Interim [18F]Fluorodeoxyglucosepositron Emission Tomography Suvmax Reduction Is Superior to Visual Analysis to Predict Early patient's Outcome in Hodgkin Lymphoma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3630-3630
Author(s):  
Cedric Rossi ◽  
Salim Kanoun ◽  
Alina Berriolo-Riedinger ◽  
Olivier Humbert ◽  
Inna Dygay-Cochet ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Hodgkin Lymphoma ◽  
Predictive Value ◽  
Visual Analysis ◽  
Conflicts Of Interest ◽  
B Cell Lymphoma ◽  
Emission Tomography ◽  
Operating Characteristics ◽  
Point Scale ◽  
Interim Pet

Abstract Abstract 3630 Positron emission tomography with [18F]fluorodeoxyglucose (PET) performed after two cycles of chemotherapy could predict treatment outcome in Hodgkin lymphoma (HL) (Gallamini et al J.Clin.Oncol. 2007; 25: 3746), but suitable criteria to interpret interim PET remain to be established. A standardized visual analysis using a 5-point scale (5PS) was proposed to assess interim PET response and an international validation study is currently on going. However, standardized uptake value (SUV) may improve interim PET accuracy, and maximum SUV reduction (ΔSUVmax) between baseline and interim PET was shown to be superior to visual analysis in patients with diffuse large B cell lymphoma (Casasnovas et al, Blood 2011; 118: 37). To compare the clinical usefulness of both methods in patients with HL, we analysed interim PET according to visual and SUV criteria in a retrospective single centre study. From January 2007 to January 2010, 59 consecutive patients with a first diagnosis ofHL were treated in our institution. All patients received 4 to 8 cycles of chemotherapy including ABVD in 50 cases (85%) and BEACOPP in 9 cases. Radiotherapy was performed in 14 responding patients with localized disease. PET was done at baseline (PET0) and after 2 cycles of chemotherapy (PET2) and therapeutic strategy was not modified according to PET2 result. All PET scans were reviewed by SK, ABR and IDC, and interpreted using the 5PS criteria, PET being considered positive when the 5PS score was 4 or 5. SUVmax reduction values between PET0 and PET2 (ΔSUVmaxPET0–2) were available for all patients, and after using the receiver operating characteristics approach, patients with a ΔSUVmaxPET0–2 >71% were considered as good responders after 2 cycles. Progression-free survival (PFS) and freedom from treatment failure (FFTF) were analyzed according to PET results based on 5PS and ΔSUVmaxcriteria. Median follow-up was 39 months (range: 6–62). Using visual analysis,46 (78%) patients achieved a negative PET2. Seven of them experienced a treatment failure, leading to a PET2 negative predictive value (NPV) of 85%. Fourty nine (83%) patients had a ΔSUVmaxPET0–2 >71% and 6 of them failed to treatment (NPV = 88%). By contrast PET2 positive predictive value (PPV) was significantly better for ΔSUVmax analysis (70%) compared to visual analysis (46%). Using ΔSUVmax analysis, 6 (46%) of the 13 PET2 positive patients could be reclassified as good responder after 2 cycles of chemotherapy. While visual PET2 positivity was associated to a lower 3-year PFS (45%) or FFTF (51%) compared to PET2 negativity (3-year PFS=80%, p=0.001 and 3-year FFTF= 82%, p<0.0035; respectively), ΔSUVmaxPET0–2 (>71% vs≤71%) was more accurate to identify patients with significantly different 3-year PFS (81% vs 30%; p<0.0001; HR = 6.77) and FFTF (85% vs 30%; p<0.0001; HR = 8.79). In multivariate analysis, using the international prognosis score and ΔSUVmaxPET0–2 as covariates, ΔSUVmaxPET0–2 remains the unique independent predictor for PFS (p = 0.0001; RR: 7.9) and FFTF (p = 0.0001; RR: 9.1). SUVmax reduction between baseline and interim PET was more accurate than visual analysis based on the 5-point scale to predict early outcome of patients treated for HL. ΔSUVmax reduces the excess of positive results related to the PET2 visual interpretation, and appears to be the best method so far to assess early PET response in HL. Disclosures: No relevant conflicts of interest to declare.

