scholarly journals 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 ◽  
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.

scholarly journals Real-World Adherence to National Comprehensive Cancer Network (NCCN) Guidelines Regarding the Usage of PET/CT and Reported Deauville Scores in Advanced Stage Classical Hodgkin Lymphoma: A Community Oncology Practice Perspective

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 32-33
Author(s):  
Christopher A. Yasenchak ◽  
Jamyia Clark ◽  
Nicholas Liu ◽  
April Beeks ◽  
Michelle A. Fanale ◽  
...  
Keyword(s):  
National Comprehensive Cancer Network ◽  
Stage Iii ◽  
Classical Hodgkin Lymphoma ◽  
Publicly Traded ◽  
Nccn Guidelines ◽  
Interim Pet ◽  
Deauville Score ◽  
Community Oncology ◽  
Pet Ct ◽  
Cancer Network

Introduction: Current National Comprehensive Cancer Network (NCCN) guidelines recommend one of three frontline (1L) regimens to treat stage III or IV classical Hodgkin Lymphoma (cHL): doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A+AVD), or bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (escalated (e) dose-BEACOPP). PET/CT imaging is important at initial staging and in follow up including after two cycles (interim PET2) to assess and adapt treatment based on response for patients who newly start treatment with ABVD (Johnson et al., 2016). Despite NCCN guidelines, physicians in community oncology practices may face challenges optimizing outcomes for ABVD patients utilizing the interim PET2 adaptive approach. This study evaluated interim PET2 utilization and reported Deauville scores (DS) in patients with stage III or IV cHL treated in the 1L setting. Methods: This retrospective observational study included adult patients diagnosed with stage III or IV cHL and treated with 1L ABVD, A+AVD, or eBEACOPP within the US Oncology Network (USON) between 01 January 2017 and 31 January 2020. Patients enrolled in therapeutic clinical trials or received treatment for another primary cancer diagnosis were excluded. Patient data were sourced from the USON's electronic health records database, iKM™. Demographic, clinical, and treatment characteristics were sourced from structured iKM elements. Interim PET2 details, including Deauville scores, were obtained from manual chart review. Descriptive statistics were generated for all patient characteristics. Results: 262 patients with cHL were eligible. The majority of the patients were <39 years (48.9%), male (56.9%), Caucasian (58.8%), stage IV cHL (50.8%), had a low (<4) International Prognostic Score (76.0%), completed most treatment cycles (median = 6 [IQR 2,4]) and were treated with 1L ABVD (74.0%). Almost all patients (98.5%) had at least one documented PET-CT of which 87.6% had one at baseline (≤90 days prior to treatment initiation) and 79% had an interim PET-CT (Figure). For patients treated with 1L ABVD with an interim PET-CT, 65% did not report a Deauville score vs. 35% with a documented Deauville score (of which, 29% with score of 1-3 and 5.0% with score of 4-5). 54% of patients treated with 1L A+AVD did not report a Deauville score compared to 42% with scores of 1-3 and 4% with scores of 4-5. The majority of patients (93%) treated with 1L ABVD with or without a reported Deauville score de-escalated to AVD. Results were consistent in the sensitivity analysis of patients with both baseline PET-CT and interim PET-CT. Conclusions: Findings from this retrospective, observational, community oncology study found that Deauville scores were reported for only 1/3 of interim PET-CT in patients treated with 1L ABVD patients with stage III or IV cHL. Despite this, initial treatment modification of de-escalation from ABVD to AVD was common and escalation to BEACOPP was rarely observed. These results suggest that albeit interim PET-CT is utilized, the Deauville scores to inform escalation or de-escalation of treatment decisions in stage III or IV cHL patients is missing and not universally reported in the community oncology setting. Our findings support a potential opportunity to educate oncologists and radiologists on the importance of consistently reporting PET-CT Deauville scores given the fact that providers may lack the complete information to ensure treatment modifications are optimized for patient outcomes. Additionally, compared with ABVD, A+AVD that does not require treatment adaptation by interim PET/CT Deauville score may be a therapy option. Figure 1 Disclosures Yasenchak: BeiGene: Speakers Bureau; Seattle Genetics: Honoraria, Research Funding; Takeda: Honoraria. Clark:McKesson Life Sciences: Current Employment, Current equity holder in publicly-traded company. Liu:Seattle Genetics: Current Employment, Current equity holder in publicly-traded company. Beeks:F. Hoffmann-La Roche Ltd: Consultancy; McKesson: Current Employment. Fanale:Seattle Genetics: Current Employment, Current equity holder in publicly-traded company. Robert:McKesson: Current Employment. Yu-Isenberg:Seattle Genetics: Current Employment, Current equity holder in publicly-traded company.

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

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1698-1698
Author(s):  
Ho-Young Yhim ◽  
Sung Kyun Yim ◽  
So Yeon Jeon ◽  
Yeon-Hee Han ◽  
Myung-Hee Sohn ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Ct Scan ◽  
Treatment Outcomes ◽  
B Cell Lymphoma ◽  
Low Risk ◽  
Ct Scans ◽  
Newly Diagnosed ◽  
Interim Pet ◽  
Pet Ct ◽  
Pet Ct Scan

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.

