TMTV was compared to EFS at 24 months the mean TMTV was 304 for those who had an event versus 294 without (p=0.95). TLG compared to EFS at 24 months showed a mean TLG of 3391 for those who had an event versus 4914 without (P=0.40). GCB and non-GCB had mean TMTV of 264 and 339 respectively with p =0.59. COO when compared to TLG had means of 4365 and 4933 for GCB and non-GBB respectively with p=0.79.Whereas there was no correlation between stage and COO (p=0.4296) TMTV correlated with Ann Arbor staging (p=0.0002). Conclusion This retrospective study failed to demonstrate a correlation between pre-treatment TMTV, TLG, COO and EFS at 24 months revealing the lack of prognostic significance of pretreatment PET scan derived metrics in DLBCL. Prior studies with TMTV did not evaluate EFS at 24 months as an endpoint and therefore, longer follow up might be needed to demonstrate prognostic significance of pretreatment TMTV minimizing it clinical significance. The different subtypes of DLBCL based on COO as assessed by Hahns algorithm also did not differ in their disease burden as measured by TMTV. Disclosures No relevant conflicts of interest to declare.

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Clinical usefulness of PET/CT in initial staging and response evaluation of primary gastric lymphoma

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e19541 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e19541-e19541

Author(s):

J. Yi ◽

S. Kim ◽

S. Lee ◽

S. Park ◽

Y. Ko ◽

...

Keyword(s):

Ct Scan ◽

B Cell ◽

Cell Lymphoma ◽

Gastric Lymphoma ◽

B Cell Lymphoma ◽

Ct Scans ◽

Primary Gastric Lymphoma ◽

Pet Ct ◽

Pet Ct Scan

e19541 Background: Positron emission tomography (PET)/computed tomography (CT) scan has a well-established role in the management of non-Hodgkin's lymphoma (NHL). However, in case of the primary gastric lymphoma, which is the most frequent extranodal NHL, the role of PET/CT scan is still controversial. Methods: We retrospectively analyzed 42 patients with primary gastric lymphoma who underwent PET/CT scans; 32 patients with diffuse large B-cell lymphoma (DLBCL) and 10 patients with extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) were analyzed. The PET/CT scans were compared with clinicopathologic features and the results of CT and endoscopy. After corresponding treatment, response was evaluated by conventional CT scans or PET/CT scans and endoscopy with biopsy Results: Nine patients were up-staged based on the results of their PET/CT scan compared to CT (7 DLBCL, 2 MALT lymphomas) while six patients were down-staged by the PET/CT scan. The high SUVmax group, defined as SUVmax ≥ median value, was significantly associated with an advanced Lugano stage (P < 0.001). Three patients with DLBCL, who showed an initially high SUVmax, died of disease progression. Although not statistically significant, there was a tendency of inferior outcome in the group with high SUVmax. Among 24 patients for whom follow-up PET/CT scan with endoscopy was performed, 11 patients with ulcerative or mucosal lesions showed residual FDG uptake. All of these gastric lesions were grossly and pathologically benign lesions without evidence of lymphoma cells. Conclusions: PET/CT scan can help staging patients with primary gastric lymphoma, and the maximum SUV has possibility to have prognostic value. However, the residual FDG uptake observed during follow-up should be interpreted cautiously in association with the results of endoscopy and multiple gastric biopsies. No significant financial relationships to disclose.

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To evaluate prognostic significance of metabolic-derived tumour volume at staging 18-flurodeoxyglucose PET-CT scan and to compare it with standardized uptake value-based response evaluation on interim 18-flurodeoxyglucose PET-CT scan in patients of non-Hodgkin’s lymphoma (diffuse large B-cell lymphoma)

Nuclear Medicine Communications ◽

10.1097/mnm.0000000000001159 ◽

2020 ◽

Vol 41 (4) ◽

pp. 395-404

Author(s):

Nitin Gupta ◽

Natasha Singh

Keyword(s):

Ct Scan ◽

Cell Lymphoma ◽

Prognostic Significance ◽

Standardized Uptake Value ◽

B Cell Lymphoma ◽

Tumour Volume ◽

Response Evaluation ◽

Large B Cell Lymphoma ◽

Pet Ct ◽

Pet Ct Scan

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Effect of Steroid Treatment on the Diagnostic Yield of Baseline PET CT in Aggressive B Cell Lymphoma

Blood ◽

10.1182/blood-2021-146118 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 1453-1453

Author(s):

Karyn Revital Geiger ◽

Oren Pasvolsky ◽

Tamar Berger ◽

Pia Raanani ◽

Tzippy Shochat ◽

...