Comparative Assessment of Different Criteria for Interim-PET Interpretation in a Cohort of Hodgkin Lymphoma Patients Treated in a Single Center.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3657-3657
Author(s):  
Andrea Gallamini ◽  
Stephane Chauvie ◽  
Francesca Fiore ◽  
Roberto Sorasio ◽  
Flavia Salvi ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Hodgkin Lymphoma ◽  
Conflicts Of Interest ◽  
Prognostic Score ◽  
Advanced Stage ◽  
Dimensional Approach ◽  
Treatment Change ◽  
Bulky Disease ◽  
Fdg Uptake ◽  
Interim Pet

Abstract Abstract 3657 Poster Board III-593 Introduction Interim-PET scan performed early during treatment is the most important prognostic factor in Hodgkin lymphoma (HL). However, simple reproducible criteria for scan interpretation are lacking and still await standardization. Aim of the study To evaluate in a cohort of ABVD-treated HL patients in a single centre the overall accuracy of different criteria of interim PET interpretation in which interim scan was not decisional for treatment change. Patients and methods From December 2003 till June 2008, 75 HL patients were consecutively admitted to hematology department of Santa Croce Hospital in Cuneo. Baseline and interim-PET (PET-2) scans were performed with a PET/CT equipment. Limited-stage patients (I-IIA) were treated with ABVD x 3-4 plus Involved-field radiotherapy; advanced-stage (IIB-IVB) patients with ABVD x 6 plus consolidation radiotherapy on bulky disease. The injected dose was 370 MBq/70 kg. 2D images were acquired a mean of 71 (47-122) minutes after Fluorodeoxyglucose (FDG) injection. Images were reconstructed with OSEM (3 iteration, 26 subsets). PET-2 was performed after a median of 11(8-13) days from 2nd ABVD end, and no treatment change was allowed based on PET-2 results. Two expert nuclear medicine physicians independently interpreted the PET-2 scans and jointly reviewed the discordant cases. Six interpretation criteria on the basis of literature reports were used: three qualitative, two quantitative, based on Standardized Uptake Value (SUV) assessment, and one with a qualitative/dimensional approach, with a dimensional cutoff value for FDG correction of 15 mm.: Juweid 2007 (Ju), Gallamini 2007 (Ga), Barrington 2008 (Ba) for qualitative, SUVmax determination, SUVmax variation (deltaSUV) for quantitative, and Barrington + dimensional (Ba/d) for a qualitative/dimensional approach. Results Clinical characteristics of the patients were: mean age 33 (14 - 73), male sex 39/75, limited vs. advanced stage 37/38, International Prognostic Score (IPS), (in 69/75 patients) was 0 in 17,1 in 19, 2 in 19, 3 in 8, 4 in 5, 5-7 in 1 patients. After a mean follow-up of 937 days 67 patients are in CR, and 8 experienced treatment failure, three of them have died. In case of residual FDG uptake the mean diameter of the persisting lesion was 19.9 mm. Overall, 2/8 patients with treatment failure (True PET-2+) and all the 9 patients with false+ or false- PET-2 (whatever criteria) showed a persistent FDG uptake in a single lesion, with a median diameter of 14 millimetres. Sensitivity and specificity, were:100%,70%, for Ju; 63%, 87% for Ga; 63%, 91% for Ba; 75%, 93% for SUVmax; 50%, 94% for deltaSUV; 89%, 89% for Ba/d. Among the qualitative assays Ba and Ba/d showed the best results. The latter were equivalent to both quantitative assay. Using the Ba /d score 8 patients showed false-positive scans: 6/8 with stage IIA and 7/8 with bulky disease, and the 3-year failure-free survival for the entire cohort and for advanced-stage patients were 98%, 53% and 96% and 25% for PET-2 negative and positive patients, respectively. Conclusions This study suggest that (1) the criteria of the Harmonization Study for end-treatment evaluation of response should not be used for PET-2 interpretation (2) the lower performance of qualitative in respect to the quantitative criteria is offset by the adjunction of dimensional parameters; (3) due to the small size of the residual lesion with a persistent FDG avidity in PET-2, the contribute of the dimensional criteria could sensibly improve the performance of qualitative criteria, such as Ba, that are currently used for multicenter clinical trials. Disclosures: No relevant conflicts of interest to declare.

