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

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.

Download Full-text

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

Blood ◽

10.1182/blood.v116.21.2808.2808 ◽

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.

Download Full-text

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

Blood ◽

10.1182/blood.v120.21.5076.5076 ◽

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.

Download Full-text

Prognostic value of PET-CT in early stage Hodgkin Lymphoma (HL) using updated 5 point scoring system.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.15_suppl.e19013 ◽

2016 ◽

Vol 34 (15_suppl) ◽

pp. e19013-e19013

Author(s):

Vishwanath Sathyanarayanan ◽

Dai Chihara ◽

Michelle A. Fanale ◽

Colleen M Costelloe ◽

Elham Ghonimi ◽

...

Keyword(s):

Hodgkin Lymphoma ◽

Scoring System ◽

Prognostic Value ◽

Early Stage ◽

Pet Ct

Download Full-text

SUV Max Reduction Criteria of Interim Positron Emission Tomography Improves Prognostic Value in Diffuse Large B-Cell Lymphoma: A Single-Center Retrospective Review

Blood ◽

10.1182/blood.v124.21.1654.1654 ◽

2014 ◽

Vol 124 (21) ◽

pp. 1654-1654

Author(s):

Yusuke Okamoto ◽

Shinichi Ochi ◽

Takashi Nagayama ◽

Shogo Nabe ◽

Kazuya Sakai ◽

...

Keyword(s):

Prognostic Value ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Emission Tomography ◽

P Value ◽

Interim Pet ◽

Large B Cell Lymphoma ◽

Pet Ct ◽

18F Fdg ◽

Large B Cell

Abstract Background: A consensus is yet to be reached on therole of interim fluorine-18 fluorodeoxyglucose (18F-FDG) position emission tomography-computed tomography (PET-CT) for prognosis in diffuse large B-cell lymphoma (DLBCL), but it has been recently reported that maximum standardized uptake value (SUV max) reduction between baseline and midtherapy may be a better predictor of overall survival (OS) and event free survival (EFS). Patients and Method: 456 patients were newly diagnosed with DLBCL in our institute between February 2007 and January 2013. Primary central nervous system lymphoma or primary effusion lymphoma patients were excluded from this study. All patients who were not perfomed PET were also excluded. In order to determine the predictive value of interim PET-CT and SUV max reduction criteria on OS and EFS for patients with DLBCL, we retrospectively analyzed the PET-CT and SUV max data of 104 first-line DLBCL patients treated with 6 to 8 courses of R-CHOP or R-THPCOP therapy. PET-CT was performed at diagnosis (baseline), and after 2 to 4 courses (interim PET). Interim PET was scheduled two weeks after the second to fourth cycle of immunochemotherapy. A visual analysis of interim PET was done with the use of the Deauville criteria, and an analysis of the SUV max reduction criteria was calculated by [(SUV max reduction from baseline to interim PET)/SUV max at baseline]. For each PET image, the tumor with the most intense 18F-FDG uptake was identified among all foci with the use of a graded color scale. The hottest volumetric region was determined, and the SUV max was calculated. To assess the SUV max, the hottest tumor in any region or organ on interim PET was used for comparison, even if its location differed from the initial hottest tumor in baseline PET. Survival curves were estimated with Kaplan–Meier analysis and compared using the log-rank test. Results: One hundred and four patients were enrolled in this study, and their characteristics are detailed in Table 1. With a median follow-up of 38.5 months, the two-year overall survival and EFS were 83.3% and 73.6%. The results forinterim PET were 66.3% (69/104) negative and 33.7% (35/104) positive, respectively. Interim PET negative versus positive two-year OS was 85.0% (95%CI 0.739-0.917) versus 79.9% (95%CI 0.624-0.899) (P value 0.58), and the two-year EFS was 77.7% (95%CI 0.658-0.860) versus 65.7% (0.476-0.789) (P value 0.24), respectively (Figure 1). The SUV max cutoff values 66% estimated by receiver-operating-characteristic (ROC) analysis to distinguish treatment response were similar to other independent cohort studies at 2 to 4 cycles of induction treatment, and this threshold was chosen to analyze our series. For SUV max data, the two-year OS was 84.4% (95%CI 0.750-0.904) for a SUV max reduction ≥66.0% compared with 75.0% (95%CI 0.408-0.912) for a reduction of <66.0% (P value 0.02). The two-year EFS for the former was 75.7% (95%CI 0.654-0.833) compared with 58.3% (95%CI 0.270-0.801) for the latter (P value 0.03) (Figure 2). Baseline characteristics according to SUV max reduction criteria [SUV max≥66%(n=92),and SUV max<66%(n=12)] are summarized in Table 1. Conclusions: Analysis of the data in our study was unable to demonstrate the predictive value of interim PET for OS and EFS, but SUV max reduction criteria may improve the prognostic value of interim PET. However, the 66% cutoff value must be validated in a larger-scale prospective trial, and further investigation and the standardization of SUV max reduction criteria are needed. Disclosures No relevant conflicts of interest to declare.

