scholarly journals Prognostic Stratification of Baseline Total Metabolic Tumor Volume on PET/CT Combined with MYC/Bcl-2 Dual Expression in Patients with Primary Gastrointestinal Diffuse Large B-Cell Lymphoma

2020 ◽  
Author(s):  
Chong Jiang ◽  
Yue Teng ◽  
Jieyu Chen ◽  
Zhong Zheng ◽  
Zhen Wang ◽  
...  
Keyword(s):  
Tumor Volume ◽  
Cell Lymphoma ◽  
Risk Group ◽  
B Cell Lymphoma ◽  
Metabolic Tumor Volume ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Prognostic Stratification ◽  
Dual Expression ◽  
Large B Cell

Abstract Purpose: The aim of the present study was to explore whether pretreatment total metabolic tumor volume (TMTV) combined with MYC/BCL-2 dual expression (DE) would improve the prognostic stratification of patients who were newly diagnosed with primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL).Materials and methods: Eighty-three patients between March 2011 and November 2019, diagnosed with PGI-DLBCL prior to treatment, were included in this retrospective study. Baseline TMTV on PET/CT scans were calculated automatically using the boundaries of voxels presenting a SUVmax≥2.5. Expression of MYC/BCL-2 were detected at protein levels via immunohistochemistry（IHC）. The distributions of Progression-free survival (PFS) and overall survival (OS) rates were estimated using the Kaplan-Meier method and differences were compared using a log-rank test followed by multivariate analysis using the Cox proportional hazards model.Results: TMTV and DE were significantly associated with a worse PFS and OS. Multivariate analysis revealed that TMTV (HR=6.090, P<0.001) and DE (HR=2.761, P=0.021) were each independent predictors of PFS, whereas TMTV (HR=9.512, P<0.001) was the only independent predictor of OS. A monogram comprised of TMTV and DE expression identified four groups with very different outcomes: (PFS:χ2=32.178, P<0.001; OS:χ2=23.091, P<0.001): low-risk group (low TMTV and non-DE, 46 patients); low-intermediate risk group (low TMTV and DE, 16 the patients); high-intermediate risk group (high TMTV and non-DE, 12 patients); and high-risk group (high TMTV and DE patients, 9 patients). Conclusions: TMTV and DE independently predicted survival outcomes in PGI-DLBCL patients. Furthermore, our findings suggest that combination of TMTV and DE may further improve the ability of clinicians to stratify patients in terms of differential prognoses.

scholarly journals Molecular Profile and FDG-PET/CT Total Metabolic Tumor Volume Improve Risk Classification at Diagnosis for Patients with Diffuse Large B-Cell Lymphoma

2016 ◽  
Vol 22 (15) ◽  
pp. 3801-3809 ◽  
Author(s):  
Anne-Ségolène Cottereau ◽  
Hélène Lanic ◽  
Sylvain Mareschal ◽  
Michel Meignan ◽  
Pierre Vera ◽  
...  
Keyword(s):  
B Cell ◽  
Tumor Volume ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Metabolic Tumor Volume ◽  
Molecular Profile ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Large B Cell

Molecular Profile and FDG-PET/CT Metabolic Tumor Volume Improve Risk Classification at Diagnosis for Patients with Diffuse Large B Cell Lymphoma

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1452-1452
Author(s):  
Anne-Ségolène Cottereau ◽  
Hélène Lanic ◽  
Michel Meignan ◽  
Pierre Vera ◽  
Hervé Tilly ◽  
...  
Keyword(s):  
Overall Survival ◽  
Tumor Volume ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Metabolic Tumor Volume ◽  
Large B Cell Lymphoma ◽  
Kaplan Meier ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Large B Cell