Keyword(s):

Ct Scan ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Treated Group ◽

Steroid Treatment ◽

Naive Group ◽

Pet Ct ◽

Pet Ct Scan ◽

Aggressive B Cell Lymphoma

Abstract Aggressive B cell lymphomas often require prompt steroid treatment prior to baseline 18f-fluorodeoxyglucose positron-emission tomography (PET CT) scan and definitive treatment in order to alleviate symptoms and/or prevent organ damage. Since lymphomas are a steroid sensitive malignancy, there is a concern that steroid prophase might affect PET CT results and diagnostic yield. We conducted a retrospective cohort study to evaluate the effect of steroid treatment prior to baseline PET CT scan on the standardized uptake value (SUV) max and additional PET CT parameters by examining two groups of patients: steroid-naïve and steroid-treated patients. The effect of steroid administration on SUV max was examined across different daily and weekly steroid doses and durations of treatment. Between January of 2017 and May 2020, 187 newly diagnosed patients with aggressive B cell lymphoma who had a pre-treatment PET CT scan were evaluated. 160 patients (85.5%) had Diffuse large B-cell lymphoma (DLBCL)/ High-grade B-cell lymphoma, 13 patients (7%) had primary mediastinal (thymic) large B-cell lymphoma, 9 patients (4.8%) had primary DLBCL of the central nervous system and 5 patients (2.7%) had Burkitt lymphoma. 132 patients (70.6%) were included in the steroid-naïve group and 55 patients (29.4%) in the steroid-treated group. In the steroid-treated group, the mean duration of steroid treatment was 10.49 (±9.28) days. Average daily dose of steroid treatment was equivalent to 72.27 (±36) mg of prednisone and the mean cumulative prednisone dose during the week prior to PET CT scan was equivalent to 367.95 (±239.9) mg of prednisone. There was no statistical significant difference between the groups in age, gender or KI67. However, patients in the steroid treated group had a significantly higher stage of disease compared to the steroid-naïve group (mean 3.44 compared to 2.99, respectively, p=0.01). The steroid-treated group also had a trend towards a higher IPI score (mean 2.45 versus 2.08, p=0.08) and a trend towards a higher LDH level (mean 2309.89 U/L, range 250-81374 versus mean 877.65 U/L, range 272-22036, p= 0.07), as depicted in table 1. There was no statistical difference in SUV max between the steroid-naïve and steroid-treated groups (p=0.97). This was consistent across various steroid treatment durations and dosage regimes. Patients in the steroid-treated group had a trend towards a higher tumor burden and a larger tumor volume compared to the steroid-naïve group, however it did not reach statistical significance. Mean tumor volume was 179.04 cm 3 in the steroid naïve group and 337.06 cm 3 in the steroid treated group (p=0.17). Mean tumor burden was 1944.84 in the steroid-naïve group and 3016.94 in the steroid-treated group (p=0.09). There was no difference in additional PET CT parameters including SUV mean, SUV max and SUV mean of liver and mediastinum between the groups as depicted in table 2. In conclusion, in aggressive B cell lymphoma, pre-treatment with steroids prior to initial PET CT scan does not affect SUV max or other PET CT parameters and does not reduce PET CT diagnostic yield. Figure 1 Figure 1. Disclosures Gurion: Medison: Consultancy; Gilead Sciences: Consultancy; Takeda Pharmaceuticals: Consultancy; JC Health Care: Honoraria; Roche: Honoraria.

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Excellent Results In the Treatment of Primary Mediastinal Lymphomas

Blood ◽

10.1182/blood.v116.21.4915.4915 ◽

2010 ◽

Vol 116 (21) ◽

pp. 4915-4915 ◽

Cited By ~ 2

Author(s):

Tamas Schneider ◽

Zsuzsanna Molnar ◽

Erika Toth ◽

Jozsef Lovey ◽

Erika Szaleczky ◽

...