Clinical Usefulness and Prognostic Value of Interim PET/CT for the Treatment of Peripheral T Cell Lymphomas.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2808-2808
Author(s):  
Deok-Hwan Yang ◽  
Jung-Joon Min ◽  
Ho-Chun Song ◽  
Yong Yeon Jeong ◽  
Soo-Young Bae ◽  
...  
Keyword(s):  
T Cell ◽  
High Risk ◽  
Predictive Value ◽  
Conflicts Of Interest ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Interim Pet ◽  
Pet Ct

Abstract Abstract 2808 Although interim 18F-fluoro-2-dexoy-D-glucose-positron emission tomography (FDG-PET)/computerized tomography (CT) scan has emerged as a powerful prognostic tool in predicting treatment outcome in Hodgkin's lymphoma (HL) and diffuse large B cell lymphoma (DLBCL), the positive predictive value (PPV) of interim PET/CT scanning has not been determined in patients with peripheral T cell lymphoma (PTCL). The sequential interim PET/CT was prospectively investigated to determine whether it provided additional prognostic information and could be a positive predictable value for the treatment of PTCL. Patients and Methods: Fifty-five newly diagnosed patients with PTCL were enrolled from Sep. 2005 to July 2009 at a single institution. The PET/CT analysis was performed at the time of diagnosis and mid-treatment of CHOP/CHOP-like or other chemotherapy (EPOCH and IMEP). The clinical stage and response of the patients were assessed according to revised response criteria for aggressive lymphomas (Cheson, J Clin Oncol, 2007). The positivity of interim PET/CT was determined based on the semi-quantitative assessment of the maximal standardized uptake value (Cut-off SUVmax value of 3.0). Results: Median age was 55 years (range: 23–77). 31 patients (56.4%) presented in advanced stages and 13 (23.6%) had bone marrow involvements. The histological subtypes were 40.0% PTCL-unspecified (n=22), 5.1% angioimmunoblastic T cell (n=5), 38.2% nodal or extranodal NK/T cell (n=21), and others. At diagnosis, 24 patients (43.6%) were classified as high-risk by the international prognostic index (IPI) and 22 (40%) were classified as high-risk (more than 2 factors) by the prognostic index for PTCL (PIT). 47 patients could be assessed the interim response and 24 patients (43.6%) remained positive metabolic uptakes in interim PET/CT. The patients with positive interim PET/CT showed a significantly higher relapse rate (75.0%) than those with negative interim PET/CT (43.5%) (P =0.028). After following median 12.7 months, positivity of interim PET/CT was the prognostic factor for both OS and PFS, with a hazard ratio of 4.11 (1.30 – 13.01) and 3.26 (1.19 – 8.96), respectively. Six patients (10.9%) who determined to have positive interim PET/CT were revealed false-positive uptakes after locoregional biopsy (PPV of 0.75). Conclusions: Interim PET/CT has a significant predictive value for disease progression and survival of PTCL. The patients with positive interim PET/CT response should be considered an intensive therapeutic plan for overcoming their poor clinical outcome. Disclosures: No relevant conflicts of interest to declare.

Interim 18-FDG-Positron Emission Tomography/Computed Tomography (PET) Failed to Predict Different Outcome in Diffuse Large B-Cell Lymphoma (DLBCL) Patients Treated with Rituximab-CHOP.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 99-99 ◽  
Author(s):  
Patrizia Pregno ◽  
Annalisa Chiappella ◽  
Marilena Bellò ◽  
Roberto Passera ◽  
Simone Ferrero ◽  
...  
Keyword(s):  
Predictive Value ◽  
Visual Analysis ◽  
Performance Status ◽  
Bone Marrow Involvement ◽  
B Cell Lymphoma ◽  
Pet Scan ◽  
Published Data ◽  
Interim Pet ◽  
Positron Emission ◽  
End Of Treatment

