PET Compared With CT As a Prognosticator After Rituximab Induction Therapy In Follicular Lymphoma: Report From The National Lymphocare Study

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4245-4245
Author(s):  
Ida Wong-Sefidan ◽  
Michelle Byrtek ◽  
Xiaolei Zhou ◽  
Jonathan W. Friedberg ◽  
Christopher Flowers ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Induction Therapy ◽  
Research Funding ◽  
Therapy Response ◽  
Response Assessment ◽  
Ct Scans ◽  
Off Label Use ◽  
Pet Ct ◽  
Equity Ownership

Abstract Introduction While the utility of positron emission tomography (PET) compared with computed tomography (CT) for end-of–induction (EOI) therapy response assessment in follicular lymphoma (FL) remains unclear, emerging data suggest that PET performed at the end of therapy can predict survival. To further define the role of PET compared with CT in the management of patients with FL, we used the National LymphoCare Study (NLCS) database to examine the use of PET and CT in clinical practice, to assess the prognostic role of PET and CT after induction therapy, and to evaluate whether PET provides better prediction of outcomes compared with response based on CT scans. Methods NLCS is an observational study comprising 2700+ FL patients enrolled between 2004 and 2007. In NLCS, 1072 patients with FL completed induction rituximab (R) monotherapy or R-chemotherapy and had EOI imaging response assessments via PET ± CT or CT alone performed between 2 cycles prior to and 12 weeks after the end of therapy. Response assessments (complete response [CR], partial response [PR], stable disease [SD], and progressive disease [PD]) were determined by the local investigators; CR was classified as a negative scan, while PR, SD, and PD were classified as positive scans. Multivariate logistic regression was used to evaluate baseline factors associated with receiving PET imaging. Outcomes were defined as the number of days from the EOI response assessment until date of death (overall survival [OS]), date of disease progression (as determined by the treating physician) or death (progression-free survival [PFS] defined for patients without PD at date of EOI assessment). To directly compare survival in each imaging group, a propensity score (PS) was calculated to adjust for imbalances between the groups. Cox proportional hazards models with PS matching were used to estimate the effects of PET and CT response on OS and PFS. All variables potentially related to outcome or imaging selection were included in the calculation of the PS. A total of 395 and 380 matched pairs were available for comparative analysis of OS and PFS, respectively. Kaplan-Meier estimates of PFS and OS were also calculated. Results Of 497 PET ± CT scans performed at EOI, 330 (66.4%) were reported as negative, and 167 (33.6%) were reported as positive. Of 575 CT scans performed at EOI, 233 (40.5%) were reported as negative, and 342 (59.5%) were reported as positive. Grade 3 histology, available bone marrow assessment, Southwest region, and R-CHOP induction were associated with greater likelihood of receiving PET imaging. Median follow-up was 6.3 years. Five-year PFS and OS outcomes are detailed in Table 1. Patients who remained PET-positive had significantly poorer OS (PS-adjusted hazard ratio [HR] 2.21, 95% confidence interval [CI] 1.32–3.68) and PFS (PS-adjusted HR 1.48, 95% CI 1.06–2.07) compared with patients who were PET-negative at EOI. Compared with patients who were CT-negative at EOI, patients with CT-positive scans at EOI trended toward inferior OS (PS-adjusted HR 1.50, 95% CI 0.96–2.34) and PFS (PS-adjusted HR 1.37, 95% CI 1.00–1.87) outcomes, but the trend was not statistically significant. Patients with PET-positive vs CT-positive scans had no significant differences in OS (PS-adjusted HR 0.96, 95% CI 0.61–1.51) and PFS (PS-adjusted HR 1.10, CI 95% 0.78–1.39) outcomes. Patients with PET-negative vs CT-negative scans had no significant differences in OS (PS-adjusted HR 0.65, 95% CI 0.39–1.08) and PFS (PS-adjusted HR 1.02, 95% 0.75–1.39) outcomes. Conclusions After accounting for baseline differences between patients receiving PET and CT response assessments, PET response performed after R-induction therapy is a prognosticator of OS and PFS in patients with FL, while CT response shows a trend toward association with OS and PFS, which is not statistically significant. There is a trend toward improved OS in PET-negative compared with CT-negative patients, but it is not statistically significant. There is no difference in PFS or OS when comparing PET-positive with CT-positive patients. PET performed at the end of R induction in patients with FL is highly predictive of outcome; however, it remains uncertain whether response by imaging with PET has better predictive power of survival compared with conventional imaging with CT. Disclosures: Off Label Use: Review will likely involve off label use of drugs for follicular lymphoma in the upfront setting. Byrtek:Genentech: Employment, Equity Ownership. Flowers:Bio-Oncology: Consultancy; Genentech: Consultancy; Celgene: Consultancy; Janssen: Research Funding; Spectrum: Research Funding; Sanofi: Research Funding; Celgene: Research Funding; Abbott: Research Funding; Millennium/Takeda: Research Funding. Link:Millenium: Research Funding; Genentech: Research Funding; Spectrum: Consultancy; Pharmacyclics: Consultancy; Millenium: Consultancy; Genentech: Consultancy; Pharacyclics: Research Funding. Zelenetz:Cephalon: Consultancy; Gilead: Consultancy; Seattle Genetics: Consultancy; Sanofi-Aventis : Consultancy; Genentech: Research Funding; GSK: Research Funding; Roche: Research Funding; Cancer Genetics: Scientific Advisor Other; Celgene: Consultancy; GSK: Consultancy. Dawson:Roche: Equity Ownership; Genentech: Employment. Reid:Genentech: Research Funding.

