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.

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.

scholarly journals Doublet Versus Triplet PET: Is END of Therapy PET Needed IF Interim PET Is Negative in Hodgkin'S or Diffuse Large B CELL Lymphoma?

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5354-5354
Author(s):  
Imran K Tailor ◽  
Bilal Btoosh ◽  
Shaimaa Hamdy ◽  
Shanker Raja ◽  
Mohammed O Alharbi ◽  
...  
Keyword(s):  
B Cell ◽  
Conflicts Of Interest ◽  
Cell Lymphoma ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Standard Of Care ◽  
Complete Response ◽  
Interim Pet ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Introduction: Baseline (PETb) and end of therapy (PETe) FDG PET is standard of care in the management of hodgkin's lymphoma (HL) and diffuse large B cell lymphoma (DLBCL). The role of interim PET (PETi) in HL is well established while its role in DLBCL is not well defined. We evaluated the utility of triPET (PETb, PETi and PETe ) in management of these two lymphomas. Methods: Retrospective review of PET archives revealed a total of 37 pts (HL=22, DLBCL=15). TriPET were acquired per accepted protocol. SUVmax and Deauville scores (DSc) were obtained from five target lesions, the average i.e. composite SUVmax & DSc were computed for each pt. Statistical analyses were performed with the composite maxSUV (cSUV) and Deauville scores (cDSc) (using EXCEL). Following statistics were performed (separately and combined in HL and DLBCL); mean+SD, PPV and NPV for complete response (CR) Vs. progressive disease (PD) on PETi using the following variables 1. cSUV and 2. cDSc and 3. delta change (DELT). Median progression free survival (PFS) was the clinical endpoint for response. Results: The mean PFS in our group was 17 and 15 months in HL and DLBCL respectively. Using cut off thresholds for intP to predict CR at cSUV<=2.0, , cDSC<=2.0 and DELT >=80%,. In HL: for cSUV- PPV 67%, NPV 95%; for DELT of cSUV PPV 100%, NPV 95%; for cDSC-PPV 30%, NPV 100%. In DLBCL: for cSUV- PPV 25%, NPV 100%; for DELT of cSUV PPV 33%, NPV 100%; for cDSC- PPV 50%, NPV 100%. Conclusion: The results from our series suggest that PETi has a role not only in HL but in DLBCL as well. Our modest cohort suggests that a negative PETi in DLBCL had a NPV of 100% across cSUV, cDSc and DELT, with regards to CR. Our data also suggests that PETe is not needed if PETi is -ve. While in HL subset, our results concur with results from other groups, this needs to be validated in a larger series. Disclosures No relevant conflicts of interest to declare.

Interim 18-FDG-PET/CT failed to predict the outcome in diffuse large B-cell lymphoma patients treated at the diagnosis with rituximab-CHOP

Blood ◽  
2012 ◽  
Vol 119 (9) ◽  
pp. 2066-2073 ◽  
Author(s):  
Patrizia Pregno ◽  
Annalisa Chiappella ◽  
Marilena Bellò ◽  
Barbara Botto ◽  
Simone Ferrero ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Cox Models ◽  
Interim Pet ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Large B Cell

Abstract Role of interim-PET (I-PET) in diffuse large B-cell Lymphoma (DLBCL) is controversial. To determine predictive value of I-PET on progression-free survival (PFS), we enrolled 88 first-line DLBCL patients treated with 6-8 R-CHOP courses regardless of I-PET. PET/CT were performed at diagnosis, after 2 to 4 courses and at the end of therapy with central reviewing according to visual dichotomous criteria. Results are as follows: I-PET, 72% negative, 28% positive; final-PET (F-PET), 88% negative, 12% positive; clinical complete response 90%. Concordance between clinical response and F-PET negativity was 97% because of 2 false positive. With a median follow-up of 26.2 months, 2-year overall survival and PFS were 91% and 77%, respectively. Two-year PFS for I-PET and F-PET negative versus positive were as follows: I-PET 85% versus 72% (P = .0475); F-PET 83% versus 64% (P < .001). Because of a small number of events, 2 independent bivariate Cox models were tested for PFS. In model 1, F-PET contradicted I-PET (hazard ratio [HR] = 5.03, P = .015 vs 1.27, P = 691); in model 2, F-PET (HR = 4.54) and International propnostic Index score (HR = 5.36, P = .001) remained independent prognostic factors. In conclusion, positive I-PET is not predictive of a worse outcome in DLBCL; larger prospective studies and harmonization of I-PET reading criteria are needed.

