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

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

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Predictive value of F-18 FDG PET/CT quantization parameters in diffuse large B cell lymphoma: a meta-analysis with 702 participants

Medical Oncology ◽

10.1007/s12032-014-0446-1 ◽

2014 ◽

Vol 32 (1) ◽

Cited By ~ 32

Author(s):

Mixue Xie ◽

Kefei Wu ◽

Yan Liu ◽

Qi Jiang ◽

Yanhui Xie

Keyword(s):

B Cell ◽

Predictive Value ◽

Fdg Pet ◽

Cell Lymphoma ◽

Meta Analysis ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Pet Ct ◽

Fdg Pet Ct ◽

Large B Cell

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Predictive value of interim FDG-PET/CT findings in patients with diffuse large B-cell lymphoma treated with R-CHOP

Oncotarget ◽

10.18632/oncotarget.27103 ◽

2019 ◽

Vol 10 (52) ◽

pp. 5403-5411 ◽

Cited By ~ 1

Author(s):

Kazuhiro Kitajima ◽

Masaya Okada ◽

Kyoko Yoshihara ◽

Tazuko Tokugawa ◽

Akihiro Sawada ◽

...

Keyword(s):

B Cell ◽

Predictive Value ◽

Fdg Pet ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Ct Findings ◽

Pet Ct ◽

Fdg Pet Ct ◽

Large B Cell

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Predictive value of baseline 18F‑FDG PET/CT and interim treatment response for the prognosis of patients with diffuse large B‑cell lymphoma receiving R‑CHOP chemotherapy

Oncology Letters ◽

10.3892/ol.2020.12393 ◽

2020 ◽

Vol 21 (2) ◽

Author(s):

Lili Zhu ◽

Yankai Meng ◽

Lili Guo ◽

Hanqing Zhao ◽

Yue Shi ◽

...

Keyword(s):

B Cell ◽

Predictive Value ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Chop Chemotherapy ◽

Large B Cell Lymphoma ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Large B Cell

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Right Atrium Mass Assessed with 18F-FDG PET/CT Scan Turns Out to Be an Uncommon Relapse of Testicular Diffuse Large B-cell Lymphoma: A Case Report

Diagnostics ◽

10.3390/diagnostics10110987 ◽

2020 ◽

Vol 10 (11) ◽

pp. 987

Author(s):

Stefano Panareo ◽

Luca Urso ◽

Ivan Santi ◽

Gian Matteo Rigolin ◽

Antonio Cuneo ◽

...

Keyword(s):

Ct Scan ◽

Cell Lymphoma ◽

Superior Vena ◽

Vena Cava ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Pet Ct Scan

We report the case of a 71-year-old man affected by testicular large B-cell lymphoma (DLBCL), treated with right orchiectomy and first-line chemotherapy (R-CHOP, 8 cycles). A complete remission was obtained after therapy. Twenty-two months after the primary diagnosis the patient suddenly presented dyspnoea and superior vena cava syndrome; thus, he underwent a CT scan that revealed a large mass in the right atrium, expanding to the superior vena cava. A differential diagnosis between a neoplastic mass and a clot was proposed. The subsequent MR did not clarify the nature of the mass; therefore, the patient underwent an 18F-FDG PET/CT scan (PET/CT), after a specific preparation to reduce fluoro-deoxyglucose (FDG) myocardial uptake. PET/CT revealed an intense FDG uptake involving the whole mass (SUVmax 9.4), suggestive for neoplasm and confirmed by the subsequent endocardiac biopsy. The patient was treated with 8 cycles of R-COMP, obtaining a complete remission, as indicated by the PET/CT performed after the seventh cycle of therapy. The case that we are reporting highlights that DLBCL can have an uncommon relapse presentation in the atrium. PET/CT, compared to conventional imaging, can be a valuable tool to detect early and better characterize cardiac lesions in order to improve the poor prognosis of these conditions.

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

Blood ◽

10.1182/blood.v126.23.1458.1458 ◽

2015 ◽

Vol 126 (23) ◽

pp. 1458-1458 ◽

Cited By ~ 1

Author(s):

He Huang ◽

Jiatian Lin ◽

Chengcheng Guo ◽

Shanshan Li ◽

Huangming Hong ◽

...