Role of PET/CT As a Measure of Minimal Residual Disease (MRD) Negativity Among Patients with Myeloma Post Autologous Stem Cell Transplant (ASCT)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4202-4202
Author(s):  
Ajay K. Nooka ◽  
Jonathan L. Kaufman ◽  
A. Tuba Karagulle Kendi ◽  
Yan Li ◽  
Chikaodili O Obidike ◽  
...  
Keyword(s):  
Stem Cell ◽  
Research Funding ◽  
Residual Disease ◽  
Standardized Uptake Value ◽  
Response Assessment ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Pet Ct ◽  
Lytic Lesions

Abstract Background: In the context of improved novel therapeutic anti-myeloma regimens using combinations of antibodies and other small molecules, measuring the efficacy of therapy is an ongoing challenge. Minimal residual disease (MRD) assessment by multiparameter flow cytometry (MFC), polymerase chain reaction (ASO-PCR), next-generation sequencing are sensitive tests that are becoming more significant as improved therapies result in deeper responses, however challenges remain, such as standardizing these testing methods. 18F Fluorodeoxglucose Positron Emission Tomography/Computed Tomography (PET/CT) is a non invasive imaging modality that can provide essential information in diagnosis and management of MM. PET/CT has high sensitivity (80-90%) and specificity (80-100%) to detect MM lesions. PET/CT also has a recently acknowledged role in prognostic information. Standardized uptake value maximum (SUVmax) is a widely used PET/CT parameter for assessment of therapy response in a variety of cancers. Recent publication by Zamagni et al showed that in addition to the presence of three or more focal lesions, a maximum standardized uptake value (SUVmax) of over 4.2 and presence of extramedullary disease were negative prognostic factors. Our aim in this study was to evaluate the prognostic role of PET/CT in MM patients post ASCT at day 100 restaging. Methods: We have identified 130 myeloma patients that underwent autologous stem cell transplant (ASCT) from 09/2014 until 04/2015. Along with their hematologic restaging post-ASCT for response assessment per International Myeloma Working Group (IMWG) criteria, patients also underwent PET/CT for MRD assessment. After excluding 3 patients that underwent tandem transplants, and one patient that received stem cell boost, 102 patients were evaluable for the current analysis (24 patients did not undergo PET/CTs). We have done an exploratory analysis with previously described SUVmax cut off of <2.0 (Waheed S) and <4.2 (Zamagni E). Results: The median age of the patients that underwent ASCT was 64 years (range: 38-76 years). 77 pts (75%) received melphalan 200 mg/m2, 22 pts (22%) received melphalan 140 mg/m2, 2 pts received melphalan+bortezomib and 1 pt received BEAM regimen as conditioning regimen. Median time from day 0 to response assessment is 98 days (range: 55-189 days). Hematological restaging shows that 89% of patients achieved ≥VGPR (SCR: 46% and CR: 11%). 13 pts did not have prior lytic lesions while 89% had lytic lesions (one lesion: 4%, two lesions: 2% and multiple (≥3): 82%). PET/CT negativity was achieved among 63% of the patients. At SUV cut off of <2.0 and <4.2, PET/CT negativity was achieved among 64% of the patients and 83% of the patients respectively. Taking the patients that have achieved SCR, for the same cut offs, PET/CT negativity rates were 59% and 76% respectively (Table 1). Conclusions: Negative PET/CT rates post-ASCT are in accordance with previously published studies. With taking SUVmax as sole criteria for assessing MRD negativity, false positive PET/CT results will continue to remain a challenge. Although SUVmax is the most widely used PET/CT parameter, it has limitations. There are other PET/CT parameters mean or peak standardized uptake values (SUVmean, SUVpeak); metabolic tumor volume (MTV); total lesion glycolysis (TLG); standardized added metabolic activity (SAM); and, normalized standardized added metabolic activity (NSAM) used in clinical practice and research. These PET/CT parameters may have role as prognostic imaging probes in MM patients post ASCT. With longer follow up to assess PFS and OS, we can evaluate the prognostic impact of using PET/CT as MRD measure. Table 1. PET parameters and hematological responses Response Response rates PET positive PET negative PET positive (≥SUV 2.0) PET negative (<SUV 2.0) PET positive (≥SUV 4.2) PET negative (<SUV 4.2) SCR 46 19 27 19 27 11 35 CR 11 7 4 6 5 3 8 VGPR 34 9 25 9 25 3 31 PR 10 2 8 2 8 0 10 PD 1 1 0 1 0 1 0 ≥CR 57 26 31 25 32 14 43 ≥VGPR 91 35 56 34 57 17 74 Disclosures Nooka: Onyx Pharmaceuticals: Consultancy; Spectrum Pharmaceuticals: Consultancy. Kaufman:Milleniumm, Celgene, Novartis, Onyx, Spectrum: Consultancy. Gleason:Celgene: Consultancy; Novartis: Consultancy; Onyx: Consultancy. Lonial:Celgene: Consultancy, Research Funding; Millennium: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding; Onyx: Consultancy, Research Funding; Janssen: Consultancy, Research Funding.