Abstract Abstract 99 Introduction. The PET scan has a definite role to assess the response at the end of treatment of DLBCL. The evaluation of response by PET after few courses of chemotherapy might be useful to predict chemosensitivity and possibly the outcome in this subset of patients. So far, the predictive value of interim PET in DLBCL pts is still contradictory. The visual analysis of PET results by dichotomous evaluation as positive or negative is often difficult to apply and standardized criteria of interpretation of interim PET have not been established yet. Moreover, published data are often based on retrospective studies, including miscellanea of subtypes and therapies. Our study was aimed to determine the predictive value of interim and final PET on PSF in DLBCL patients. Patients and Methods. From April 2004 to December 2008, 82 newly diagnosed DLBCL patients treated in 5 Hematology Department were included. Clinical features were as follows: median age 56 years (range 19-81); 42 males and 40 females, 29 patients stage I-II and 53 stage III-IV; according to IPI score 47 at low/low-intermediate risk and 35 at intermediate/intermediate-high. All patients were treated according to planned therapy, not modified by PET-2 results, with 6-8 R-CHOP. All patients had PET scan performed at the diagnosis, during treatment (PET-2) and at the end of therapy (PET-3). All PET results were defined as positive or negative by visual dichotomous consensus response criteria. Results. All patients were evaluable for response. PET-2 was performed after 2 R-CHOP in 46 pts, after 3 in 13 and after 4 in 23. At the end of therapy 73 pts (89%) achieved a CR and 9 (11%) were non responders. Fifty-five patients (67%) were negative and 27 (33%) positive at the PET-2 and 69 pts (84%) were negative and 13 (16%) positive at the PET-3. The concordance between clinical CR and PET-3 negativity was 99%: one CR pt was false PET-3 positive due to parothid carcinoma . Correlation between PET results and outcome was evaluated. There was correlation between PET-2 results and CR rate: CR 96% in PET-2 negative pts vs 74% in PET-2 positive (p .004). With a median FU of 18 months, PFS was 78%. PET-2 did not correlate with PFS (p .198): 46/55 (84%) PET-2 negative patients were in CCR and 20/27 (74%) PET-2 positive patients did not progres (Figure 1A). Conversely PET-3 strongly predicted PFS (p .015): 58/69 (84%) were in CCR and 8/13 (61%) did not progressed. (Figure 1B). A further analysis for progression event was performed to adjust the effect of PET-2 analysis for other known risk factors (age up to/over 60, stage, Performance status, LDH, number of extranodal sites, IPI, bulky, Bone Marrow involvement): only LDH (p .005)and IPI 0-2 vs 3-5 (p .001 ) were confirmed as independent predictors of progression event. Conclusions. Our results indicate that in this omogeneous group of DLBCL patients treated with R-CHOP interim PET failed to predict outcome. However, a longer follow up is necessary to validate our data. Conversely PET results at the end of treatment strongly correlate with PFS. Prospective larger studies will be needed to establish the real role of interim PET to predict the outcome in this subset of patients. Disclosures: Ladetto: CELGENE: Honoraria; JANSSEN-CILAG: Research Funding. Vitolo:Roche: lecture fees.

Metabolic Tumor Volume Influences Response to Brentuximab-Vedotin in Relapsed Refractory Hodgkin Lymphoma

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 588-588
Author(s):  
Yassine Al Tabaa ◽  
Michel Meignan ◽  
Scherman Elodie ◽  
Corinne Haioun ◽  
Pauline Brice ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Hodgkin Lymphoma ◽  
Tumor Volume ◽  
Visual Analysis ◽  
Single Agent ◽  
B Cell Lymphoma ◽  
Metabolic Tumor Volume ◽  
Tumor Burden ◽  
Brentuximab Vedotin ◽  
Future Research

Abstract Purpose: The total metabolic tumor volume at baseline (T-MTV0) computed on PET has been proposed as a prognostic factor at staging in Hodgkin lymphoma (HL) and diffused large B cell lymphoma (DLBCL). It has also been described to play a role in non-HL treatment by monoclonal antibodies since it could influence antibody exposure and efficacy in a murine model (Dayde D, et al. Blood 2009) that has been confirmed in DLBCL patients study (Casasnovas O, et al. Abstract Lugano 2015). We hypothesized the metabolic tumor burden could influence the efficacy of a monoclonal antibody-drug conjugated (ADC) such as monotherapy based anti-CD30 ADC brentuximab-vedotin (BV). In the present study, we assessed the pre-treatment baseline total metabolic tumor volume based on PET evaluation in the response to BV treatment as a single agent in patients with RR-HL, as well as its prognostic value. Methods: A retrospective multi-center study was built from January 2011 to June 2015. Forty-one consecutive heavily pre-treated patients with a diagnosis of relapsed refractory HL (RR-HL) were included. PET was performed at baseline (PET0) and after 4-6 cycles of BV defining two groups of responders, good responder group achieving a complete metabolic response (CMR group, 23 patients), and non-responder group (no-CMR group, 18 patients), using the revised Lugano classification with the 5-point scale visual analysis PET/CT. T-MTV0 was measured with a semiautomatic method using a 41%-SUVmax-threshold. SUVmax at PET0 (SUVmaxPET0) was measured in each patient and represented the hottest lesion independently from the site. To assess the influence of the T-MTV0 on BV efficacy, we compared the baseline metabolic tumor volume between the two groups. The ROC curve was established to determine the optimal cut-off of T-MTV0 to predict treatment failure. Results: T-MTV0 ranged from 14 cm3 to 213 cm3 in the 41 patients (median 62 cm3; 25th - 75th percentiles 25 - 94 cm3) and SUVmaxPET0 ranged from 4,1 to 19,3 (median 10,4; 25th-75th percentiles 7,8 - 13,7). T-MTV0 was significantly higher in the no-CMR group as compared with the CMR group (median 96 and 30 cm3; 25th-75th percentiles 90 - 139 cm3 and 18 - 38 cm3, respectively; p< 0.01). Considering metabolic sites, the nodal metabolic tumor volume (N-MTV0) represented the main component of T-MTV0 and was significantly higher than the extra nodal metabolic tumor volume (EN-MTV0) in the CMR group (p = 0.025). However, the EN-MTV0 dominated in the no-CMR group and was significantly higher than the N-MTV0 (p = 0.01). SUVmaxPET0 as well as clinical characteristics were not significantly different in the two groups. Furthermore the TMTV0 cut-off value was 62 ml and predictive of treatment failure. Conclusion: In the present study, we demonstrated that tumor metabolic burden and nodal or extra-nodal localizations influence response to BV as a single agent in RR-HL patients, offering some future research directions in the development of new schedules of antibodies administration in anticancer therapy such as the concept of the individual adjustment of treatment dose to tumor burden. This may guide clinicians in their choice of therapeutic strategy. Disclosures Thieblemont: St. Louis Hospital, Paris, France: Employment. Cartron:Sanofi: Honoraria; Gilead: Honoraria; GSK: Honoraria; Roche: Consultancy, Honoraria; Celgene: Honoraria.

