Risk Stratification Integrating Deauville Score on Interim PET-CT Scan and Baseline International Prognostic Index in Diffuse Large B-Cell Lymphoma Patients

Abstract Background Interim 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scan may predict outcomes in patients with diffuse large B-cell lymphoma (DLBCL). However, overall accuracy in predicting treatment outcomes on adopting 5-point Deauville score (DS) was considerably low in DLBCL because of mainly low positive predictive value of interim PET-CT scans. This suggested that additional tool might be needed to more accurately predict treatment outcomes. International prognostic index (IPI) was greatly associated with outcomes for DLBCL and considered to reflect biologic aggressiveness of DLBCL. Thus, we hypothesized that combined assessments using DS on interim PET-CT scan and baseline IPI might improve the prediction of treatment outcomes in DLBCL patients. In this study, we aimed to establish the risk predicting model integrating DS on interim PET-CT as an estimate of early metabolic response and baseline IPI as a predictor of biologic aggressiveness in patients with newly diagnosed DLBCL. Methods In this retrospective cohort study, we consecutively enrolled patients with newly diagnosed DLBCL. Patients were eligible if they were histologically confirmed with DLBCL from Jan 2007 to June 2016, received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), and had PET-CT scan data at baseline and at interim after 3 cycles of R-CHOP. Primary CNS or transformed DLBCLs were excluded. Interim PET-CT was assessed using 5-point DS and four point or higher was regarded as positive. All PET-CT scans were assessed by 2 experienced nuclear medicine physicians, who were masked to treatment outcomes of the patients. Discrepant interpretations between 2 nuclear medicine physicians were resolved by consensus through mutual discussion. Results A total of 316 patients were screened for eligibility. Ninety-six patients were excluded from the analysis due to following reasons: unavailable baseline (n=9) or interim PET-CT scans (n=48), early death before interim PET-CT (n=16), Primary CNS or transformed DLBCLs (n=15), and insufficient medical records (n=8). Thus, 220 patients were analyzed. Median age was 64 years (range, 19-87) and 132 (60%) were male. Based on the IPI risk, patients were classified as the low or low-intermediate (LI; N=126, 57%), and high-intermediate (HI) or high (N=94, 43%) groups. Interim DS was determined as 1 (n=67, 30.5%), 2 (n=65, 29.5%), 3 (n=39, 17.7%), 4 (n=36, 16.4%), and 5 (n=13, 5.9%). With a median follow-up of 56.6 months (IQR 36.0-71.8), 5-year progression-free survival (PFS) rate was 65.2% (95% CI, 58.1-72.3) and overall survival (OS) rate was 69.9% (95% CI, 63.2-76.6). Interim DS (1-3 vs 4-5) and the IPI (low-LI vs HI-high) were independently associated with PFS (for interim DS of 4-5, hazard ratio [HR], 2.96 [95% CI, 1.83-4.78], P < 0.001; for HI-high IPI, HR, 4.84 [2.84-8.24], P < 0.001) and OS (for interim DS of 4-5, HR, 2.98 [1.79-4.98], P < 0.001; for HI-high IPI, HR, 5.75 [3.14-10.51], P < 0.001) in the multivariate analysis. We stratified patients into 3 groups based on the risk of progression: Low (low-LI IPI and interim DS 1-3), Intermediate (low-LI IPI with interim DS 4-5, or HI-high IPI with interim DS 1-3), and High (HI-high IPI and interim DS 4-5) risk groups. The risk stratification model showed a significant association with PFS (for low risk vs intermediate risk, HR 3.98 [95% CI, 2.10-7.54], P<0.001; for low risk vs high risk, HR 13.97 [7.02-27.83], P<0.001; Fig 1A) and OS (for low risk vs intermediate risk, HR 4.14 [2.01-8.54], P<0.001; for low risk vs high risk, HR 16.05 [7.59-33.94], P<0.001; Fig 1B). Conclusion Combining interim DS with baseline IPI can improve risk stratification in patients with newly diagnosed DLBCL. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

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Prognostic Significance Of Positron Emission Tomography-Computed Tomography In Patients With Marginal Zone Lymphoma

Blood ◽

10.1182/blood.v122.21.4324.4324 ◽

2013 ◽

Vol 122 (21) ◽

pp. 4324-4324

Author(s):

Cheolwon Suh ◽

Ji Hyun Park ◽

Dok Hyun Yoon ◽

Jooryung Huh ◽

Jin Sook Ryu ◽

...