Result of FDG PET-CT Imaging After Immunochemotherapy Induction Is a Powerful and Independent Prognostic Indicator of Outcome for Patients with Follicular Lymphoma: An Analysis From the PRIMA Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 855-855 ◽  
Author(s):  
Judith Trotman ◽  
Marion Fournier ◽  
Thierry Lamy ◽  
Jane A Estell ◽  
Anne Sonet ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Fdg Pet ◽  
Cox Model ◽  
Response Assessment ◽  
Post Treatment ◽  
Ct Scans ◽  
Induction Treatment ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Abstract 855 Aim: Despite its often indolent clinical course, follicular lymphoma (FL) is a heterogeneous disease. Current criteria for early identification of patients with a poor prognosis are suboptimal - the FLIPI and F2 index are insufficient prognostic markers for individual patients and the limitations of post-treatment conventional response criteria have long been acknowledged. FL shows increased FDG uptake, but unlike DLBCL, minimal data exist about the role of PET-CT in response assessment. We have used the prospective conventional response assessment and 42 month patient follow-up in the PRIMA (Primary Rituximab and Maintenance, Salles et al., ASCO 2010, Abstr#8004) study as a platform for analysis of the utility of PET-CT in FL. Methods: The PRIMA database was interrogated and investigators surveyed to identify PET-CT scans performed during staging and induction response assessment. Single modality PET-only scans were not eligible for inclusion. Local PET interpretation (positive + or negative -) was used to explore associations with patient outcomes. The primary endpoint was PFS from PRIMA registration. Results: 277 PET-CT scans on 160 patients from 40 centres were identified. Baseline patient characteristics did not differ from the overall PRIMA patient population. Positive PET-CT scans were recorded in 119/120 (99%) at diagnosis, 11/33 (33%) interim restaging scans and 32/124 (26%) post induction treatment (R-CHOP or R-CVP). There was significant correlation between PET-CT result and conventional response assessment at the end of immunochemotherapy (p<0.0005). The incidence of post-treatment PET+ increased across the categories of lesser conventional responses, occurring in 8% (4/50) CR, 31% (12/39) CRu, 41% (11/37) PR, 67% (2/3) SD, and 80% (4/5) PD. While 73/91 (80%) of PET- patients were in CR/CRu, given the very high overall response rate on study, 16/33 (48%) of the PET+ population were also in CR/CRu. With a median follow-up of 42 months, a significantly inferior actuarial 3yr PFS was observed in post-treatment PET+ vs. PET- patients (Figure 1): 32% (95% CI 17–48%) vs. 74% (95% CI 63–82%) (log rank p<0.0001, HR 3.5, 95% CI 2.0–6.1), median PFS 19 months (13-35) vs. not reached, (52-NR). Using proportional hazard regression analysis, both conventional response (overall p=0.0002) and PET+ status (HR 2.8 p=0.0007) were significant predictors of inferior PFS. However, the predictive power of conventional response assessment was limited to non-responders: SD/PD vs. CR/CRu (HR 6.5, p<0.0001), and SD/PD vs. PR (HR 5.2, p=0.0009). Comparison of PR vs. CR/CRu was not different (HR 1.2, p=0.5). While PET+ status had a significant negative impact on PFS in both the CR/CRu (HR 2.6, p=0.015) and PR (HR 4.3 p=0.018) patient groups, there was no difference in outcome between CR/CRu vs. PR patients within the PET+ (HR 1.5 p=0.42) and PET- (HR 1.0 p=0.98) subgroups. When only patients randomised for the maintenance element of the PRIMA study were considered, post-treatment PET+ (15/59) remained predictive of 3yr PFS (27 vs. 69%, HR 3.1, p=0.005) in the observation arm, but post-treatment PET+ (9/47) was not significantly associated with an adverse outcome in patients receiving rituximab maintenance (3-year PFS 56 vs. 81%, HR 2.2, p= 0.18). In a multivariate Cox model including responding patients the following factors were negative predictors of PFS: post-treatment PET+ (HR 3.1 p<0.0014); R-CVP induction therapy (HR 2.8, p<0.014); and baseline β2M ≥3 (HR 2.6 p<0.0042), while conventional PR and FLIPI were not. Conclusion: This PRIMA sub-study demonstrates that post-treatment PET-CT is a powerful predictor of PFS that complements conventional response evaluation after first line immunochemotherapy for FL. Patients who are PET- can expect a prolonged PFS whether in conventional CR or PR, but for those remaining PET+, with a median 19 month PFS, the disease cannot be characterized as indolent. Future clinical trials should evaluate an FDG PET-CT response adapted approach focused on improving outcomes for this group. Disclosures: Seymour: Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Shpilberg:Roche: Consultancy, Honoraria.