scholarly journals Prognostic Value of Baseline Quantitative PET Metrics for Patients with Unfavourable Early Stage Hodgkin Lymphoma Enrolled in the Standard Arm of the EORTC/Lysa/FIL H10 Trial

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 184-184 ◽  
Author(s):  
Anne Ségolène Cottereau ◽  
Annibale Versari ◽  
Annika Loft ◽  
Rene-Olivier Casasnovas ◽  
Monica Bellei ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Hodgkin Lymphoma ◽  
Prognostic Value ◽  
Conflicts Of Interest ◽  
Early Stage ◽  
Cox Model ◽  
B Cell Lymphoma ◽  
Interim Pet ◽  
Quantitative Pet ◽  
Pet Ct

Abstract Objective: Baseline quantitative PET parameters measuring tumour burden and metabolism are proposed as early prognosticators of outcome in different lymphoma subtypes. It has been shown that in advanced stage Hodgkin lymphoma (HL) and Primary mediastinal B cell lymphoma, total metabolic tumor volume (TMTV) or total lesion glycolysis (TLG) predicted outcome better than the bulk. From the H10 EORTC/LYSA/FIL randomized intergroup trial (NCT00433433) including patients with supradiaphragmatic stage I/II, histologically proven classical HL, we investigated the prognostic value of quantitative PET metrics measured on baseline FDG PET/CT in the unfavorable group of the standard arm. Methods: One hundred and fifty patients were randomly selected from the 352 patients recruited by the LYSA centers, in the unfavorable group (≥ 4 nodal areas or age ≥ 50 yrs or mediastinal thoracic (MT) ratio ≥ 0.35 or erythrocyte sedimentation rate (ESR) ≥ 50 (without B-symptoms) or ESR ≥ 30 (with B-symptoms)) of the standard arm of the H10 trial. Only patients who had baseline PET/CT with fused images available were analyzed. Standard treatment was 4 cycles of ABVD completed by involved-node radiotherapy. All patients had an interim PET performed after 2 ABVD cycles (PET2). Baseline TMTV was computed using the 41% and 25% SUVmax thresholding methods; SUVmax, TLG41%, TLG25% were calculated. PET2 was centrally reviewed reported. Optimal quantitative parameters cut-off to predict PFS and OS were determined by ROC curves, and Kaplan Meier (KM) curves were obtained. Multivariate analyses were performed using a Cox model. Results: 128 patients with a median age of 32 years were analyzed: 54 (42%) had B symptoms, 74 (58%) had ESR>40 (ROC optimal cut off), 48 (37%) mediastinal bulk as defined above. Median TMTV41%, TMTV25%, SUVmaxand TLG41%, TLG25%were 81 cm3 (25th-75thpercentiles 44-145 cm3), 194 cm3 (112-323), 11 (8-14), 407 cm3 (221-475) and 731 cm3 430-1321) respectively. After a median follow-up of 5 years, the 5y-PFS was 84% and the 5y-OS was 92%. The strongest PET quantitative parameter to predict outcome was the TLG41% (p=0.0006 HR=6.5 for PFS with a cut off of 420 cm3, p=0.025 HR=7.7 for OS with a cut off of 584 cm3). Patients with a high TLG41% had a 5y-PFS of 76% vs 92% (95%CI 71-81; 88-96) and a 5y-OS of 88% vs 96% (95%CI 83-92; 92-100) for those with the lower TLG41% respectively. Similar results were found using 25% SUVmax threshold (p=0.0005 HR=4.7 for PFS, p=0.0032 HR=7.9 for OS). TMTV41% higher than 149 cm3 cut off was associated with a worse PFS (p=0.0099, HR=3.26) and OS (p=0.022, HR=4.8) but with a lower significance level. A SUVmax greater than 14 was also associated with a worse PFS (p=0.018 HR=3.0) with a 5y-PFS of 74% vs 86% but not with OS. In multivariate analysis testing TLG41% and SUVmax or TLG41%and TMTV41%, only TLG41% remained significant (p=0.0096 and p=0.015 for PFS and OS respectively). B symptoms and ESR>40 were predictive of PFS (p=0.0077 HR=3.7 and p=0.0062 HR=6.07 respectively) but not of OS. MT ratio was predictive of neither PFS nor OS (p=0.49, p=0.20). In multivariate analysis, B symptoms, ESR>40 and TLG41% remained significant independent predictors of PFS (p=0.038; p=0.034; p=0.014 respectively). For the 124 patients with a centralized reading available, a positive PET after two cycles (PET2 +) using IHP criteria (n=29) was associated with a worse PFS (p=0.0006). In multivariate analysis testing TLG41% and interim PET, they both remained independent prognosticators (p=0.014 and p=0.025 respectively). Interestingly combining TLG41% and interim PET brings out 3 distinctive prognostic categories (p<0.0001): negative PET2 and low TLG41% with good outcome (5y-PFS=92%, n=60); positive PET2 and high TLG41% with bad outcome (5y-PFS=57%, n=21) and an intermediate category (5y-PFS=88%, n=43) cf. KM curve. No progression was observed in the 8 patients with a positive interim PET but a low baseline TLG41%, suggesting that TLG41% results may reduce the numbers of false positive PET2 patients. Conclusion: Quantitative PET parameters improve patient risk stratification at staging. The study data suggest that TLG is an independent prognosticator of outcome and seems particularly interesting in early stage HL patients, to identify in conjunction with the early PET response, those patients who require treatment intensification. Disclosures No relevant conflicts of interest to declare.