Keyword(s):

Ct Scan ◽

Marginal Zone ◽

Prognostic Significance ◽

Post Treatment ◽

Emission Tomography ◽

Ct Scans ◽

Interim Pet ◽

Positron Emission ◽

Pet Ct ◽

Pet Ct Scan

Abstract Background & Aims 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) scan has been increasingly used for initial staging and response evaluation in patients with lymphomas, and its clinical utility is well established in Hodgkin’s lymphoma (HL) as well as in diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). However, its role remains undetermined in marginal zone lymphomas (MZL), due to its relatively low FDG avidity as well as small numbers of patients in the Western countries although it is the most common type of indolent lymphoma in Korea. Thus, we aimed to assess the prognostic significance of PET-CT scan performed after first-line therapy in patients with MZL. Patients & Methods We retrospectively reviewed the medical records of a total of 194 patients with pathologically confirmed MZL in the Asan Medical Center between February 2003 and February 2011. Post-treatment FDG PET-CT scan was defined as which performed during the periods of 2 to 4 weeks after the completion of chemotherapy or 7 to 9 weeks after radiotherapy. Among them, we identified 32 patients with evaluable pretreatment, interim and post-treatment PET-CT scans who received chemotherapy. We investigated the prognostic significance of maximum standardized uptake value (SUVmax) at pretreatment PET-CT and metabolic complete response (mCR) at post-treatment PET-CT. The log-rank test was used to assess the correlation of event-free survival (EFS) and overall survival (OS) with baseline SUVmax or the presence of mCR. All categorical variables were analyzed using Chi-square test or Fisher’s exact test. Results In a total of analyzable 32 patients, histopathologic subtypes of them were as follow: Mucosa-associated lymphoid tissue (MALT) lymphoma (n=14, 43.8%), nodal MZL (n=17, 53.1%), and splenic MZL (n=1, 3.2%). The median SUVmax in pretreatment PET-CT was 5.3 (range, 1.3 – 18.8). There were no significant associations of SUVmax (cutoff: 5.3) at pretreatment PET-CT to mCR in both post-treatment and interim PET-CT scans (p =0.694 and p=0.723, respectively). However, high SUV group (SUVmax at baseline PET-CT >5.3) showed inferior 5-year EFS and OS to low SUV group (¡Â 5.3) with marginal statistical significicance (p=-0.072 and p=0.101, respectively). With a median follow-up duration of 41 months (range, 9 to 99 months), 5-year OS and EFS rate were 87.9% and 43.9%, respectively. 5-year EFS was significantly superior in patients who attained mCR at post-treatment PET-CT (p =0.010, 55.0% to 0%), and also in interim PET-CT (p=0.007, 70.6% to 13.1%). In addition, patients who attained early mCR showed significantly better 5-year EFS than patients of delayed and never mCR groups (p=0.011, 70.6% to 22.5%, and 0%). Conclusion In our study cohort, patients with low SUVmax (¡Â 5.3) in pretreatment PET-CT showed strong trends of superior EFS and OS. More importantly, early attained mCR and mCR at post-treatment PET-CT were independent predictors of higher 5-year EFS rates. Disclosures: No relevant conflicts of interest to declare.

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[18f]PET-CT Scan Is Highly Accurate in Identifying Marrow Involvement of Diffuse Large B-Cell Lymphoma

Blood ◽

10.1182/blood.v128.22.2355.2355 ◽

2016 ◽

Vol 128 (22) ◽

pp. 2355-2355

Author(s):

Prakash Vishnu ◽

Andrew Wingerson ◽

Marie Lee ◽

Margaret Mandelson ◽

David M Aboulafia

Keyword(s):