scholarly journals [18 F]-Fludarabine Positron Emission Tomography in Diffuse Large B-Cell Lymphoma (DLBCL) Patients: Results of a Phase I Study

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3917-3917
Author(s):  
Sylvain P Chantepie ◽  
Narinée Hovhannisyan ◽  
Stéphane Guillouet ◽  
Alain Manrique ◽  
Oumedaly Reman ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Fdg Pet ◽  
Conflicts Of Interest ◽  
Standardized Uptake Value ◽  
B Cell Lymphoma ◽  
Lymphoid Cells ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
18F Fdg

Abstract Introduction: [18 F]-Fludarabine is a promising novel positron emission tomography (PET) radiotracer for lymphoid malignancies. The rationale for its development is the high selectivity of fludarabine uptake within lymphoid cells, irrespective of their cycle activity, and the fluorine atom within the molecule, which is replaced by [18 F] and leads to a positron emitting biomarker. Pre-clinical studies (Dhilly et al, Mol Imaging Biol 2014,16:118-26 ; Hovhannisyan et al, EJNMMI Res 2015,5:23) showed a marked tumor uptake in lymphoma-bearing mice. The aim of this study was to describe anatomical sites with abnormal [18F]-fludarabine uptake in DLBCL patients. This study was designed as a clinical proof of concept. Methods: [18F]-Fludarabine was produced according to a method already described (Guillouet et al, Mol Imaging Biol 2014,16:28-35). [18F]-Fludarabine PET/CT (Discovery RX VCT 64, GE Healthcare) was performed in 5 histologically confirmed and treatment naïve DLBCL patients (65 ± 8 years old). Successive partial body PET scans (skull vertex to mid-thigh) were acquired for 250 min after intravenous injection of [18F]-fludarabine with an activity of 4MBq/kg. PET images were analyzed drawing VOIs over the uptake sites on a late scan and projected onto all co-registered scans of the same subject. The intensity of tracer uptake was evaluated with standardized uptake value (SUVmax). The performance of [18F]fludarabine PET/CT was visually compared with conventional assessments (high-resolution CT) and [18F]-FDG PET. Results: CT and [18F]-FDG PET staging of the 5 patients was I to IV. No adverse event was recorded during and after the procedure. In all 5 patients, the uptake of [18F]-fludarabine coincides with sites expected to be involved following conventional staging. SUVmax were significantly higher in involved sites in comparison with non-lymphoma sites (Figure 1). As previously demonstrated in an animal model, we found no uptake in the cardiac muscle and brain in contrast to [18F]-FDG PET. Bone marrow was histologically normal in the 5 patients and [18F]-fludarabine PET displayed no hypermetabolism. A progressive splenic uptake (x4 to x8 at 250 min) was observed in every patient. The possibility of an unexpected splenic infiltration appears to be a better explanation than uptake by physiologically normal lymphoid tissue. Comparison of [18F]-FDG and [18F]-fludarabine PET showed discrepancies in 2 patients. The first had bilateral hilar [18F]-FDG uptakes (Figure 1C), not present in [18F]-fludarabine PET, which persisted on [18F]-FDG PET after completion of the treatment and disappearance of all suspected pathological sites. This pattern suggests a non-specific [18F]-FDG hypermetabolism. The second patient had a right testis positive [18F]-FDG PET, not evident with [18F]-fludarabine PET. Histology of the testis confirmed the presence of NHL. The interpretation of this would require further extensive data. Conclusion: [18F]-Fludarabine PET/CT appears to be a promising tool to diagnose discordance and follow-up NHL. These preliminary results showed a clear specificity of this novel radiotracer for lymphoma tissues and support the development of this innovative biomarker for lymphoproliferative diseases. Studies for a more detailed comparison with [18F]-FDG PET are in progress. Figure 2. Figure 2. Disclosures No relevant conflicts of interest to declare.