Metabolic Tumor Volume Is an Independent Prognosis Factor Predicting patient's Outcome in Hodgkin Lymphoma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3631-3631
Author(s):  
Salim Kanoun ◽  
Cedric Rossi ◽  
Alina Berriolo-Riedinger ◽  
Olivier Humbert ◽  
Inna Dygay-Cochet ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Therapeutic Strategy ◽  
Tumor Volume ◽  
Conflicts Of Interest ◽  
False Negative ◽  
Metabolic Tumor Volume ◽  
Operating Characteristics ◽  
Bulky Disease ◽  
Interim Pet ◽  
Bulky Tumor

Abstract Abstract 3631 Positron emission tomography with [18F]fluorodeoxyglucose (PET) performed after two cycles of chemotherapy allows to predict treatment outcome in Hodgkin lymphoma (HL) with a pretty good accuracy specifically when the SUVmax reduction (DSUVmax) of the most hypermetabolic lesion is used to interpret interim PET. However, about 15% of false negative and 30% of false positive interim PET results are observed. To investigate the prognosis impact of the metabolic tumor volume at baseline (MTV0) we compared the respective clinical usefulness and prognosis value of the MTV0 and the SUVmax reduction between baseline PET (PET0) and interim PET (PET2) performed after 2 cycles of chemotherapy (DSUVmaxPET0–2) in a retrospective single centre study. From January 2007 to January 2010, 59 consecutive patients with a first diagnosis of HL were treated in our institution. All patients received 4 to 8 cycles of chemotherapy including ABVD in 50 cases (85%) and BEACOPP in 9 cases. Radiotherapy was performed in 14 responding patients with localized disease. PET was done at baseline (PET0) and after 2cycles of chemotherapy (PET2) and therapeutic strategy was not modified according to PET2 result. All PET scans were reviewed by SK, ABR and IDC. MTV0 was measured with a semi-automatic method using various volume shapes and systematic 41% SUVmax thresholding. Based on a receiver operating characteristics approach patients with a MTV0 >225 cc were considered to have a hypermetabolic bulky disease. Interim PET were interpreted using DSUVmaxPET0–2 and patients with a DSUVmaxPET0–2 >71% were considered as good responders after 2 cycles. Progression-free survival (PFS) and freedom from treatment failure (FFTF) were analyzed according to MTV0 and DSUVmaxPET0–2.Median follow-up was 39 months (range: 6–62). Median MTV0 was 120 cc (range: 10 – 1610) and 17 patients (29%) had a MTV0 >225 cc. Patients with a MTV0 >225 cc had more frequently a bulky tumor>10 cm (41% vs 5%; p = 0.0021). MTV0 (≤ 225 vs > 225) was predictive of 3-year PFS (85% vs 42%; p = 0.001) and FFTF (88% vs 45%; p = 0.0015). Bulky tumor was also predictive of 3-year PFS (44% vs 78%, p <0.04), but of border line significance for 3-year FFTF (80% vs 53%, p = 0.09). In multivariate analysis, using the international prognosis score, DSUVmaxPET0–2, MTV0 and bulky tumor as covariates, only DSUVmaxPET0–2 and MTV0 remained independent predictors for PFS (p= 0.0005; RR=6.4, and p<0.007; RR= 4.2, for DSUVmaxPET0–2 and MTV0 respectively) and FFTF (p= 0.0002; RR= 8.2,and p= 0.01; RR= 4.4, for DSUVmaxPET0–2 and MTV0 respectively). Then, 3 prognosis groups could be identified (Figure 1): patients with either DSUVmaxPET0–2>71 and MTV0≤225 (n = 37; 63%), or DSUVmaxPET0–2<71 or MTV0>225 (n = 17; 29%), or DSUVmaxPET0–2<71 and MTV0>225 (n = 5; 8%), had a 92%, 48%, and 20% 3-year PFS (p<0.0001) and a 94%, 54% and 20% 3-year FFTF (p<0.0001) respectively. MTV0 is more relevant that tumor bulk to predict outcome of patients with Hodgkin lymphoma, and adds significant prognosis insights to interim PET response assessment. The combination of MTV0 with DSUVmaxPET0–2 allows identifying 3 subsets of HL patients with significantly different outcomes that may help clinicians to guide therapeutic strategy. Figure 1: PFS according to DSUVmaxPET0–2 and MTV0 results Figure 1:. PFS according to DSUVmaxPET0–2 and MTV0 results Solid line: patients with DSUVmaxPET0–2 >71 and MTV0 ≤225. Dashed line: patients with DSUVmaxPET0–2 <71 or MTV0 >225. Dotted line: patients with DSUVmaxPET0–2 <71 and MTV0 >225. Disclosures: No relevant conflicts of interest to declare.

Positron Emission Tomography–Driven Strategy in Advanced Hodgkin Lymphoma: Prolonged Follow-Up of the AHL2011 Phase III Lymphoma Study Association Study

2022 ◽  
Author(s):  
René-Olivier Casasnovas ◽  
Reda Bouabdallah ◽  
Pauline Brice ◽  
Julien Lazarovici ◽  
Hervé Ghesquieres ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Hodgkin Lymphoma ◽  
Emission Tomography ◽  
Phase Iii ◽  
Second Primary ◽  
Second Primary Malignancy ◽  
Interim Pet ◽  
Positron Emission ◽  
Study Results

PURPOSE The AHL2011 study (ClinicalTrials.gov identifier: NCT01358747 ) demonstrated that a positron emission tomography (PET)-driven de-escalation strategy after two cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) provides similar progression-free survival (PFS) and overall survival (OS) and reduces early toxicity compared with a nonmonitored standard treatment. Here, we report, with a prolonged follow-up, the final study results. METHODS Patients with advanced Hodgkin lymphoma (stage III, IV, or IIB with mediastinum/thorax ratio > 0.33 or extranodal involvement) age 16-60 years were prospectively randomly assigned between 6 × BEACOPP and a PET-driven arm after 2 × BEACOPP delivering 4 × ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in PET2– and 4 × BEACOPP in PET2+ patients. PET performed after four cycles of chemotherapy had to be negative to complete the planned treatment. RESULTS In total, 823 patients were enrolled including 413 in the standard arm and 410 in the PET-driven arm. With a 67.2-month median follow-up, 5-year PFS (87.5% v 86.7%; hazard ratio [HR] = 1.07; 95% CI, 0.74 to 1.57; P = .67) and OS (97.7% in both arms; HR = 1.012; 95% CI, 0.50 to 2.10; P = .53) were similar in both randomization arms. In the whole cohort, full interim PET assessment predicted patients' 5-year PFS (92.3% in PET2–/PET4–, 75.4% [HR = 3.26; 95% CI, 18.3 to 5.77] in PET2+/PET4– and 46.5% [HR = 12.4; 95% CI, 7.31 to 19.51] in PET4+ patients, respectively; P < .0001) independent of international prognosis score. Five-year OS was also affected by interim PET results, and PET2+/PET4– patients (93.5%; HR = 3.3; 95% CI, 1.07 to 10.1; P = .036) and PET4+ patients (91.9%; HR = 3.756; 95% CI, 1.07 to 13.18; P = .038) had a significant lower OS than PET2–/PET4– patients (98.2%). Twenty-two patients (2.7%) developed a second primary malignancy, 13 (3.2%) and 9 (2.2%) in the standard and experimental arms, respectively. CONCLUSION The extended follow-up confirms the continued efficacy and favorable safety of AHL2011 PET-driven strategy, which is noninferior to standard six cycles of BEACOPP. PET4 provides additional prognostic information to PET2 and allows identifying patients with particularly poor prognosis.