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

Blood ◽  
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.

scholarly journals 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 ◽  
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.

scholarly journals 18f-Fludeoxyglucose and 11c-Methionine PET/CT Scans in Patients with Multiple Myeloma Following Autologous Stem-Cell Transplantation (auto-HSCT)

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3433-3433
Author(s):  
Maxim V. Solovev ◽  
Larisa P. Mendeleeva ◽  
Maiia V. Firsova ◽  
Irakly P. Aslanidi ◽  
Olga V. Mukhortova ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Ct Scan ◽  
Mean Value ◽  
Disease Stage ◽  
Ct Scans ◽  
Pet Ct ◽  
Abnormal Accumulation ◽  
The Mean ◽  
18F Fdg ◽  
Pet Ct Scan

Abstract Introduction: Over the past years, possible use of PET/CT scan for diagnosis of multiple myeloma has been intensively studied; there is evidence that the use of 11C-methionine instead of 18F-fludeoxyglucose (18F-FDG) in multiple myeloma patients promotes the decrease in false negative PET/CT scan results. Comparative evaluation of the efficacy of detection of residual tumor lesions in MM patients following auto-HSCT using different radiopharmaceuticals for PET/CT scans is an important task. Goal of the study: To compare the results of tumor imaging using 18F-FDG and 11C-methionine PET/CT scan in MM patients following auto-HSCT. Materials and methods: Over the period from December 2016 to March 2018, 27 MM patients (8 males and 19 females) aged 32 to 64 years (median=57) were enrolled into a prospective study designed to evaluate efficacy of detection of tumor lesions using PET/CT scan technique. The disease stage according to the International Staging System (ISS) was I, II and III in 10, 7 and 10 patients, respectively. The onset of myeloma cast nephropathy was diagnosed in 4 (18%) patients, intraosseous plasmacytomas were found in 18 (67%) patients, extramedullary brain lesions was observed in 1 case. All patients received induction therapy with bortezomib; immunomodulatory drugs were used in 6 cases. Mobilization of CD34+ blood cells was carried out according to the regimen Cyclophosphamide 4 g/m2 + G-CSF. While using high-dose melphalan (200 mg/m2), a single (n=21) or tandem (n=6) auto-HSCT was conducted. On Day 100 after the initiation of auto-HSCT, PET/CT scan with two radiopharmaceuticals - 18F-FDG and 11C-methionine was performed. The obtained images were evaluated by visual inspection and semi-quantitative analysis. There were foci of increased accumulation of each agent (areas of hypermetabolism) not related to its physiological distribution. For each of the radiopharmaceuticals, the standardized uptake value (SUVmax) in the lesions was estimated automatically. The results of PET/CT and anti-tumor response achieved following auto-HSCT were compared according to the criteria developed by the International Myeloma Working Group. Statistical analysis was performed using Statistica 10 software. The quantitative values were expressed as the mean value ± standard deviation or the median value. Comparison of the respective measurements was carried out using the Student's t-test. To compare frequencies of data between independent groups, the Fisher's exact test or chi-square test were used. Results: Following auto-HSCT, 60% of patients demonstrated complete remission (CR). When using 18F-FDG, abnormal accumulation was observed in 37% (n=10) cases, PET-negative results were obtained in 63% (n=17) patients. Following administration of 11C-methionine, hypermetabolic foci were revealed in 67% (n=18) cases, lack of accumulation was observed in 33% (n=9) patients (Fig. 1). When using 11C-methionine, MM patients were found 1.8 times more likely to demonstrate abnormal accumulation of the radiopharmaceutical (p<0.02). Following administration of 18F-FDG, PET/CT scans of MM patients demonstrated 1 to 6 (mean value = 1±1.5) foci of abnormal fixation, while the use of 11C-methionine allowed revealing 1 to 12 (mean value=2.5±3.1) lesions. When using 11C-methionine, the number of lesions demonstrating abnormal accumulation of the radiopharmaceutical was 2.5 times that of 18F-FDG (p<0.05). Mean value of SUVmax for 18F-FDG was 1.02±1.6, while the mean value of SUVmax for 11C-methionine was 2.29±2.04. When using 11C-methionine, the values of SUVmax significantly exceeded the respective parameter associated with the use of 18F-FDG (p=0.02). Discussion: The results of our study have demonstrated a significant role of 11C-methionine for detection of tumor lesions in MM patients following auto-HSCT. The use of 11C-methionine PET/CT scan allows improving the accuracy of diagnosis of tumor lesions in MM patients following auto-HSCT. Disclosures No relevant conflicts of interest to declare.