Discrepancy of Interim PET/CT Responses Based on Visual and Quantitative SUV-Based Assessments in the Patients with Diffuse Large B-Cell Lymphoma and Extranodal Involvements

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1446-1446
Author(s):  
Deok-Hwan Yang ◽  
Joon Ho Moon ◽  
Seung-Shin Lee ◽  
Jung-Joon Min ◽  
Shin-Young Jeong ◽  
...  
Keyword(s):  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Visual Assessment ◽  
Long Term Outcomes ◽  
Interim Pet ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Visual Assessments ◽  
Large B Cell

Abstract Background 18 F-FDG PET is currently used in diffuse large B-cell lymphoma (DLBCL) for staging and evaluation of therapeutic efficacy at various time points. Nevertheless, the predictive value of interim PET/CT (iPET/CT) has not been consistent throughout the studies. Since FDG is not a tumor-specific substance, it may accumulate to the point of being detected in a variety of benign conditions or infectious lesions, which may give rise to false positive interpretation. Particularly, iPET/CT assessment in patients with multifocal, non-contiguous involvement at extranodal (EN) sites may result in a false determination of prognosis due to tracer uptake of inflammatory or physiologic anatomic sites, which could contribute to the variability in outcomes and the poor reproducibility. Therefore, the purpose of this study is to investigate the predictive accuracy of iPET/CT response based on visual and quantitative SUV-based assessments in patients with DLBCL and EN involvements. Methods iPET/CT responses for 163 patients with newly diagnosed DLBCL and EN involvements were investigated retrospectively. iPET/CT responses were based on the visual and quantitative SUV-based assessments. Briefly, the assessment of PET/CT was performed at the time of diagnosis, at the third or fourth cycles and at the completion of R-CHOP. For visual assessment, the five-point scale (5-PS) based on the Deauville criteria was used and graded as negative or positive by comparison with initial PET/CT scan and grade 1-3 were considered as negative and grade 4-5 were considered the residual metabolic response. Second, we classified patients using the quantitative analysis of 18 F-FDG uptake changes based on the percentage of SUVmax reduction (DSUVmax) between initial and interim PET/CT scans. The cutoff points of DSUVmax were 65.7% based on previous reports. Results Median age was 61 years (range 18-83 years) and 88 patients (54.0%) in advanced disease (III/IV). Patients were classified according to the IPI risk with 95 patients (58.3%) being classified as low or low-intermediate and 68 patients (41.7%) as high-intermediate or high risk. Number of extranodal site(s) were 1 site in 102 patients (62.6%), 2 sites in 39 (23.9), 3 sites in 18 (11.0), and 4 sites in 4 (2.5%). iPET/CT responses based on visual analysis were classified into grade 1-3 of 5-PS in 99 patients (60.7%) and grade 4-5 in 64 (39.3%), and based on SUV-based, classified into higher the cutoff of DSUVmax (>65.7%) in 140 patients (85.9%) and lower (<65.7%) in 23 patients (14.1%), respectively. On visual assessment, iPET/CT-positive patients had no difference of relapse rates (28.3±5.4%) compared to those of iPET/CT-negative patients (23.1±4.5%) (p=0.419). Among the patients with 5-PS grade 4-5, 46 patients (71.9%) achieved higher the optimal cutoff of DSUVmax (>67.5%). The 5-year overall survival (OS) rates and progression free survival (PFS) rates were 75.6±3.8% vs 60.6±11.7% (p=0.056), and 77.9±3.7% vs 55.9±12.1% (p=0.007) depending on the cutoff of DSUVmax, respectively. Among the patients with 1 EN involvement, DSUVmax successfully predict the long-term outcomes in terms of 5yr-OS (83.2±4.3% vs 62.1±14.6%, p=0.012) and PFS (86.9±3.9% vs 41.3±16.6%, p<0.001), while for those with more than 1 EN involvements, DSUVmax failed to predict long-term outcomes. In the multivariate analysis, DSUVmax <65.7% (HR=2.675, 95% CI 1.304-5.486, p=0.007), ECOG 2-3 (HR=2.553, 95% CI 1.228-5.309, p=0.012), and the involvement of more than 1 EN sites (HR=2.370, 95% CI 1.247-4.504, p=0.008) were unfavorable factors for PFS. Visual assessments based on Deauville 5-PS score could not predict the disease progression or long-term outcomes regardless of the number of extranodal involvements or IPI risk groups. Conclusion The quantitative SUV-based assessments in iPET/CT could have significant potential as a prognostic predictor of PFS and OS, especially in the patients with 1 EN site involvement. However, the visual assessments have the limitations to predict long-term outcomes with high false positive rates at EN involvements. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