Ct Scan ◽

De Novo ◽

Cell Lymphoma ◽

Stage Iv ◽

B Cell Lymphoma ◽

Newly Diagnosed ◽

Large B Cell Lymphoma ◽

Pet Ct ◽

Pet Ct Scan ◽

Large B Cell

Abstract BACKGROUND: Recent advances in imaging and the use of prognostic indices and molecular profiling have improved our ability to characterize disease and predict outcomes in diffuse large B cell lymphoma (DLBCL). About 1/3rd of patients with DLBCL have bone marrow involvement (BMI) at the time of diagnosis, and bone marrow aspirate/biopsy (BMAB) is considered the gold standard to detect such involvement. [18F] fluorodeoxyglucose (FDG) positron emission tomography combined with computed tomography (PET-CT), has become a standard pre-treatment imaging in DLBCL and may be a noninvasive alternative to BMAB to ascertain BMI. Prior studies have suggested that PET-CT scan may obviate the need for BMAB as a component for staging patients with newly diagnosed DLBCL, but owing to a variety of reasons this is not yet a standard of practice. The aim of this retrospective study which included 99 patients with newly diagnosed de-novo DLBCL, who had undergone both BMAB and PET-CT, was to determine the accuracy of PET-CT in detecting BMI in DLBCL and define overall survival (OS) in these patients based on BMI by BMAB vs. PET-CT. METHODS: This study is a single institution retrospective review of patients' medical records. All patients with newly diagnosed DLBCL at Virginia Mason Medical Center between January 2004 to December 2013 who underwent pretreatment PET-CT and BMAB were included. PET-CT images were visually assessed for BMI including the posterior iliac crest. Patients with primary mediastinal DLBCL, previous history or co-existence of another lymphoma subtype and those with a non-diagnostic BMAB, and in whom the PET-CT did not show marrow signal abnormality were excluded from the analysis. Ann Arbor stage was determined using PET-CT with and without the contribution of BMAB, and the proportion of stage IV cases by each method was measured. RESULTS: 99 eligible patients were identified. The median age was 62 years (range, 24-88), 62 (59%) were male, 53 (50%) had elevated LDH and 17 (16%) had an ECOG performance status of >2. Thirteen (12%) patients had > 1 extra-nodal site of lymphoma involvement. R-IPI score was 1 in 39 (37%), 2 in 42 (40%), 3 in 20 (19%), and 4 in 4 (4%) patients. A total of 38 (36%) patients had BMI established by either PET-CT (n=24, 19%), BMAB (n=14, 13%), or both (n=12, 11%). 12 of the 24 patients (50%) with positive PET-CT had BMI by DLBCL, while only 2 of the 81 patients (2%) with negative PET-CT showed BMI. BMAB upstaged 1 of the 53 (2%) stage I/II patients to stage IV. The sensitivity of PET-CT scan to detect BMI by DLBCL was 86% while the specificity was 87%. 84 patients (85%) had concordant results between lymphomatous BMAB and PET-CT (12 patients were positive for both, and 72 patients were negative for both), but 15 patients (15%) had a discordant interpretation (3 patients were positive by BMAB and negative by PET-CT, and 12 patients were negative by BMAB and positive by PET-CT). PET-CT was highly accurate for detecting BMI at diagnosis in de-novo DLBCL. Although patients with positive BMAB patients had inferior 5 year OS estimates compared to negative BMAB (66% vs. 85%), no difference was demonstrated between PET-CT positive vs. PET- CT negative patients. (79% vs. 83%) (Table 1) CONCLUSIONS: In patients with newly diagnosed DLBCL, PET-CT is highly accurate in detecting BMI by lymphoma. In clinical practice, routine BMAB may no longer be necessary for all patients with DLBCL, who are staged by PET-CT, unless the results would change both staging and therapy. The prognostic implication of BMI identified by PET-CT compared to BMAB remains unknown. Whether a PET-CT precludes the need for a BMAB in patients with DLBCL remains to be evaluated in a prospective study. 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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Prognostic Value of Interim and End of Treatment FDG-PET/CT Scan Results in Adult Patients with Burkitt Lymphoma - a Retrospective Analysis of a Single Center Cohort

Blood ◽

10.1182/blood.v126.23.5025.5025 ◽

2015 ◽

Vol 126 (23) ◽

pp. 5025-5025

Author(s):

Eldar Priel ◽

Meirav Kedmi ◽

Tima Davidson ◽

Ginette Schiby ◽

Elena Ribakovsky ◽

...