scholarly journals Role of FDG-PET/CT in the Staging of Patients with Follicular Lymphoma

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5010-5010 ◽  
Author(s):  
Sayako Yuda ◽  
Dai Maruyama ◽  
Hiroaki Kurihara ◽  
Akiko Miyagi Maeshima ◽  
Kosuke Toyoda ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Follicular Lymphoma ◽  
Fdg Pet ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Response Assessment ◽  
Bone Marrow Examination ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Introduction The Lugano Classification incorporating recommendations of 18-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography/computed tomography (PET/CT) in the staging and response assessment of FDG-avid lymphomas was published. This classification is based on plenty of reports that suggested that evaluation with FDG-PET/CT improved the accuracy of the staging and response assessment of FDG-avid lymphomas, especially of diffuse large B-cell lymphoma and Hodgkin lymphoma. However, we are not sure of the role of FDG-PET/CT in indolent B-cell lymphomas, such as follicular lymphoma (FL). Patients and Methods Patients who were initially diagnosed as having FL of grade 1 to 3a at our institution between 2010 and 2012 were included in this study. We analyzed the number of nodal areas and the location of extranodal diseases identified by FDG-PET/CT added to the conventional evaluation consisting of CT, bone marrow examination and upper gastrointestinal endoscopy. The clinical stage by the conventional evaluation was compared to that by the Lugano Classification using FDG-PET/CT. It was also investigated whether adding PET/CT to the conventional evaluation might have had any influence on the decision regarding the initial treatment for patients with FL. Results A total of 67 patients with a median age of 62 years (range: 39-85) were included in this analysis. In comparison with CT, FDG-PET/CT identified a higher number of nodal areas in 11 patients (16%). Most of the extranodal sites except bone marrow and gastrointestinal tract were more frequently detected by PET-CT. Bone marrow examination detected 22 patients (33%) with bone marrow involvement, while PET-CT detected only 4 patients (6%). Gastrointestinal lesions were identified in 15 patients (22%) with conventional evaluation and in 4 patients (6%) by PET-CT (Table 1). In one of these 4 patients, endoscopic biopsy revealed that the PET-CT positive lesion was adenoma. In seven patients (10%), upstaging occurred through conventional evaluation plus PET-CT: 3 patients were upstaged from stage I to II, 2 from stage II to IV, 1 from stage II to III, and 1 from stage III to IV (Table 2). International Prognostic Index (IPI) and Follicular Lymphoma International Prognostic Index (FLIPI) were revised upward in 9 patients (13%) and 12 patients (18%), respectively. However, the change of stage, IPI, or FLIPI did not affect the decision regarding the initial treatment. Conclusion Our data suggest that FDG-PET/CT cannot take the place of the conventional evaluation, especially in patients with FL, because of the low sensitivity of involvements in bone marrow and gastrointestinal tract, although it may be helpful to use FDG-PET/CT in the staging of FL. Moreover, FDG-PET/CT might not have had any impact on the decision regarding the treatment strategy in FL. That may be partly because the lesions detected only by FDG-PET/CT did not affect the judgment of tumor burden. Prospective evaluation of the influence of FDG-PET/CT on the clinical outcomes is needed to establish an appropriate evaluation in the staging of patients with FL. Disclosures Maruyama: Takeda Pharmaceutical Company Limited: Honoraria; Eisai Co., Ltd.: Honoraria. Kobayashi:Nippon Shinyaku: Honoraria; Pfizer: Research Funding. Tobinai:Gilead Sciences: Research Funding.