Keyword(s):

Survival Rate ◽

Complete Remission ◽

Ct Scan ◽

B Cell Lymphoma ◽

Event Free Survival ◽

Free Survival ◽

Large B Cell Lymphoma ◽

Pet Ct ◽

Pet Ct Scan

Abstract Abstract 4915 Primary mediastinal large B-cell lymphoma (PMBCL) is a subtype of diffuse large B-cell lymphoma (DLBCL) with unique clinical and radiological appearance and distinct histopathologic and genetic features. PMBCL accounts for approximately 3% of primary lymphoid tumors. Because of the relative rarity of this disease there are not enough prospective randomised trials with sufficient number of patients and therefore there is not a standard treatment either. Before the rituximab era contradictory results were published with standard cyclophosphamide, doxorubicin, oncovine, prednisone (CHOP) treatment and radiotherapy. The most favourable results were obtained with the combination of third-generation regimens (methotrexate with leucovorin rescue, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin/MACOP-B/, etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin/VACOP-B/) and radiotherapy. Immuno-chemotherapy has been an important step forward in the efficiency of the treatment of PMBCL patients. The addition of rituximab (R) to the standard CHOP-21 regimen has significantly improved the remission rate, the overall survival (OS), the event-free survival (EFS) and the disease-free survival rate. An American working group has obtained more than 90% OS and EFS rates with using dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab (DA-EPOCH-R) alone without radiotherapy (Dunleavy et al, Blood 2005). A German working group published excellent results with CHOP-14 treatment of DLBCL patients younger than 60 years and with R-CHOP-14 treatment of elderly patients (Pfreundschuh et al, Blood 2004 and Pfreundschuh et al, Blood 2005). We have treated 23 newly diagnosed PMBCL patients with R-CHOP-14 regimen between July 2005 and July 2009. The median age of the 17 women and 6 men was 32 years (range 21–53). 11 patients had stage I and another 11 patients had stage II disease. Among these patients 4 and 3 cases had extranodal manifestations (5 pleural, 3 pericardial and 2 lung infiltrations). Only 1 patient had stage IV disease (with lung involvement). Elevated lactate dehydrogenase (LDH) levels were found in 22 cases. Bulky mediastinal tumor (>10 cm) was observed in 18 patients but all 23 patients had a mass larger than 7 cm. All 23 patients were considered to have good prognosis (revised International Prognostic Index/R-IPI/: 1–2). The mean number of chemotherapy regimens was 7,1 (range 4–8). In 20 cases radiotherapy (average dose 36 Gy) was used post chemotherapy as consolidative treatment. As a result, 21 patients obtained complete remission confirmed with a PET/CT scan. In 1 case even the repeated PET/CT scan could not clear the effect of the therapy but she is supposedly in complete remission because of the relatively long event-free survival and the morphologic improvement of the CT image. One patient who only obtained partial remission after chemotherapy and stayed PET/CT scan positive, underwent autologous stem cell transplantation and then achieved complete remission confirmed with PET/CT scan. During the median 32 months follow-up (range 12–61) no relapse has occurred. One patient died of acute arterial haemorrhage due to an acute tuberculosis infection after 13 months follow-up time. The 3 years overall survival rate was 95,6% and the event-free survival rate was 91,3% respectively. The authors have found the well tolerable R-CHOP-14 regimen combined with radiotherapy very effective in PMBCL patients and recommend this treatment. This combination was found more effective than the third-generation or R-CHOP-21 regimens and similar to DA-EPOCH-R treatment. Decreasing or completely withholding the radiotherapy may be considered in cases of negative interim PET/CT scans. Disclosures: No relevant conflicts of interest to declare.

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PB1837 THE PREDICTIVE VALUE OF PET/CT SCAN IN DIFFUSE LARGE B-CELL LYMPHOMA IN OPTIMIZING THE TREATMENT DECISION

HemaSphere ◽

10.1097/01.hs9.0000565852.22530.6f ◽

2019 ◽

Vol 3 (S1) ◽

pp. 840 ◽

Cited By ~ 1

Author(s):

H. Zawam ◽

S. Alrefai ◽

M. Abougabal ◽

R. Salama ◽

H. Zawam ◽

...

Keyword(s):

Ct Scan ◽

B Cell ◽

Predictive Value ◽

Cell Lymphoma ◽

Treatment Decision ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Pet Ct ◽

Pet Ct Scan ◽

Large B Cell

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METABOLIC HETEROGENEITY OF BASELINE 18-FDG PET-CT SCAN PREDICTS OUTCOME IN PRIMARY MEDIASTINAL B-CELL LYMPHOMA.

Hematological Oncology ◽

10.1002/hon.2437_47 ◽

2017 ◽

Vol 35 ◽

pp. 60-61 ◽

Cited By ~ 1

Author(s):

L. Ceriani ◽

L. Milan ◽

M. Martelli ◽

A.J. Ferreri ◽

A. Di Rocco ◽

...