Keyword(s):

Ct Scan ◽

Fdg Pet ◽

Adult Patients ◽

Ct Scans ◽

Survival Outcomes ◽

Interim Pet ◽

End Of Treatment ◽

Pet Ct ◽

Fdg Pet Ct ◽

Pet Ct Scan

Abstract Introduction: End of treatment FDG-PET/CT activity is a powerful predictor of survival outcome in patients with Hodgkin, Diffuse large B cell and Follicular lymphomas. The predictive value of interim PET/CT scan on survival in Hodgkin lymphoma is also well established. To date, there are limited data regarding the prognostic significance of interim and end of treatment FDG-PET/scan results in adult patients with Burkitt lymphoma (BL), mainly due to the rarity of this entity. In this single-center retrospective study we analyzed the survival outcomes of patients with BL according to the findings on interim and end of treatment FDG-PET/CT scans using the Deauville criteria. Methods: We thoroughly reviewed the clinical records of all BL patients who were treated in our medical center between 2005-2014. Thirty three patients and 104 scans were included in our final analysis. Interim PET/CT scan was performed before starting the 3rd cycle of the therapy. PET/CT scans were scored as positive or negative based on the five-point scale: scores 1-3 represented complete metabolic response (CMR) and scores 4-5 defined persistent or progressive disease. Response and survival outcomes were defined according to the Lugano Classification. Survival was calculated with the Kaplan-Meier method and survival comparison was analyzed with the Log-Rank test. Results: Twenty four (73 %) were males and median age was 48 years (22-78). Two patients were HIV positive. Twenty four patients (73%) had stage 3 or 4 disease and 25 patients (76%) had high-intermediate or high risk disease according to the International Prognostic Index. All patients received intensive regimens, and the majority of them (78%) were treated according to the GMALL-B-ALL/NHL2002 protocol. Rituximab was part of treatment in 28 (85%) patients. After a median follow-up of 1.92 years (yrs) (0.08-9.58), 7 patients (21%) have died: six due to advanced BL and one from treatment related toxicity. The overall (OS) and progression-free survival (PFS) at 3-yrs for all patients were 76% and 70%, respectively. Importantly, OS was predicted by the results of end of treatment PET/CT scans: patients in CMR (n=21) had OS of 90% while those with positive PET/CT (n=5) had OS of 30% at 3 years (Figure 1, p=0.001). Early-interim PET/CT results did not predict either PFS or OS at 3 years (OS - 85% for patients in CMR and 60% for patients with positive PET, p=0.27). Conclusions: The current retrospective study indicates that adult patients with BL, who receive rituximab-based intensive regimens, such as the GMALL-B-ALL/NHL2002 protocol, have a favorable outcome. End of treatment PET activity strongly predicted survival outcomes while interim PET result did not correlate with prognosis. Based on our data, it appears that changing treatment in adult patients with BL only on the basis of interim PET/CT results is not advised, unless there is clear evidence of progression. *Authors EP, MK & TD equally contributed to this study. Disclosures No relevant conflicts of interest to declare.

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Predictive Value of Interim 18f-FDG PET-CT Scans on Diffuse Large B-Cell Lymphoma Treated with R-CHOP: A Prospective Study of Chinese Southwest Oncology Group (CSWOG)

Blood ◽

10.1182/blood.v124.21.3011.3011 ◽

2014 ◽

Vol 124 (21) ◽

pp. 3011-3011

Author(s):

He Huang ◽

Jia Tian Lin ◽

Chengcheng Guo ◽

Huangming Hong ◽

Raj Shrestha Prem ◽

...

Keyword(s):