Role of WB-MR/DWIBS compared to 18F-FDG PET/CT in the therapy response assessment of lymphoma

2015 ◽  
Vol 121 (2) ◽  
pp. 132-143 ◽  
Author(s):  
Nicola Maggialetti ◽  
Cristina Ferrari ◽  
Carla Minoia ◽  
Artor Niccoli Asabella ◽  
Michele Ficco ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Therapy Response ◽  
Response Assessment ◽  
Pet Ct ◽  
Therapy Response Assessment ◽  
18F Fdg ◽  
Fdg Pet Ct

Positron Emission Tomography–Computed Tomography (PET-CT) After Induction Therapy Is Highly Predictive of Patient Outcome in Follicular Lymphoma: Analysis of PET-CT in a Subset of PRIMA Trial Participants

2011 ◽  
Vol 29 (23) ◽  
pp. 3194-3200 ◽  
Author(s):  
Judith Trotman ◽  
Marion Fournier ◽  
Thierry Lamy ◽  
John Francis Seymour ◽  
Anne Sonet ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Follicular Lymphoma ◽  
Induction Therapy ◽  
Complete Response ◽  
Emission Tomography ◽  
Ct Scans ◽  
Risk Of Death ◽  
Positron Emission ◽  
Pet Ct

Purpose The utility of [18F]fluorodeoxyglucose (FDG) positron emission tomography–computed tomography (PET-CT) in assessing response at the end of induction therapy is well documented in Hodgkin's and diffuse large B-cell lymphomas, but its role in follicular lymphoma (FL) remains undetermined. We investigated the prognostic significance of PET-CT performed after first-line therapy in patients with FL treated in the prospective Primary Rituximab and Maintenance (PRIMA) study. Patients and Methods Results of PET-CT scans performed after induction immunochemotherapy were recorded retrospectively. Patients went on to either observation or rituximab maintenance per protocol independent of the PET-CT result. Patient characteristics and outcomes were then evaluated. Results Of 122 PET-CT scans performed at the end of the induction immunochemotherapy, 32 (26%) were reported as positive by the local investigator. Initial demographic or disease characteristics did not differ between PET-CT–positive (PET-positive) and PET-CT–negative (PET-negative) patients. PET status correlated with conventional response criteria (P < .001). Patients remaining PET positive had a significantly (P < .001) inferior progression-free survival at 42 months of 32.9% (95% CI, 17.2% to 49.5%) compared with 70.7% (95% CI, 59.3% to 79.4%) in those who became PET negative. PET status, but not conventional response (complete response or complete response unconfirmed v partial response) according to IWC 1999, was an independent predictive factor for lymphoma progression. The risk of death was also increased in PET-positive patients (hazard ratio 7.0; P = .0011). Conclusion [18F]FDG PET-CT status at the end of immunochemotherapy induction in patients with FL is strongly predictive of outcome and should be considered a meaningful clinical end point in future studies.