Keyword(s):

Ct Scan ◽

B Cell ◽

Fdg Pet ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Pet Ct ◽

Metabolic Heterogeneity ◽

Fdg Pet Ct ◽

Pet Ct Scan

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Suspected osseous recurrence visualized on a 68Ga- DOTATATE PET/CT scan during the follow-up of a patient with a resected pulmonary carcinoid tumour

Nuklearmedizin ◽

10.1055/s-0037-1621660 ◽

2011 ◽

Vol 50 (05) ◽

pp. N57-N59

Author(s):

S. Geiger ◽

S. Horster ◽

A. R. Haug ◽

A. Hausmann ◽

M. Schlemmer ◽

...

Keyword(s):

Ct Scan ◽

Carcinoid Tumour ◽

Pulmonary Carcinoid ◽

Pet Ct ◽

Pet Ct Scan

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Surveillance PET-CT Scanning Is Useful in the First 18 Months Following Completion of Therapy for Patients with Diffuse Large B-Cell Lymphoma with IPI≥3.

Blood ◽

10.1182/blood.v120.21.2652.2652 ◽

2012 ◽

Vol 120 (21) ◽

pp. 2652-2652

Author(s):

Chan Y Cheah ◽

Michael S Hofman ◽

Michael J. Dickinson ◽

Andrew Wirth ◽

David A Westerman ◽

...

Keyword(s):

B Cell ◽

Cell Lymphoma ◽

High Sensitivity ◽

B Cell Lymphoma ◽

Ct Scanning ◽

Primary Therapy ◽

Large B Cell Lymphoma ◽

Pet Ct ◽

Large B Cell

Abstract Abstract 2652 Introduction Despite improvements in cure rates for patients with diffuse large B-cell lymphoma (DLBCL), up to 40% relapse after achieving initial remission, mostly within 18 months from treatment. There is no consensus as to role, or most appropriate form of post-remission surveillance. Our aim was to explore the role of Positron Emission Tomography combined with computer tomography (PET-CT) scanning in the follow up of patients with diffuse large B-cell lymphoma (DLBCL) achieving complete metabolic response (CMR) after primary therapy, identify patterns of relapse and define a risk-adapted strategy. Results We included 116 patients with de novo DLBCL treated at our centre between 2002 and 2009 with a negative post-treatment PET-CT, and at least one surveillance PET-CT scan. International Prognostic Index (IPI) was <3 in 77 (66%) and ≥3 in 37 (32%) patients. With a median follow up of 53 months (range 8–133), 456 surveillance scans were performed (range 1–10 per patient). 13 patients (11%) relapsed, with an actuarial 5 year relapse free survival of 86%. Two-thirds of relapses occurred in the first 18 months following completion of treatment. In seven cases (54%), the relapse was suspected based on symptoms and in six (46%) the relapse was subclinical and detected with PET. There was no difference in survival (P=0.76) or second line IPI (P=1.00) between the groups, as the number of relapses was small. PET-CT had very high sensitivity (100%), specificity (98%) and negative predictive value (NPV, 100%) with positive predictive value (PPV) 56% in the cohort of patients with a low IPI (<3) compared with 80% if the IPI was ≥3. Across the entire cohort, the average number of patients in remission needed to scan to detect one subclinical relapse within the first 18 months was 42. However, for those with an IPI ≥3 the number needed to scan to detect one subclinical relapse was 22. Surveillance PET-CT had a very low yield after 18 months had elapsed from the conclusion of primary therapy (1 true positive among 170 scans). Interim response PET-CT was performed in 81 (70%) patients; achieving CMR was not a predictor of time to relapse (P=0.65) or having a positive surveillance scan, irrespective of IPI (P=1.00). Second malignancies were detected by PET-CT in eight patients (7%). Conclusion The achievement of CMR at the completion of primary therapy identifies a group of patients with favourable outlook and a low risk of relapse. Surveillance PET-CT scanning within this select cohort has high sensitivity, specificity and NPV and despite the low number of relapses retains a high PPV, particularly in patients with IPI≥3. Surveillance PET-CT is useful in the first 18 months following completion of primary therapy in patients in whom IPI at diagnosis is ≥3. We feel that such a strategy would be appropriate to evaluate in a prospective comparative trial. Disclosures: No relevant conflicts of interest to declare.