Download Full-text

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

Blood ◽

10.1182/blood.v120.21.3630.3630 ◽

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.

Download Full-text

The prognostic value of positron emission tomography performed after two courses (INTERIM-PET) of standard therapy on treatment outcome in early stage Hodgkin lymphoma: A multicentric study by the fondazione italiana linfomi (FIL)

American Journal of Hematology ◽

10.1002/ajh.23994 ◽

2015 ◽

Vol 90 (6) ◽

pp. 499-503 ◽

Cited By ~ 37

Author(s):

Luigi Rigacci ◽

Benedetta Puccini ◽

Pier Luigi Zinzani ◽

Alberto Biggi ◽

Antonio Castagnoli ◽

...

Keyword(s):

Positron Emission Tomography ◽

Treatment Outcome ◽

Hodgkin Lymphoma ◽

Standard Therapy ◽

Prognostic Value ◽

Early Stage ◽

Emission Tomography ◽

Multicentric Study ◽

Interim Pet ◽

Positron Emission

Download Full-text

Elderly Hodgkin Lymphoma At MSKCC From 1994–2008: Characteristics, Outcome and Risk Factor Analysis in 133 Patients,

Blood ◽

10.1182/blood.v118.21.3648.3648 ◽

2011 ◽

Vol 118 (21) ◽

pp. 3648-3648 ◽

Cited By ~ 1

Author(s):

Zachary H Word ◽

Jocelyn C Maragulia ◽

Janelle Walkley ◽

Daniel R. Smith ◽

Paul Hamlin

Keyword(s):