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.

scholarly journals Central Review of PET/TC: First Spanish Experience in a Phase 2 Randomized Trial in Diffuse Large B-Cell Lymphoma (DLBCL) Patients

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5042-5042
Author(s):  
Mónica Coronado-Poggio ◽  
Ana Cristina Hernandez-Martinez ◽  
M. Pilar Sarandeses ◽  
Montse Cortés-Romera ◽  
Marc Simó-Perdigó ◽  
...  
Keyword(s):  
Visual Analysis ◽  
B Cell Lymphoma ◽  
Visual Assessment ◽  
Semiquantitative Analysis ◽  
Review Panel ◽  
Interim Pet ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Semiquantitative Method ◽  
Deauville Criteria

Abstract Background: Positron emission tomography / computed tomography with fluorodeoxyglucose (FDG-PET/CT) is widely accepted for staging and for end treatment assessment in patients with DLBCL, and has demonstrated to have prognostic impact when used to evaluate early response to chemotherapy (CT) in this group of patients. In the last years, many changes in the way of interpreting PET/CT have been proposed, both for interim and for end of treatment (Barrington SG, J Clin Oncol 2014;32:3048-3058) We present preliminary data of the first Spanish centralized PET/CT review in a Phase 2 randomized trial in young patients with poor prognosis diffuse large B-cell lymphoma (DLBCL), which compares 6 cycles of RCHOP versus 6 cycles of a modified RCHOP regimen, Bortezomid-R CAP (BRCAP). ClinicalTrials.gov Identifier: NCT01848132. The main objective is to evaluate concordance between reviewers in interim and final PET, in order to stablish the best criteria for PET/CT assessment. PET2 ability to predict PET4 result is also analyzed. Methods: A blinded, prospective, centralized review in real time of PET/CT images was realized by the GELTAMO PET network. For each patient, images of basal (PET0), interim PET2 and PET4 and final PET after completion of chemotherapy (PET 6) were sent to a central platform, and then analysed by the review panel composed of seven expert nuclear medicine physicians. PET2 and PET4 were interpreted visually based on Deauville criteria (considering scores 4 and 5 as positive), and also semiquantitavely (considering a positive PET2 when ΔSUVmax≤66% and a positive PET4 when ΔSUVmax≤70%). PET6 was interpreted following Deauville criteria. Final result of every PET/CT was defined as positive or negative by the central review panel. When discordance between visual and semiquantitative analysis was found in interim PET, semiquantitative method was determinant of final result. A positive PET4 result determined dropped out from trial. Concordance between all readers was analysed using Cohen's kappa coefficient. Results: Of the first 76 patients that underwent PET/CT, 64 patients completed PET0, PET2 and PET4; 34 patients underwent PET0, PET2, PET4 and PET6. In the central review, 44/64 patients (69%) were PET2(-) and 20/64 (31%) were PET2(+); 44/64 (69%) were PET4(-) and 20/64 (31%) PET4(+); 21/34 (62%) were PET6(-) and 13/34 (38%) were PET6(+). We found 43 patients with negative PET2 and PET4, 19 patients with positive PET2 and PET4, 1 patient with positive PET2 and negative PET4, and 1 patient with negative PET2 and positive PET4. PET2 result was predictive of PET4 (p<0.001). Concordance between reviewers for PET2 using visual assessment was good (median kappa=0,74) and very good using semiquantitative analysis (median kappa: 0,83). Concordance between reviewers for PET4 using visual assessment was good (kappa=0,72) and very good when semiquantitative analysis was used (median kappa=0,87). For PET6, concordance between readers was moderate (kappa=0.45). Conclusion: In this homogeneus group of patients, a centralized semiquantitative analysis of interim PET after 2 and 4 cycles of chemotherapy improves concordance between readers in comparison with visual analysis. When semiquantitative method is used, PET2 is predictive of PET4 result. In the same way, visual analysis of PET6 using Deauville criteria seems to have a worse concordance between readers, but more patients need to be analyzed to confirm this result. Disclosures No relevant conflicts of interest to declare.