Keyword(s):

Ct Scan ◽

Predictive Value ◽

Fdg Pet ◽

B Cell Lymphoma ◽

Cancer Center ◽

Chop Regimen ◽

Interim Pet ◽

Pet Ct ◽

Fdg Pet Ct ◽

Pet Ct Scan

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

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PB1837 THE PREDICTIVE VALUE OF PET/CT SCAN IN DIFFUSE LARGE B-CELL LYMPHOMA IN OPTIMIZING THE TREATMENT DECISION

HemaSphere ◽

10.1097/01.hs9.0000565852.22530.6f ◽

2019 ◽

Vol 3 (S1) ◽

pp. 840 ◽

Cited By ~ 1

Author(s):

H. Zawam ◽

S. Alrefai ◽

M. Abougabal ◽

R. Salama ◽

H. Zawam ◽

...

Keyword(s):

Ct Scan ◽

B Cell ◽

Predictive Value ◽

Cell Lymphoma ◽

Treatment Decision ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Pet Ct ◽

Pet Ct Scan ◽

Large B Cell

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Panaortitis diagnosed by 18F-FDG PET/CT scan in a patient with diffuse large B-cell lymphoma

Revista Española de Medicina Nuclear ◽

10.1157/13107976 ◽

2007 ◽

Vol 26 (4) ◽

pp. 232-233 ◽

Cited By ~ 2

Author(s):

E. Roldán Valadez ◽

I. Vega-González ◽

G. Valdivieso-Cárdenas

Keyword(s):

B Cell ◽

Fdg Pet ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Pet Ct Scan ◽

Large B Cell

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Final Results of a Prospective Evaluation of the Predictive Value of Interim Positron Emission Tomography in Patients With Diffuse Large B-Cell Lymphoma Treated With R-CHOP-14 (SAKK 38/07)

Journal of Clinical Oncology ◽

10.1200/jco.2014.58.9846 ◽

2015 ◽

Vol 33 (23) ◽

pp. 2523-2529 ◽

Cited By ~ 78

Author(s):

Christoph Mamot ◽

Dirk Klingbiel ◽

Felicitas Hitz ◽

Christoph Renner ◽

Thomas Pabst ◽

...

Keyword(s):

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Ct Scans ◽

Interim Pet ◽

Large B Cell Lymphoma ◽

Positron Emission ◽

End Of Treatment ◽

Pet Ct ◽

Large B Cell

Purpose Our main objective was to prospectively determine the prognostic value of [18F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) after two cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone given every 14 days (R-CHOP-14) under standardized treatment and PET evaluation criteria. Patients and Methods Patients with any stage of diffuse large B-cell lymphoma were treated with six cycles of R-CHOP-14 followed by two cycles of rituximab. PET/CT examinations were performed at baseline, after two cycles (and after four cycles if the patient was PET-positive after two cycles), and at the end of treatment. PET/CT examinations were evaluated locally and by central review. The primary end point was event-free survival at 2 years (2-year EFS). Results Median age of the 138 evaluable patients was 58.5 years with a WHO performance status of 0, 1, or 2 in 56%, 36%, or 8% of the patients, respectively. By local assessment, 83 PET/CT scans (60%) were reported as positive and 55 (40%) as negative after two cycles of R-CHOP-14. Two-year EFS was significantly shorter for PET-positive compared with PET-negative patients (48% v 74%; P = .004). Overall survival at 2 years was not significantly different, with 88% for PET-positive versus 91% for PET-negative patients (P = .46). By using central review and the Deauville criteria, 2-year EFS was 41% versus 76% (P < .001) for patients who had interim PET/CT scans after two cycles of R-CHOP-14 and 24% versus 72% (P < .001) for patients who had PET/CT scans at the end of treatment. Conclusion Our results confirmed that an interim PET/CT scan has limited prognostic value in patients with diffuse large B-cell lymphoma homogeneously treated with six cycles of R-CHOP-14 in a large prospective trial. At this point, interim PET/CT scanning is not ready for clinical use to guide treatment decisions in individual patients.

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