Risk Factors ◽

Hodgkin Lymphoma ◽

Conflicts Of Interest ◽

Early Stage ◽

Prognostic Score ◽

Dose Intensity ◽

Baseline Risk ◽

Curative Intent ◽

Prognostic Features ◽

Interim Pet

Abstract Abstract 3648 Background: Hodgkin Lymphoma (HL) is generally associated with young age and high cure rates, but inferior outcomes are seen in the 15–20% of patients (pts) aged ≥60 at diagnosis. Failure free survival rates (FFS) are reported at 30–50% for older pts vs 70–85% for younger pts. Reasons for inferior outcomes include ageism, comorbidity, more aggressive biology, reduced dose intensity and excess toxicity; hence, standard ABVD is difficult to tolerate, and more aggressive regimens like BEACOPP excessively toxic. The International Prognostic Score (IPS), used to predict outcomes in advanced (adv) HL, has not been specifically examined in pts >60 years. We sought to characterize the risk factors, tolerance of treatment and outcomes among elderly HL pts at our institution. Methods: We reviewed records for pts ≥ 60 years old with a diagnosis of HL seen at MSKCC between January 1994 and December 2008. Data was extracted regarding demographics, prognostic features, treatment, and outcomes including toxicity, overall survival (OS) and disease specific survival (DSS). Results: 238 pts were identified of whom 105 were excluded from analysis, primarily due to second-opinion only/incomplete records (n=58), age <60 years at diagnosis (n=38), and diagnosis other than HL (n=6), leaving 133 pts for analysis. Characteristics of this group are described in table 1. 110 pts (83%) were treated with curative intent chemotherapy; the most common regimen used was ABVD in 71 pts (66%), followed by Stanford V in 13 pts (12%) and MOPP-like regimens in 6 (5%). 52 pts (35 early, 17 adv) received radiation. Cause of death was HL in 20 (33.3%), unknown in 19 (31.6%), other malignancy in 14 (23%), toxicity in 7 (12%). Median OS and DSS, respectively: for all pts was 8.6 and 9.8 years; for early stage both OS and DSS 10.0 years and for adv stage 4.0 and 8.8 years. Median follow-up for surviving pts was 4.5 years, at which time Kaplan-Meier (KM) estimates of OS for all pts/early stage/adv stage are 64%/ 81%/49% respectively (figure 1, 2). DSS for all pts/early stage/adv stage are 69% / 90% / 58%. Complete data was present for all IPS variables in 72 of 82 adv stage pts. Thirty (41.7%) pts had ≥4 IPS risk factors and significantly inferior OS and DSS of 24% and 35%, respectively compared with 59% and 66% with <4 IPS risk factors. Median OS and DSS for the high risk group were both 1.1 years; in low risk pts they were 5.6 years (OS) (Figure 3) and 11 years (DSS). EBV status, comorbidity and any dose delays >7 days or >14 days did not predict outcome. Interim PET scan was performed on 33 pts, of whom 22 were adv stage. Nine of 22 were performed after the 2nd cycle and 13 after the 4th. There was a trend toward inferior survival in 8 pts with positive interim PET compared to 14 with negative interim PET (p=0.077). Conclusions: Elderly HL pts treated at MSKCC frequently had adverse baseline risk factors including mixed cellularity histology, adv. stage, high comorbidity, and IPS≥4 at presentation; despite this, curative intent therapy was given in 83% of pts and is associated with outcomes comparable to reported clinical trials in elderly HL. The IPS is predictive of outcome in adv stage elderly HL pts, with IPS≥4 associated with worse outcomes; Interim PET scans also trended to predict outcome in this population. Our analysis supports the need for development of novel treatment paradigms in this patient population. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

Whole body diffusion-weighted MRI to predict treatment outcome after one cycle of immunochemotherapy in aggressive non-Hodgkin lymphoma.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.7534 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 7534-7534

Author(s):

Katja De Paepe ◽

Frederik De Keyzer ◽

Oliver Bechter ◽

Ciska-Anne Van Keerberghen ◽

Olivier Gheysens ◽

...

Keyword(s):

Multivariate Analysis ◽

Treatment Outcome ◽

Hodgkin Lymphoma ◽

Hazard Ratio ◽

Whole Body ◽

Interim Pet ◽

Non Hodgkin Lymphoma ◽

Diffusion Weighted ◽

End Of Treatment ◽

Pet Ct

7534 Background: Treatment adaptation based on early identification of non-Hodgkin lymphoma (NHL) patients not responding to therapy might improve survival. The role of interim fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) after 2-4 cycles of immunochemotherapy (ICT) herein is experimental as it renders false positive results, due to a rituximab-induced inflammatory response. Whole body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) was evaluated as a radiation-free imaging technique to predict treatment outcome in NHL after one cycle ICT (2-3 weeks). Methods: 47 patients with aggressive NHL (35 DLBCL,2 primary mediastinal BCL,3 unclassifiable BCL, 2 Burkitt,2 MCL, 2 peripheral TCL and 1 extranodal NK-TCL) were enrolled. All had baseline and interim WB-DWI/MRI, and end-of-treatment PET/CT; 39/47 had interim PET/CT. International prognostic index (IPI), immunohistochemical (IHC) markers Ki-67, Bcl-6 and Bcl-2 were evaluated for their predictive value. WB-DWI/MRI was assessed quantitatively with histogram analysis (high b-value signal intensity (SI) and apparent diffusion coefficient (ADC)). Patients were categorized as non-responder when lesions had decreased ADC or insufficient SI decrease between scans. Kaplan-Meier survival analysis was performed with log rank, Cox hazard ratio calculation and multivariate analysis. Outcome measure was disease-free-survival (DFS). Results: Median follow-up time was 43 months (4-70 months). 33 patients had complete remission (CR), 5 progression and 9 recurrent disease. WB-DWI/MRI predicted DFS correctly in 45/47 (96%) [log rank p<0.001; hazard ratio (HR) 52, (CI 95% 6-401)]; end-of-treatment PET/CT was correct in 37/47 (79%) [p=0.003;HR 4.3, (1.5-12.4)], and interim PET/CT in 28/39 (72%) [p=0.016;HR 3.9, (1.2-12.5)]. IPI score and IHC parameters were not significantly predictive. Multivariate analysis showed WB-DWI/MRI as the only independent prognostic factor (p<0.001). Conclusions: WB-DWI/MRI can accurately predict treatment outcome in aggressive NHL after only one cycle of immunochemotherapy without the burden of radiation exposure. Clinical trial information: NCT01231269.