scholarly journals Prognostic Value of Interim and End-of-Treatment PET-CT in Patients with Mature T-Cell and NK-Cell Lymphomas: A 10-Year Single Institution Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2930-2930
Author(s):  
Akihiro Kitadate ◽  
Kota Fukumoto ◽  
Hiroki Kobayashi ◽  
Yoshiaki Abe ◽  
Kentaro Narita ◽  
...  
Keyword(s):  
T Cell ◽  
Nk Cell ◽  
Conflicts Of Interest ◽  
Cell Lymphoma ◽  
Standardized Uptake Value ◽  
B Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Deauville Score ◽  
End Of Treatment ◽  
Pet Ct

Abstract Background: Positron emission tomography combined with computed tomography (PET-CT) has been widely used for initial staging and monitoring of treatment response in patients with malignant lymphomas. The predictive value of interim PET-CT (iPET) and end-of-treatment PET-CT (ePET) is well-established for patients with Hodgkin lymphoma, diffuse large B-cell lymphoma, and follicular lymphoma. However, there are limited data on their prognostic values in patients with mature T-cell and NK-cell lymphomas. In this study, we aimed to assess the value of iPET and ePET in the prediction of progression-free survival (PFS) and overall survival (OS) in patients with mature T-cell and NK-cell lymphomas. Methods: Data of 99 patients with mature T/NK-cell lymphomas who underwent iPET (after 2-4 cycles of chemotherapy; performed just before the next cycle) or ePET at the Kameda Medical Center were retrospectively analyzed. PET-CT scans were scored as positive or negative based on the Deauville score using a 5-point scale. While a Deauville score of 1-3 was considered to indicate complete metabolic response (CMR) (negative), a score of 4-5 was considered as persistent or progressive disease (positive). Standardized uptake value (SUV) was normalized relative to the injected dose and lean body mass and was measured for all lesions. The highest SUV for each scan was recorded as maximum SUV (SUVmax). To quantitatively interpret iPET scans, we determined the rate of reduction in SUVmax between baseline and iPET (ΔSUVmax). Survival was calculated using the Kaplan-Meier method and compared using the log-rank test. Results: In total, 99 patients, including patients with peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) (n = 36), angioimmunoblastic T-cell lymphoma (AITL) (n = 28), anaplastic large cell lymphoma (ALCL) (n = 6), adult T-cell leukemia/lymphoma (ATLL) (n = 14), enteropathy-associated T-cell lymphoma (EATL) (n = 2), cutaneous T-cell lymphoma (CTCL) (n = 3), and NK/T-cell lymphoma (NKTCL) (n = 10), participated in this study. Of all patients, 55 (56%) were men, and the median age was 48 (range: 22-78) years. The majority of patients, except those with ATLL and NKTCL, were treated with CHOP or CHOP-like chemotherapy. After a median follow-up of 26 months, the 5-year PFS and OS rates for all patients were 24% and 41%, respectively. While 98 patients (99%) underwent iPET, 60 of them (61%) underwent ePET. Baseline PET-CT scan was positive in all cases, and the median SUVmax was 12.8 (range: 2.6-37.4). Using the ROC curve, ΔSUVmax values between baseline and iPET of >79% and >73% were predictive of better PFS and OS, respectively (PFS: sensitivity 77%, specificity 69%, area under the curve [AUC] 0.82, 95% confidence interval [CI] = 0.68-0.88 and OS: sensitivity 78%, specificity 63%, AUC 0.78, 95% CI = 0.62-0.83). While iPET results were negative in 49 of 98 (50%) cases, ePET results were negative in 35 of 60 (59%) cases. The proportion of patients with PTCL-NOS, AITL, ALCL, ATLL, EATL, CTCL, and NKTCL who achieved CMR with iPET or ePET were 53% (19/36), 82% (23/28), 67% (4/6), 36% (5/14), 50% (1/2), 67% (2/3), and 80% (8/10), respectively. The 5-year PFS and OS were significantly longer in patients with negative results on both iPET (PFS: 41% vs. 7%, p < 0.0001; OS: 67% vs. 15%, p < 0.0001) and ePET (PFS: 39% vs. 0%, p < 0.0001; OS: 72% vs. 11%, p < 0.0001). Conclusion: These results indicate that iPET and ePET are good predictors of PFS and OS in patients with mature T-cell and NK-cell lymphomas. Furthermore, our findings highlight the significance of iPET findings in the early identification of potential candidates for an intensive therapeutic strategy, with the aim of improving clinical outcomes. Risk-adapted treatment strategies based on iPET and ePET findings should be investigated in larger and prospective clinical trials. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