Revised staging system for malignant lymphoma based on the Lugano classification

2019 ◽  
Vol 49 (10) ◽  
pp. 895-900 ◽  
Author(s):  
Wataru Munakata ◽  
Takashi Terauchi ◽  
Dai Maruyama ◽  
Hirokazu Nagai
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Hodgkin Lymphoma ◽  
B Cell Lymphoma ◽  
Staging System ◽  
Emission Tomography ◽  
Fluorodeoxyglucose Positron Emission Tomography ◽  
Bone Marrow Biopsies ◽  
Positron Emission ◽  
Fluorodeoxyglucose Positron Emission

Abstract The Lugano classification was published in 2014 to form the basis for revising the recommendations regarding anatomic staging and evaluation of disease before and after therapy. This staging system was adopted by the eighth edition of the Cancer Staging Manual of the American Joint Committee on Cancer. In this review, we aimed to discuss this updated staging system for malignant lymphomas. The most important change was that fluorodeoxyglucose positron emission tomography/computed tomography became the new standard imaging technique for staging of all fluorodeoxyglucose-avid histologies. Due to the introduction of fluorodeoxyglucose positron emission tomography/computed tomography for staging, the evaluation of not only lymph node involvement but also organ involvement, including liver or spleen, has become simplified. Furthermore, it is possible to eliminate bone marrow biopsies in patients with Hodgkin lymphoma and diffuse large B-cell lymphoma. Although patients were grouped according to the absence (A) or presence (B) of disease-related symptoms based on the previous classification, only the patients with Hodgkin lymphoma need to be assigned the designations A or B in this revision. Hopefully, these revised recommendations will improve patient management and the conduct of clinical trials.

Prognostic Value of Interim PET/CT in Patients with Poor Risk Diffuse Large B-Cell Lymphoma (DLBCL). Experience of the Spanish Geltamo Group

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 5076-5076
Author(s):  
Mónica Coronado ◽  
Emilia Pardal ◽  
Rosa Couto ◽  
Fatima de la Cruz ◽  
Carlos Panizo ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Young Patients ◽  
Standardized Uptake Value ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Visual Assessment ◽  
Poor Risk ◽  
Interim Pet ◽  
Randomized Phase Ii ◽  
Pet Ct

Abstract Abstract 5076 Background: Interim FDG-PET appears to be useful to guide risk stratification of patients with DLBCL, but remains controversial because the absence of consensus criteria for assessment. The reduction of maximum Standardized Uptake Value (SUVmax) between baseline and interim PET improves the accuracy and reproductibility of this method (Casasnovas, Blood 2011). Patients and Methods: A prospective non randomized phase II trial (EudraCT:2006-005254-68) was undertaken in young patients (pts) newly diagnosed of poor risk DLBCL. Therapy was changed after 3 cycles of R- MegaCHOP based on PET (using local assesment and visual scale); pts with positive PET received early salvage therapy. Primary end points were Progression free survival (PFS) and Overalll survival (OS). Retrospectively, central review was done by three experts using visual assessment (Deauville criteria) and semiquantitative asessment. Baseline and interim SUVmax, and ΔSUVmax were evaluated (cutt off ΔSUVmax: 66%). Significance of PET parameters in OS was analyzed. Results: 71 pts were enrolled and central review was possible in 50 pts, from which 80% have complete follow up (mean 37, 6 months, 3. 4–56. 4). OS was significantly influenced by interim PET result, using visual (p=0. 046) but mainly by semiquantitative analysis (p=0. 0008). ΔSUVmax had impact on the overall survival (p=0. 007) whereas basal SUVmax did not. Conclusions: Our preliminary results show that outcome of DLBCL pts with a positive interim PET is worse despite change of therapy. Semiquantitative PET evaluation seems to be necessary, being ΔSUVmax a good prognostic parameter. Disclosures: No relevant conflicts of interest to declare.

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