Abstract Introduction: The addition of rituximab to the CHOP backbone has improved the outcome of patients with diffuse large B-cell lymphoma (DLBCL). However, over 30% of patients still have a high risk of treatment failure or relapses and cannot be selected accurately by the classic prognostic factors. Molecular profiling has individualized categories with different outcomes. Baseline total metabolic tumor volume seems also to be an important tool to predict outcome in DLBCL, as demonstrated by Casasnovas (Casasnovas et al Hematol Oncol 2015:33,suppl 1) but has not been associated with molecular data. Our study investigated the prognostic impact of baseline PET metrics, including total metabolic tumor volume (TMTV0) and their added value to molecular characteristics (ABC/GCB status, MYC overexpression). Methods: From 2003 to 2009, 81 patients with newly diagnosed DLBCL were retrospectively included. They were treated with rituximab associated with CHOP or ACVBP regimen. All had a baseline FDG-PET/CT. TMTV0 was computed by summing the metabolic volumes of all nodal and extranodal lesions obtained using the 41% SUVmax thresholding method. According to the gene expression profile (GEP), determined using DASL (cDNA-mediated Annealing, Selection, Ligation and extension), a subset of 57 patients was classified in GCB or ABC subtypes. An exploratory analysis was done on MYC expression. Optimal cut points for binary outcome were determined by X-tile" and ROC analysis. Results: 81 patients with a median age of 66 years were enrolled: 80% were stage III/IV, 73% had elevated LDH, 67% IPIaa>1. Median pre-therapy TMTV0 was 320 cm3 (25th-75th percentiles 106-668 cm3). With a median follow-up of 64 months, the 5y-PFS was 60% and the 5y-OS was 63% in the whole population. Using a cut off of 300 cm3, patients with a high TMTV0 (n=43, 53%) had a significantly shorter PFS and OS than those with a low TMTV0 (5y-PFS: 76% vs. 43%, p=0.0023, HR=3.0 and 5y-OS: 78% vs. 46%, p=0.0047, HR=3.0). Patients with a high TMTV0 had a more aggressive disease, with significantly more advanced stage (100%) and higher frequency of IPIaa>1 (93%) than patients with a low TMTV0 (p<0.0001 and p<0.0001 respectively). As expected, ABC status (n=27) was associated with a worse outcome (5y-PFS: 38% vs. 70%, p=0.019, HR=2.4; 5y-OS:37% vs 73%, p=0.0046, HR=3.1). In multivariate analysis, TMTV0 and cells of origin were independent prognostic factors for PFS (p=0.028 and p=0.038 respectively) and OS (p=0.035 and p=0.013). Combining these two factors, TMTV0 allowed a better sub-stratification of ABC/GCB patients (p=0.013 for PFS and p=0.0036 for OS). GCB patients with small TMTV0(n=15) had a 87% 5y-PFS and 86% 5y-OS compared to 53% and 60% for GCB with high TMTV0 (n=15); ABC patients with small TMTV0 (n=11) 50% and 60% compared to 30% and 23% for ABC with high TMTV (n=16) (figure 1). Patients with overexpression of MYC (n=26) had an increased risk of relapse or progression (p=0.0032, HR=3.08) and a reduced survival rates (p=0.0004, HR=4.25). Combining MYC with TMTV0 gave an added prognostic value by splitting the population in 3 risk groups: MYC negative and low TMTV0 (n=16, 5y-PFS of 93% and 5y-OS 93%) ; MYC negative and high TMTV0 (n=15, 45% and 55%) ; MYC positive whatever TMTV0 (n=26, 30% and 30%), p=0.0011 and p=0.0005 respectively. Conclusion: The addition of TMTV0 improved the risk stratification of ABC/GCB subtypes and MYC expression. The combination of molecular and imaging characteristicts at diagnosis could lead to a more accurate selection of patients, in order to increase tailor therapy. Figure 1. Kaplan Meier estimates of progression-free (PFS) and overall survival (OS) according to the baseline total metabolic tumor volume (TMTV0) combining with ABC/GCB Figure 1. Kaplan Meier estimates of progression-free (PFS) and overall survival (OS) according to the baseline total metabolic tumor volume (TMTV0) combining with ABC/GCB Figure 2. Figure 2. Disclosures No relevant conflicts of interest to declare.

scholarly journals Prognostic value of metabolic tumor volume on PET / CT in primary gastrointestinal diffuse large B cell lymphoma

2012 ◽  
Vol 103 (3) ◽  
pp. 477-482 ◽  
Author(s):  
Moo-Kon Song ◽  
Joo-Seop Chung ◽  
Ho-Jin Shin ◽  
Joon-Ho Moon ◽  
Jeong-Ok Lee ◽  
...  
Keyword(s):  
B Cell ◽  
Prognostic Value ◽  
Tumor Volume ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Metabolic Tumor Volume ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Large B Cell

scholarly journals High metabolic tumor volume is associated with decreased efficacy of axicabtagene ciloleucel in large B-cell lymphoma