FDG-PET/CT Early After 90Y-Ibritumomab Tiuxetan Therapy Predicts Outcome in Relapsed or Refractory Indolent B-Cell Lymphoma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3648-3648
Author(s):  
Masaya Okada ◽  
Yoshihiro Fujimori ◽  
Naohiko Oku ◽  
Akira Tamekane ◽  
Toshiro Takafuta ◽  
...  
Keyword(s):  
B Cell ◽  
Fdg Pet ◽  
Conflicts Of Interest ◽  
Cell Lymphoma ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Ibritumomab Tiuxetan ◽  
Free Survival ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Abstract 3648 Background: Radioimmunotherapy (RIT) with 90Y-ibritumomab tiuxetan has been used for the treatment of relapsed or refractory indolent B-cell lymphoma. Early prediction of response to the therapy may offer the potential to identify patients who will benefit this therapy. We evaluated the efficacy of fluorine 18 fluorodeoxyglucose (FDG) combined positron emission tomographic-computed tomographic (FDG-PET/CT) imaging for assessment of therapy and predicting outcome in 90Y-ibritumomab tiuxetan radioimmunotherapy. Methods: Radioimmunotherapy with 90Y-ibritumomab tiuxetan was preformed in 52 patients with relapsed or refractory indolent B cell lymphoma (follicular lymphoma, 45; mucosa-associated lymphoid tissue lymphoma, 5; lymphoplasmacytic lymphoma, 2) at Hyogo College of Medicine Hospital from June 2009 through August 2012. FDG-PET/CT scanning was performed at two weeks and the later after 90Y-ibritumomab tiuxetan therapy. Results: In FDG-PET at 2 weeks after 90Y-ibritumomab therapy, 26 (50%) showed complete response (defined as early CR), 20 (38%) showed partial response (PR-2W) and 6 (12%) showed non response (NR-2W). Further follow-up revealed 10 later CR (8 CR out of 20 PR-2W and 2 CR out of 6 NR-2W), showing 69 %(36) of overall CR rate. Relapse was occurred in 4(17%) of 26 early CR and in 6 (60%) of 10 later CR, indicating significantly low relapse late in early CR (P= 0.0074, by Chi-square test). Patients with early CR (CR in 2 weeks after the RIT) showed significantly better progression free survival than those with later CR (P=0.0046, by Logrank test). In contrast, analysis at six weeks after the RIT showed 36 CR patients (10 of which eventually relapse), but failed to discriminate patients who had high risk of relapse. Conclusion: Our results suggest that CR assessed by FDG-PET/CT at 2 weeks after 90Y-ibritumomab tiuxetan therapy discriminates good responder to the RIT and predicts better progression free survival in relapsed or refractory indolent B cell lymphoma. Disclosures: No relevant conflicts of interest to declare.

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