Predictive Value ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Ct Scans ◽

Interim Pet ◽

Large B Cell Lymphoma ◽

Pet Ct ◽

Ct Evaluation ◽

Fdg Pet Ct ◽

Pet Ct Scan

Abstract Purpose 18F-FDG PET-CT has been widely used for pre-treatment staging and post-treatment response assessment in diffuse large B cell lymphoma (DLBCL), but the predictive value of interim PET-CT remained controversial and most of studies were retrospective. Patients and Methods Newly-diagnosed DLBCL patients treated with R-CHOP regimen were included in our prospective study to evaluate the predictive value of interim PET-CT. All patients were evaluated with PET-CT scans before treatment and after every 2 cycles of R-CHOP. PET-CT positivity or negativity was related to survival using Kaplan-Meier analysis. Results From Feb 2008 to Jan 2013, 149 patients were included. After 2 cycles of R-CHOP, the PET-CT evaluation showed CR in 82 patients. Among the remaining 67 non-CR patients, 31 achieved CR after 4 cycles. At the end of treatment, PET-CT evaluation showed CR in 121, PR in 21, SD in 3 and PD in 4 patients. With a median follow-up of 20.6 months (range 1.5-60.5 months), patients with negative PET-2 (PET-CT scan after 2 cycles) had a superior 2-year PFS than those with positive PET-2 (86.6% vs. 67.0%, p=0.019) and a tendency of superior 2-year OS without statistical differences (91.9% vs. 85.2%, p=0.330). The 2-year PFS and OS for negative PET-4 (PET-CT scan after 4 cycles) compared with positive PET-4 group were 84.8% vs. 51.9% (p=0.001) and 93.1% vs. 73.0% (p=0.027) respectively. PET-CT scans were interpreted using the International Harmonization Project (IHP) criteria above. The second analysis applying the Five-Point Scale (5PS) criteria showed that 2-year PFS for score 1-2 (uptake＜mediastinum), score 3 (mediastinum＜uptake≤liver) and score 4-5 (uptake＞liver) group were 86.6%, 75.8% and 71.0% according to PET-2, and 84.9%, 50.0% and 52.7% according to PET-4. PFS of score 3 group was not significant different from the other two groups in PET-2 (both P＞0.05), but significantly inferior to score 1-2 group (p=0.046) and similar to score 4-5 group (p=0.767) in PET-4. In the multivariate analysis, only PET-4 (95%CI, 1.07-5.44) and IPI score (95%CI, 1.53-10.06) remained independent predictive factors for PFS. Conclusion PET-CT after 4 cycles of R-CHOP in patients with DLBCL is highly predictive of PFS and should be considered in clinical practice. (Clinical Trail Registration Number: CTR-TRC-11001687) Disclosures No relevant conflicts of interest to declare.

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Predictive Value of Interim 18 f-FDG PET-CT Scans on Diffuse Large B-Cell Lymphoma Treated with R-CHOP: A Prospective Study

Blood ◽

10.1182/blood.v126.23.1458.1458 ◽

2015 ◽

Vol 126 (23) ◽

pp. 1458-1458 ◽

Cited By ~ 1

Author(s):

He Huang ◽

Jiatian Lin ◽

Chengcheng Guo ◽

Shanshan Li ◽

Huangming Hong ◽

...

Keyword(s):