Download Full-text

Prognostic value of early imaging following CAR T-cell therapy in DLBCL.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e19559 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e19559-e19559

Author(s):

Amneet Bajwa ◽

Ying Huang ◽

Rui Li ◽

Nathan Denlinger ◽

Jonathan Edward Brammer ◽

...

Keyword(s):

T Cell ◽

Prognostic Value ◽

Cox Model ◽

B Cell Lymphoma ◽

Median Number ◽

T Cell Therapy ◽

Kaplan Meier ◽

Pet Ct ◽

Progression Of Disease

e19559 Background: Chimeric antigen receptor T-cell (CART) therapies lead to durable disease control in patients (pts) with relapsed/refractory (R/R) Diffuse Large B-cell Lymphoma (DLBCL). We assessed the prognostic value of response on first staging scan, and whether pts with progression of disease (PD) convert to a response on second scan. Methods: We conducted a retrospective analysis of pts with R/R DLBCL treated with CART at our institute. Baseline characteristics were assessed at apheresis. We included staging scans (CT, PET-CT and MRI) that occurred up to 6 months (mos) after CART infusion. Responses were determined via the Lugano 2014 criteria. Overall survival (OS) was calculated from first scan to last follow-up. Kaplan Meier method and Cox model were used to correlate first scan result with OS. Results: Of the 118 pts who received CART, 111 pts had evaluable staging scans (7 passed prior to first scan). Of the 111 pts, median age was 61 years (range, 23-84), and median number of prior therapies was 3 (range, 1-7). 61 pts received tisagenlecleucel, and 50 pts received axicabtagene ciloleucel. 22% of pts had MYC rearrangement by FISH. The majority of pts were stage 3/4 (91%), with an IPI score ≥2 (82%). 32%, 66% and 2% of pts had a CT, PET-CT or MRI as their first scan respectively. After a median follow-up of 16.2 mos, median OS from first scan was not reached (NR) (95% CI, 17-NR). 37%, 5%, 32%, 25% of pts had PD, SD, PR, and CR on first scan respectively. Median time to first scan was 59 days (range, 13-115). Median OS for pts who had PD was 3 mos (95% CI 2-8), and the median OS for those who attained SD, PR or CR was NR (95% CI NR-NR). Accounting for statistically important factors on multivariate analysis, PD on first scan was an independent predictor of OS (p<.001, HR 10.1 (95% CI 4.7-22)). We observed no evidence that pts with PD on first scan convert to a response on second scan without intervention. 26 of 41 pts who had PD did not start new treatment, 17 passed without follow-up scan, 1 is in follow-up, and 8 continued to show PD on subsequent scans. Conclusions: PD on first staging scan is a strong prognostic marker for survival for pts with R/R DLBCL who receive CART. There is no evidence to suggest conversion to a response will occur for patients who have PD. Performing staging scans at an earlier time-point has value, allowing for earlier treatment changes and goals of care conversations in this pt population.[Table: see text]

Download Full-text