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Clinical Relevance Of Cachexia Assessed By An Anthropometric Tool In Elderly Patients With Diffuse Large B-Cell Lymphoma Treated By Immunochemotherapy

Blood ◽

10.1182/blood.v122.21.2926.2926 ◽

2013 ◽

Vol 122 (21) ◽

pp. 2926-2926

Author(s):

Helene Lanic ◽

Jerome Kraut ◽

Romain Modzelewski ◽

Florian Clatot ◽

Jean-Michel Picquenot ◽

...

Keyword(s):

Skeletal Muscle ◽

Weight Loss ◽

Elderly Patients ◽

Ct Scan ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Large B Cell

Abstract Background Cancer Cachexia is a metabolic syndrome that can be present even in absence of weight loss and associated with significantly impaired survival. Muscle wasting represents a key-symptom of this syndrome and we recently demonstrated the strong prognosis impact of sarcopenia assessed by computed tomography (CT)-scan in diffuse large B-cell lymphoma (DLBCL) (Lanic et al. Leukemia & Lymphoma 2013). Conversely, the clinical relevance of loss of fat mass (adipopenia) remains unclear. The aim of this study was (i) to investigate the prognostic impact of a multidimensional tool combining a nutritional parameter (albuminemia) and body composition measurements (skeletal muscle and body fat composition) in elderly patients with DLBCL treated by chemotherapy and rituximab (R) (ii) to document the evolution of sarcopenia after immunochemotherapy. Methods This retrospective analysis included 80 DLBCL patients older than 70 years (y) and treated by R-CHOP or R-miniCHOP. Skeletal muscle (SM), visceral (V) and subcutaneal (S) adipose (A) tissues were measured by analysis of stored CT images at the Lumbar vertebrae 3 (L3) level. The surface of the muscular and adipose tissues was selected according to CT Hounsfield unit. Values were normalized for stature to calculate the L3 SM index (LSMI, in cm2/m2), the LVAI and the LSAI and used to define sarcopenia and visceral/subcutaneal adipopenia. Results The characteristics of the patients were as follows: median age = 78 y [70-95]; 36 males; IPI 0-2 = 22, 3-5 = 58; treatment by R-CHOP (n = 45) or R-miniCHOP (n = 35); median body mass index (BMI; in kg/m2) = 23.9. According to the sex-specific defined cut-offs for LSMI (< 55.8 cm²/m² for men and 38.9 cm²/m² for women), 44 DLBCL patients (55 %, 23 males) were considered as sarcopenic. With a median follow-up of 39 months, the 2y overall survival (OS) in the sarcopenic population was 46% as compared to 84% in the non-sarcopenic group (HR = 3.12; CI95%, 1.66-5.88; p=0.0004). The median LSAI was 76.3 cm2/m2 [10-167] in females and 47.4 cm2/m2[22-100] in males. The median LVSAI was 43.5 cm2/m2[3-141] in females and 50.4 cm2/m2[14-159] in males. Adipopenia, defined by a low LVAI and/or a low LSAI was also highly predictive of the outcome. The 2y OS of the low LVAI population was 48% as compared to 82% for the non-adipopenic group (HR = 2.20; CI95%, 1.19-4.05; p=0.01). The 2y OS in the low LSAI population was 48% as compared to 80% in the non-adipopenic group (HR = 2.28; CI95%, 1.23-4.21; p=0.008). A Three-point cachexia score (CS) including adipopenia, sarcopenia and hypo-albuminemia (defined by an albuminemia < 35 g/L) was build and delineates three distinct risk-groups (Figure 1). More importantly the CS remains predictive of the prognosis in a multivariate analysis including BMI (< or >= 25 kg/m2), age (< or >= 80y), IPI and gender (HR=2.5; CI95%= 1.14-5.39; p =0.02). LMSI was subsequently reassessed in thirty seven patients during the routine CT scan follow-up [mean = 10 months after pre-treatment CT scan (range 2.8-19.2)]. 15 (40%) patients displayed a 5% decrease of their LSMI, whereas 13 (35%) and 9 (25%) displayed no significant change or increase (>5%) of the LMSI respectively. Conclusion Our study demonstrates that sarcopenia and adipopenia estimated by CT-scan define cachexia more accurately than BMI or weight loss in elderly DLBCL patients. These factors can be integrated in a cachexia scoring tool which predicts the outcome independently of the BMI and of the IPI. CT scan follow-up indicates that cachexia is a reversible process that should be integrated as part of the therapeutic target in combination with lymphoma treatment. A prospective multicentric trial (registered as NCT01715961/Clinical.gov) is ongoing to validate these anthropometric and nutritional parameters and compare to geriatric assessment scales. Disclosures: No relevant conflicts of interest to declare.

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