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)

2015 ◽  
Vol 33 (23) ◽  
pp. 2523-2529 ◽  
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.

End-of-treatment 18F-FDG PET/CT in diffuse large B cell lymphoma patients: ΔSUV outperforms Deauville score

2021 ◽  
pp. 1-9
Author(s):  
François Allioux ◽  
Damaj Gandhi ◽  
Jean-Pierre Vilque ◽  
Cathy Nganoa ◽  
Anne-Claire Gac ◽  
...  
Keyword(s):  
B Cell ◽  
Fdg Pet ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
End Of Treatment ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Large B Cell

scholarly journals Interim PET/CT based on visual and semiquantitative analysis predicts survival in patients with diffuse large B‐cell lymphoma

2019 ◽  
Vol 8 (11) ◽  
pp. 5012-5022 ◽  
Author(s):  
Xiaoqian Li ◽  
Xun Sun ◽  
Juan Li ◽  
Zijian Liu ◽  
Mi Mi ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Semiquantitative Analysis ◽  
Interim Pet ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Large B Cell

scholarly journals Interim positron emission tomography scans in diffuse large B-cell lymphoma: an independent expert nuclear medicine evaluation of the Eastern Cooperative Oncology Group E3404 study

Blood ◽  
2010 ◽  
Vol 115 (4) ◽  
pp. 775-777 ◽  
Author(s):  
Sandra J. Horning ◽  
Malik E. Juweid ◽  
Heiko Schöder ◽  
Gregory Wiseman ◽  
Alex McMillan ◽  
...  
Keyword(s):  
Nuclear Medicine ◽  
B Cell ◽  
Cell Lymphoma ◽  
Eastern Cooperative Oncology Group ◽  
B Cell Lymphoma ◽  
Interim Pet ◽  
Large B Cell Lymphoma ◽  
Positron Emission ◽  
Pet Scans ◽  
Large B Cell

AbstractPositive interim positron emission tomography (PET) scans are thought to be associated with inferior outcomes in diffuse large B-cell lymphoma. In the E3404 diffuse large B-cell lymphoma study, PET scans at baseline and after 3 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone were centrally reviewed by a single reader. To determine the reproducibility of interim PET interpretation, an expert panel of 3 external nuclear medicine physicians visually scored baseline and interim PET scans independently and were blinded to clinical information. The binary Eastern Cooperative Oncology Group (ECOG) study criteria were based on modifications of the Harmonization Criteria; the London criteria were also applied. Of 38 interim scans, agreement was complete in 68% and 71% by ECOG and London criteria, respectively. The range of PET+ interim scans was 16% to 34% (P = not significant) by reviewer. Moderate consistency of reviews was observed: κ statistic = 0.445 using ECOG criteria, and κ statistic = 0.502 using London criteria. These data, showing only moderate reproducibility among nuclear medicine experts, indicate the need to standardize PET interpretation in research and practice. This trial was registered at www.clinicaltrials.gov as #NCT00274924.

Interim PET/CT in diffuse large B-cell lymphoma may facilitate identification of good-prognosis patients among IPI-stratified patients

2019 ◽  
Vol 110 (3) ◽  
pp. 331-339
Author(s):  
Renata Nyilas ◽  
Bence Farkas ◽  
Reka Rahel Bicsko ◽  
Ferenc Magyari ◽  
Laszlo Imre Pinczes ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Good Prognosis ◽  
Interim Pet ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Large B Cell

Clonal Ig DNA Detection In Plasma From Patients with Untreated Diffuse Large B-Cell Lymphoma (DLBCL)

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3127-3127
Author(s):  
Nina Wagner-Johnston ◽  
Nancy L. Bartlett ◽  
Jacqueline E. Payton ◽  
Kathryn Trinkaus ◽  
Akash Sharma ◽  
...  
Keyword(s):  
B Cell ◽  
Fdg Pet ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Ct Scans ◽  
Molecular Diagnostic ◽  
Newly Diagnosed ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Large B Cell

Abstract Abstract 3127 Background: Circulating nucleic acids have been explored as tumor markers in several malignancies. Lymphoma offers a special opportunity to develop tumor DNA markers. Normal B cells undergo Ig rearrangements to generate antibody diversity. In B cell malignancies, the Ig gene rearrangements are monoclonal. Molecular diagnostic tests are widely employed in tumor specimens to detect these clone-specific Ig rearrangements when histology and immunohistochemistry are ambiguous. While long-lived plasma cells can secrete Ig over years, a B cell can only release its unique clone once. In order to sustain the presence of Ig DNA, ongoing cellular proliferation and death is required, suggesting that detection in the plasma may be a specific marker for presence of lymphoma. We previously reported our experience in screening plasma from patients (pts) with AIDS-related lymphomas (Blood 110(11):1579, 2007). The feasibility of this approach and promising results led to a pilot study evaluating clonal Ig DNA in pts with newly diagnosed diffuse large B cell lymphoma (DLBCL) without HIV. Methods: Plasma is screened for clonal Ig DNA using standardized fluorescently-labeled multiplex primers (InVivoScribe) targeting IgH rearrangements. Rearranged Ig DNA is amplified by polymerase chain reaction (PCR), and the amplified products are separated by size using capillary electrophoresis. International prognostic index (IPI) scores and results of baseline PET/CT scans, including standardized uptake value (SUV)max scores are collected from pts to determine the impact of these findings on the ability to detect clonal Ig DNA. Results: Of 36 plasma specimens evaluated to date, 28 (78%) had clonal IgH rearrangements. Clonal and polyclonal controls yielded appropriate results. Tumor specimens are available from 22 patients, including 19 formalin-fixed paraffin-embedded (FFPE) and 5 fresh frozen tissue (FFT) specimens (2 pts have both FFPE and FFT). Eight FFPE tumor specimens have been evaluated; monoclonal IgH rearrangements were present in 5 (63%), 2 had polyclonal rearrangements, and 1 had no detectable IgH rearrangements. The median IPI scores were 1.5 (75% of pts had scores of 0–2) for the group without detectable plasma clonal Ig DNA and 2 (67% of pts had scores of 0–2) for the group with detectable plasma clonal Ig DNA. Wilcoxon 2-sample test demonstrated no difference between the 2 groups with respect to IPI scores (p= 0.50). Pre-treatment PET/CT scans were interpreted as positive in 30 of 33 pts. Two pts with negative PET/CT and corresponding IPI scores of 0 and 1 respectively, did not have detectable plasma clonal Ig DNA. One pt with a negative PET/CT had an IPI score of 0 and had detectable clonal Ig DNA in the plasma. In a T-test comparison, there was no evidence for a difference in SUVmax among pts with and without detectable clonal Ig DNA (p = 0.31). Conclusions: Circulating clonal Ig DNA is detectable in pts with newly diagnosed DLBCL even with low IPI scores and negative PET/CT scans. Relatively small pt numbers limit the interpretation of the IPI/FDG-PET findings with respect to the detection of clonal Ig DNA in the plasma, and larger studies are needed to better appreciate if there is any correlation. Studies are ongoing to determine whether clonal Ig plasma DNA persists after the initiation of therapy, and whether the presence of clonal Ig DNA in plasma might complement information obtained from early interim FDG-PET in identifying patients likely to fail conventional therapy. Continued analysis of paired tumor/plasma specimens will clarify if plasma clonal Ig DNA is tumor derived. Disclosures: No relevant conflicts of interest to declare.

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