Ct Scan ◽

Predictive Value ◽

Fdg Pet ◽

B Cell Lymphoma ◽

Cancer Center ◽

Chop Regimen ◽

Interim Pet ◽

Pet Ct ◽

Fdg Pet Ct ◽

Pet Ct Scan

Abstract 18 F-PET-CT is clinically recommended for monitoring therapeutic response in DLBCL patients. But the role of interim PET-CT remains controversial, and most of the previous researches were retrospective. We designed this study to prospectively evaluate whether interim PET-CT was a valid prognostic tool for patients with DLBCL treated with R-CHOP regimen and if yes, try to determine the more appropriate time and interpretation method for interim PET-CT. This study was a sub-study of the parental study "A prospective, multicenter randomized phase III clinical trial of intensified chemotherapy in improving the treatment efficacy of patient with diffuse large B-cell lymphoma" (NCT01793844). The sub-study included patients that have already been enrolled in the parent study at Sun Yat-Sen University Cancer Center prospectively. Patients were evaluated with PET-CT scans before treatment and after every 2 cycles of R-CHOP and after the completion of first-line treatment. Regular follow-up starts from the enrollment. Between Jan. 2008 and Aug. 2014, 221 patients in Sun Yat-Sen University Cancer Center were enrolled in this sub-study, among whom 203 patients were included in the analysis and the other 18 were excluded for lacking the necessary raw data of PET-CT scan. PET evaluation would be applying the visual criteria of International Harmonization Project(IHP) and the Deauville 5-point scale(5-PS). The results showed PET positive in 103 patients and negative in 100 patients after 2 cycles of R-CHOP chemotherapy with IHP criteria. Among the 103 patients with positive PET-2, 53 patients turned negative after 4 cycles of chemotherapy and still 50 patients remain positive. At the evaluation of end-of-first-line-treatment, 165 patients achieved CR, while 30 achieved PR and 8 PD . According to 5-PS criteria, 146 patients were PET negative with 57 were positive after 2 cycles of chemotherapy. And 173 patients were negative in PET-4 evaluation, while 30 patients remained positive. With a median follow-up of 25.46 months (range 3.60~77.33 months) and according to IHP criteria, patients with negative PET-2 had superior 3-year PFS (84.7% vs. 63.8%, p < 0.001) and OS (89.8% vs. 80.4%, p = 0.045) than those with positive results. Patients with negative PET-4 also had a better clinical outcome compared with the positive group with 3-year PFS (84.1% vs. 43.8%, p < 0.001) and OS (90.7% vs. 67.8%, p < 0.001). A further analysis showed that patients who achieved PET negative just after 2 cycles of chemotherapy (Early responder, ER) had a similar prognosis comparing with those who achieved PET negative after 4 cycles (Later responder, LR). There were no significant differences in the persistent CR rates (87.00% vs. 86.79%, p = 0.971), 3-year PFS (84.7% vs. 82.2%, p = 0.867) and 3-year OS (89.8% vs. 92.9%, p = 0.638) between the ER group and the LR group. Patients who remained PET positive after 4 cycles of chemotherapy (Interim non-responder, I-NR) had the worst prognosis. Their persistent CR rate (42.00% vs. 87.00%, p < 0.001; 42.00% vs. 86.79%, p < 0.001), 3-year PFS (43.8% vs. 84.7%, p < 0.001; 43.8% vs. 82.2%, p < 0.001) and 3-year OS (67.8% vs. 89.8%, p < 0.001; 67.8% vs. 92.9%, p = 0.002) were significantly lower, comparing with the ER and LR group. And according to 5-PS criteria, the results were similar. Patients with negative PET-2 had superior 3-year PFS (82.9% vs. 51.6%, p < 0.001) and OS (89.7% vs. 72.9%, p = 0.001) than those with positive results. Patients with negative PET-4 also had a better clinical outcome compared with the positive group with 3-year PFS (81.8% vs. 30.0%, p < 0.001) and OS (90.1% vs. 54.2%, p < 0.001). In the multivariate analysis, PET-4 with IHP criteria, PET-4 with 5-PS criteria and IPI score were independent predictive factors for PFS of patients with DLBCL. A further analysis of positive predictive value (NPV) and negative predictive value (PPV) showed PET-4 was superior than PET-2, especially interpretated with 5-PS. The PPV and NPV of PET-4 with 5-PS criteria were 70.00% and 83.82% respectively. These data indicates that Interim 18 F-FDG PET-CT scan could predict the prognosis of DLBCL patients treated with R-CHOP regimen. And it was recommended that interim 18 F-FDG PET-CT scan be done after 4 cycles of chemotherapy, and that 5-PS criteria be applied in the interpretation of interim PET-CT scan rather than IHP criteria. Disclosures No relevant conflicts of interest to declare.

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Classical Hodgkin Lymphoma; Real-World Observations from Physicians, Patients, and Caregivers on the Disease and Its Treatment (CONNECT): Observations of Physicians on Treatment and Interim PET-Adapted Regimens

Blood ◽

10.1182/blood-2021-151143 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 1390-1390

Author(s):

Susan K. Parsons ◽

Kristina S. Yu ◽

Nicholas Liu ◽

Supriya Kumar ◽

Michelle A. Fanale ◽

...

Keyword(s):