scholarly journals Phase 2 Trial of Entospletinib (GS-9973), a Selective SYK Inhibitor, in Follicular Lymphoma (FL)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4419-4419 ◽  
Author(s):  
Jeff P. Sharman ◽  
Leonard M. Klein ◽  
Michael Boxer ◽  
Kathryn S. Kolibaba ◽  
Michael J. Hawkins ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Median Duration ◽  
Research Funding ◽  
Response Assessment ◽  
Phase 2 ◽  
Employment Equity ◽  
Prognostic Features ◽  
Phase 2 Trial ◽  
First Response ◽  
Equity Ownership

Abstract Background: Spleen tyrosine kinase (Syk) is a mediator of B-cell receptor signaling in normal and transformed B-cells. Entospletinib is an orally bioavailable, selective inhibitor of Syk (Kd 7.6 nM, no other kinase < 100 nM). Methods: This Phase 2 trial is evaluating Entospletinib 800 mg BID in a 41 subject cohort with previously treated FL in a study of 165 subjects with lymphoid malignancies. Tumor imaging was planned at weeks 8, 16, 24 and then every 12. Tumor response was assessed per Cheson 2007 criteria. Results: For the subjects with FL included in this analysis, median age was 67 years (range 41 – 89), 49% were male. The median number of prior Rx regimens was 2 (range 1-8). Prior treatments (Rxs) included anti-CD20 antibodies (rituximab 100%, ofatumumab 5%), alkylating agents (95%; bendamustine 51%) and anthracyclines (51%). Baseline risk factors: Ann Arbor Stg III-IV (66%), Gr 3a FL (27%), FLIPI ≥3 (34%). At the time of this analysis, 41 subjects with follicular lymphoma were enrolled and 38 subjects have been treated through first response assessment (1 subject ongoing prior to first response assessment, 1subject discontinued due to AE and 1 subject withdrew consent). Entospletinib was generally well tolerated. The most common TEAEs (any Grade/≥Gr 3, independent of causality) were fatigue (46%/12%), nausea (42%/2%), diarrhea(27%/0%), decreased appetite (22%/0%), vomiting (22%/0%) and common laboratory abnormalities were increased AST (37%/17%), increased ALT (34%/20%), increased total bilirubin (27%/5%), anemia (34%/10%) and neutropenia (22%/10%). Reversible Grade 3 or 4 ALT/AST elevations occurred in 8 (19.5%) FL subjects. 3 subjects died while on study: 2 from progressive disease and 1 from acute renal failure investigator reported as unrelated to study drug. Investigator response assessments are available for 29 subjects, 16/29 (55%) subjects experienced reduced tumor bulk measured by SPD; 3 (10%) achieved a decrease of ≥ 50%. CR has not been observed at this early evaluation. 14/41 subjects continue on Rx. Median duration of Rx for all patients was 15 weeks. Among all patients who experienced reduction in tumor volume, median duration of Rx was 25 weeks (range 4-51). Conclusions: Entospletinib monotherapy given with this dose and schedule was generally well tolerated and demonstrated moderate activity in subjects with advanced relapsed FL, including those with poor prognostic features. Updated data with longer follow-up duration will be presented at the meeting. Disclosures Sharman: Gilead Sciences: Research Funding. Klein:Gilead Sciences: Research Funding. Boxer:Gilead Sciences: Research Funding. Kolibaba:Gilead Sciences: Research Funding. Hawkins:Gilead Sciences: Research Funding. Abella:Gilead Sciences: Employment, Equity Ownership. Wu:Gilead Sciences: Employment, Equity Ownership. Yasenchak:Gilead Sciences: Research Funding.