High Risk Adva­nced Stage Hodgkin Lymphoma Is Well Controlled with 2 Cycles of Escalated Beacopp Followed By 4 Cycles of ABVD in Patients Who Rapidly Achieve Metabolic CR on Interim PET/CT Scan

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4442-4442
Author(s):  
Meirav Kedmi ◽  
Arie Apel ◽  
Tima Davidson ◽  
Elinor Goshen ◽  
Yaron Davidovitz ◽  
...  
Keyword(s):  
High Risk ◽  
Prospective Study ◽  
Ct Scan ◽  
Ct Scans ◽  
Hematological Toxicity ◽  
Advanced Stage ◽  
Entire Cohort ◽  
Interim Pet ◽  
Pet Ct

Abstract Patients with advanced stage Hodgkin Lymphoma (HL) and high international prognostic score (IPS≥3), treated with ABVD, have low freedom from progression, estimated as 60-65% at 5 years. Six cycles of escalated (esc) BEACOPP significantly improved the outcome of patients with advanced stage HL with progression free survival (PFS) of 90% and overall survival (OS) of 95% at 5 years. However, 6 cycles of escBEACOPP are associated with significant hematological toxicity and infections, as well as late adverse effects, such as increased incidence of myelodsysplastic syndrome (MDS), acute myeloid leukemia (AML) and infertility. In this retrospective study we analyzed the survival outcome of poor risk advanced stage HL patients who were treated with response- adapted therapy, tailored by the results of early interim FDG-PET/CT scans, after the initial 2 cycles of escBEACOPP. After complete or partial responses were obtained with this regimen, treatment was then de-escalated to 4 cycles ABVD. A total of sixty nine patients were evaluated, 45 of whom participated in the multicenter phase II prospective study which was conducted between 2001 and 2007 (Avigdor et al, Ann Oncol. 2010). The current study includes analyses of long term outcome of the former group, as well as the outcome of an additional 24 consecutive patients who were treated with the same protocol at Sheba Medical Center since the termination of the prospective study. The response and survival outcomes were defined according to the revised response criteria for malignant lymphoma. Scans were scored as positive or negative based only on visual assessment, according to guidelines adopted by the International Harmonization Committee. Survival was calculated with the Kaplan-Meier method and survival comparison was analyzed with the Log-Rank test. Forty five (65 %) were males and median age was 30 years (19-59). The most frequent subtype of HL was nodular sclerosis (78%). Four patients (6%) had unfavorable stage IIB, 12 (17%) had stage III and 53 (77%) had stage IV disease. Nine patients (13%) had an IPS <3, the remaining 60 patients (87%) had 3 or more IPS risk factors. Four patients received involved field radiotherapy with 30 Gy to the initial site of bulky mediastinum, after completion of chemotherapy. After a median follow-up of 5.6 years (0.4-11), 4 patients (6%) have died: 2 due to advanced HL, 1 from catastrophic APLA syndrome and 1 from lung carcinoma; the latter 2 patients were in complete response (CR). After the initial 2 cycles of escBEACOPP,52(75%) patients were in CR and 17 (25%) achieved partial response (PR). Five-year OS for the entire cohort was 93%. Importantly, OS was predicted by the results of the early-interim PET/CT scans: patients in CR had OS of 98% while those in PR had OS of 79% at 5 years (Figure 1A, p=0.015). Seventeen patients (25%) relapsed or progressed. Five-year PFS for the entire cohort was 76%, median PFS was not reached. Early-interim PET/CT results did not predict PFS at 5 years (80% for patients in CR and 60% for patients in PR, Figure 1B, p=0.2) most probably due to small sample size. The presence of extranodal disease or bulky mediastinal mass (≥10 cm on CT scan) did not predict treatment failure. As expected, grade 3-4 acute hematological toxicity was more frequent during the first 2 cycles of escBEACOPP than in the comparable ABVD phase. There was no treatment related mortality, and until now no cases of AML or MDS have been encountered. In conclusion, the current retrospective analysis indicates that combined escBEACOPP-ABVD therapy is well tolerated and certainly less toxic than 6 cycles of escBEACOPP. In patients receiving escBEACOPP-ABVD regimen, negative early-interim PET activity reliably predicted an excellent outcome, while a positive result partly identified patients with a worse prognosis. Based on relatively long follow-up data, it appears that high risk advanced HL patients, who achieve early metabolic CR (after 2 cycles of escBEACOPP), have a favorable outcome after de-escalating therapy to the less toxic ABVD regimen. Disclosures No relevant conflicts of interest to declare.

scholarly journals Adapted Treatment Guided by Interim PET-CT Scan in Advanced Hodgkin’s Lymphoma

2016 ◽  
Vol 374 (25) ◽  
pp. 2419-2429 ◽  
Author(s):  
Peter Johnson ◽  
Massimo Federico ◽  
Amy Kirkwood ◽  
Alexander Fosså ◽  
Leanne Berkahn ◽  
...  
Keyword(s):  
Ct Scan ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Interim Pet ◽  
Pet Ct ◽  
Advanced Hodgkin’S Lymphoma ◽  
Pet Ct Scan

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

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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