Ct Scan ◽

Stage Iii ◽

Ct Scans ◽

Classical Hodgkin Lymphoma ◽

Publicly Traded ◽

Nccn Guidelines ◽

Interim Pet ◽

Deauville Score ◽

Pet Ct ◽

Pet Ct Scan

Abstract Background Current NCCN guidelines recommend 1 of 3 first-line (1L) regimens for stage III or IV classical Hodgkin lymphoma (cHL): ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine), A+AVD (brentuximab vedotin, doxorubicin, vinblastine, dacarbazine), or escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone); preferred regimens vary by region (e.g., North America vs Europe). The NCCN recommends positron emission tomography/computerized tomography (PET/CT) imaging after cycle 2 (interim PET2) to guide ABVD escalation or de-escalation. We surveyed physicians on their cHL treatment decision-making process and how PET/CT scan access, reimbursement, and comprehension influence their choices as part of CONNECT, the first real-world survey of physicians, patients, and caregivers in cHL. Methods Medical oncologists, hematologist/oncologists, or hematologists who treat cHL were invited to participate in an Institutional Review Board-approved, 30-minute online anonymous survey. Eligible participants had ≥2 years of practice experience in the United States (US) and treated ≥1 adult (aged ≥18 years) with stage III or IV cHL and ≥1 adult with cHL in the 1L setting within the prior 12 months. Surveys were completed from October 19, 2020-November 16, 2020. Results Of 301 participating physicians, 80% were hematologist/oncologists with a median practice duration of 15 years; 62% practiced in community and 38% in academic settings. Participants were located in the US (South, 34%; Northeast, 26%; West, 21%; Midwest, 20%) and spent 90% of their professional time in direct patient care. In the preceding 12 months, participants treated a median (interquartile range) of 16 (7-40) patients with active cHL (stage III [median], 4; stage IV, 5) and 15 (8-40) cHL survivors. When treating cHL, 88% of participants reported giving NCCN guidelines somewhat/significant consideration. Overall, 94% of participants (n=284) reported using a PET/CT combined scan to diagnose/stage cHL, in line with current guideline recommendations. Of these participants, 97% reported typically getting an interim PET/CT scan for stage III or IV cHL with 65% typically getting the scan after cycle 2 (Figure A). Participants reported both escalating and de-escalating treatment based on interim PET/CT results (Figure B) with 61% making decisions after cycle 2. Of participants using a PET/CT scan, 42% reported receiving both a Deauville score and a standardized uptake value (SUV; Figure C) with 62% of participants noting that the Deauville score was the primary system used for reviewing PET/CT results (Figure D). However, 19% of participants reported challenges interpreting PET/CT results. Among participants using a Deauville score (n=209), consensus was limited on what defined a positive scan (≥3, 44%; ≥4, 37%). Challenges obtaining PET/CT scans were reported by 16% of participants using PET/CT scans. However, despite not reporting challenges 55% of participants on average were unable to obtain a PET/CT scan 20% of the time. Of participants using PET/CT scans, 86% reported typically receiving results within 2 business days and 14% within 3-5 business days. Twenty-one percent of participants reported that delays in PET/CT results affected their ability to use a PET-adaptive approach. Forty-nine percent of those using PET/CT scans reported increased difficulty in PET/CT access for stage III or IV cHL due to lack of insurance coverage. In absence of a PET/CT scan, 36% of participants reported using an interim biopsy and 63% an interim CT scan to inform treatment choices. Among all participants, 36% reported increased difficulty in getting patients with cHL access to PET/CT scans due to COVID-19. Conclusions Although participants consider NCCN guidelines when treating cHL, interim PET scans are not universally obtained after cycle 2 for stage III or IV cHL, with 65% of participants who use PET/CT scans obtaining an interim PET scan after cycle 2 for stage III or IV cHL. When PET/CT scans are obtained, Deauville scores are commonly provided; however, there is variability in what is termed a positive or negative Deauville score. Challenges in obtaining PET/CT scans, with increased difficulty during COVID-19, were reported. Also, there are other barriers, such as lack of insurance, that may prohibit the optimal adherence to guidelines on interim PET/CT utilization. Figure 1 Figure 1. Disclosures Parsons: SeaGen: Consultancy. Yu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Liu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Kumar: Seagen, Inc: Consultancy. Fanale: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Flora: Seagen, Inc: Research Funding.

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PET/CT Scan as a Surrogate for Treatment Outcomes in Sarcoidosis

10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a4495 ◽

2019 ◽

Author(s):

N.S. Khakoo ◽

S. Jabeen Isma ◽

M.A. Campos ◽

G. Holt ◽

M. Mirsaeidi

Keyword(s):

Ct Scan ◽

Treatment Outcomes ◽

Pet Ct ◽

Pet Ct Scan

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

Blood ◽

10.1182/blood-2018-99-113791 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 1720-1720

Author(s):

Mayur Narkhede ◽

Sadaf Qureshi ◽

Maryam Yazdy ◽

Roxanna Juarez ◽

Giuseppe Esposito

Keyword(s):

Ct Scan ◽

B Cell ◽

Prognostic Significance ◽

B Cell Lymphoma ◽

Pet Ct ◽

The Mean ◽

Pre Treatment ◽

Pet Ct Scan ◽

Stage Stage

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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