Hybrid Imaging in Evaluation of Abdominal Sarcoidosis

2018 ◽  
Vol 15 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Isidora Grozdic Milojevic ◽  
Dragana Sobic-Saranovic ◽  
Nebojsa Petrovic ◽  
Slobodanka Beatovic ◽  
Marijana Tadic ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Therapy Response ◽  
Ct Examination ◽  
Abdominal Disease ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Total Remission ◽  
Active Disease

Objective: To determine the prevalence of abdominal involvement, distribution pattern and evaluate role of hybrid molecular imaging in patients with abdominal sarcoidosis. Methods: Between January 2010 and December 2011, 98 patients with chronic sarcoidosis and presence of prolonged symptoms or other findings suggestive of active disease were referred to FDG PET/CT examination. Active disease was found in 82 patients, and they all were screened for the presence of abdominal sarcoidosis on FDG PET/CT. All patients also underwent MDCT and assessment of serum ACE level. Follow up FDG PET/CT examination was done 12.3±5.4 months after the baseline. Results: Abdominal sarcoidosis was present in 31/82 patients with active sarcoidosis. FDG uptake was present in: retroperitoneal lymph nodes (77%), liver (26%), spleen (23%), adrenal gland (3%). Majority of patients had more than two locations of disease. Usually thoracic disease was spread into the extrathoracic localizations, while isolated abdominal sarcoidosis was present in 10% of patients. After first FDG PET/CT examination therapy was changed in all patients. Eleven patients came to the follow up examination where SUVmax significantly decreased in the majority of them. Three patients had total remission, three had absence of abdominal disease but discrete findings in thorax and others had less spread disease. ACE levels did not correlate with SUVmax level. Conclusion: FDG PET/CT can be a useful tool for detection of abdominal sarcoidosis and in the evaluation of therapy response in these patients. Awareness of the presence of intra-abdominal sarcoidosis is important in order to prevent long-standing unrecognized disease.

scholarly journals High Basal Maximal Standardized Uptake Value (SUVmax) in Follicular Lymphoma Identifies Patients with a Low Risk of Long-Term Relapse

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2876
Author(s):  
Giovanni Manfredi Assanto ◽  
Giulia Ciotti ◽  
Mattia Brescini ◽  
Maria Lucia De Luca ◽  
Giorgia Annechini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Follicular Lymphoma ◽  
Standardized Uptake Value ◽  
Metabolic Tumor Volume ◽  
Late Relapse ◽  
Prognostic Role ◽  
Pet Ct ◽  
Group A ◽  
Group B

Background: Despite that the unfavorable prognostic role of a high Total Metabolic Tumor Volume (TMTV) in Follicular Lymphoma has been demonstrated, the role of SUVmax alone at baseline PET/CT could have a different prognostic role. Patients and Methods: We performed a retrospective observational monocentric cohort study. All patients affected by FL who underwent a basal PET/CT were included. Two subgroups were identified and compared in terms of PFS and OS: (A) Basal SUVmax ≤ 6; and (B) Basal SUVmax > 6. Results: Ninety-four patients were included, 34 in group A (36.2%) and 60 in group B (63.8%). The PFS at two years was comparable in the two groups (97%). The five-year PFS was 73.5% for group A and 95% for group B (p 0.005). The five-year PFS in the whole cohort was 87.5%. A clear advantage was confirmed in group A in the absence of other risk factors. Patients with SUVmax ≤ 6 and no risk factors showed a 5-year PFS of 73% against 83% for patients with SUVmax > 6 and at least two risk factors. Conclusion: A high FDG uptake favorably correlated with PFS. A low basal SUVmax reflected a higher rate of late relapse requiring a prolonged follow-up. The basal SUVmax is an approachable parameter with prognostic implications.

323P The role of SUVmax in 18F-FDG PET/CT for assessing radiation therapy response for cervical cancer

2016 ◽  
Vol 27 (suppl_9) ◽  
Author(s):  
S.H. Lee ◽  
K.C. Lee ◽  
K. Sung ◽  
E.Y. Choi ◽  
J.B. Bae ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Fdg Pet ◽  
Therapy Response ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

scholarly journals Not All That Shines on a PET Scan Is Cancer: A Silicone-Induced Granuloma Masquerading as Malignancy

2020 ◽  
Vol 11 (1) ◽  
pp. 8-12
Author(s):  
Krishna Vedala ◽  
Philip Sobash ◽  
Deborah Johnson ◽  
Krishna Kakkera
Keyword(s):  
Pet Scan ◽  
Imaging Modalities ◽  
Ct Scans ◽  
Pet Ct ◽  
Suspicious Lesions

PET/CT scans are frequently used in the initial workup of suspicious lesions but not all that lights up on a PET is cancerous. We wish to discuss a case of silicone-induced granuloma mimicking malignancy and the role of other imaging modalities for further workup.

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