2020 ◽  
Vol 4 (14) ◽  
pp. 3268-3276 ◽  
Author(s):  
Erin A. Dean ◽  
Rahul S. Mhaskar ◽  
Hong Lu ◽  
Mina S. Mousa ◽  
Gabriel S. Krivenko ◽  
...  
Keyword(s):  
B Cell ◽  
Tumor Volume ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Metabolic Tumor Volume ◽  
Primary Objective ◽  
T Cell Therapy ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract High metabolic tumor volume (MTV) predicts worse outcomes in lymphoma treated with chemotherapy. However, it is unknown if this holds for patients treated with axicabtagene ciloleucel (axi-cel), an anti-CD19 targeted chimeric antigen receptor T-cell therapy. The primary objective of this retrospective study was to investigate the relationship between MTV and survival (overall survival [OS] and progression-free survival [PFS]) in patients with relapsed/refractory large B-cell lymphoma (LBCL) treated with axi-cel. Secondary objectives included finding the association of MTV with response rates and toxicity. The MTV values on baseline positron emission tomography of 96 patients were calculated via manual methodology using commercial software. Based on a median MTV cutoff value of 147.5 mL in the first cohort (n = 48), patients were divided into high and low MTV groups. Median follow-up for survivors was 24.98 months (range, 10.59-51.02 months). Patients with low MTV had significantly superior OS (hazard ratio [HR], 0.25; 95% confidence interval [CI], 0.10-0.66) and PFS (HR, 0.40; 95% CI, 0.18-0.89). Results were successfully validated in a second cohort of 48 patients with a median follow-up for survivors of 12.03 months (range, 0.89-25.74 months). Patients with low MTV were found to have superior OS (HR, 0.14; 95% CI, 0.05-0.42) and PFS (HR, 0.29; 95% CI, 0.12-0.69). In conclusion, baseline MTV is associated with OS and PFS in axi-cel recipients with LBCL.

Association of high baseline metabolic tumor volume with response following axicabtagene ciloleucel in refractory large B-cell lymphoma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 7562-7562 ◽  
Author(s):  
Erin Dean ◽  
Hong Lu ◽  
Aleksandr Lazaryan ◽  
Gabriel S Krivenko ◽  
Christina A Bachmeier ◽  
...  
Keyword(s):  
B Cell ◽  
Tumor Volume ◽  
Response Rate ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Metabolic Tumor Volume ◽  
Durable Response ◽  
High Baseline ◽  
Large B Cell Lymphoma ◽  
Large B Cell

7562 Background: Axicabtagene ciloleucel (axi-cel) is an anti-CD19 targeted Chimeric Antigen Receptor (CAR) T-cell therapy for large B-cell lymphoma (LBCL). High tumor burden, by sum of the product of diameters (SPD) in ≥ 6 reference lesions, was associated with lower durable responses rates in the ZUMA-1 trial (Locke F.L. ASCO. 2018). Although metabolic tumor volume (MTV) predicts worse outcomes with chemotherapy in lymphoma (Guo B. PLoSOne. 2019), its prognostic significance remains unclear with axi-cel therapy. Methods: MTV was measured by MIM Software using a 41% SUVmax threshold with manual lesion contour adjustment and radiologist review. Low and high MTV groups were defined based on median cutoff value. Cytokine release syndrome (CRS) was graded by Lee et al. ( Blood. 2014). Neurotoxicity (NT) was graded by CTCAEv4. Toxicities, overall response rate (ORR), and complete response rate (CR) were evaluated via Fisher’s test; PFS and OS via Kaplan-Meier and log-rank test. Results: 48 patients with LBCL, or its variants, that received axi-cel at Moffitt from June 2015 to October 2018 were included. 31 were male, and median age was 63 years (range, 28-76). CRS occurred in 43/47 (91.5%) and NT in 32/47 (68.1%) patients. Grade 3-4 CRS in 2/47 (4.3%) and NT in 12/47 (25.5%). Median follow up for survivors was 8.9 months (range, 1.4- 36.8 months). CR was achieved in 31/48 (64.6 %) and ORR in 39/48 (81.3%). Median for the low MTV group was 35.1 mL (range, 4.24-132.8 mL), and for the high MTV group 455.5 mL (range, 162.2-1221.4 mL). High MTV was not predictive of G1-4 NT or G3-4 NT (OR = 1.14, P = 0.99; OR = 1.66, P = 0.52). Similarly, high MTV was not predictive of G1-4 CRS or G3-4 CRS (OR = 0.29, P = 0.348; OR = 1.05, P = 0.99). Low MTV was predictive of ORR (OR = 11.50, P = 0.026) and CR (OR = 9.8, P = 0.002). Patients with high MTV had inferior PFS (HR = 3.296, 95% CI 1.42-7.64, P = 0.008) and OS (HR = 6.68, 95% CI 2.56-17.32, P = 0.003). Conclusions: High baseline MTV is associated with decreased and less durable response following axi-cel. As survival data mature, future analyses will aim to assess the role of MTV as an independent prognostic tool in axi-cel recipients with LBCL.

Prognostic value of presalvage metabolic tumor volume in patients with relapsed/refractory diffuse large B-cell lymphoma

2021 ◽  
pp. 1-11
Author(s):  
Juan Pablo Alderuccio ◽  
Russ A. Kuker ◽  
Priscila Barreto-Coelho ◽  
Bianca M. Martinez ◽  
Feng Miao ◽  
...  
Keyword(s):  
B Cell ◽  
Prognostic Value ◽  
Tumor Volume ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Metabolic Tumor Volume ◽  
Large B Cell Lymphoma ◽  
Large B Cell
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