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Liao C, Deng Q, Zeng L, Guo B, Li Z, Zhou D, Ke Q, Wang M, Huang M, Tan X, Cen H. Baseline and interim 18F-FDG PET/CT metabolic parameters predict the efficacy and survival in patients with diffuse large B-cell lymphoma. Front Oncol 2024; 14:1395824. [PMID: 39435282 PMCID: PMC11491437 DOI: 10.3389/fonc.2024.1395824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 09/16/2024] [Indexed: 10/23/2024] Open
Abstract
Introduction The prognostic value of 18F-FDG PET/CT metabolic parameters, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), in diffuse large B-cell lymphoma (DLBCL) remains inadequately explored. This study aims to assess the correlation between these parameters and patient outcomes. Methods A cohort of 156 DLBCL patients underwent 18F-FDG PET/CT imaging at baseline and after 3-4 cycles of R-CHOP or CHOP-like regimen. The third quartiles of liver uptake values were used as thresholds for calculating MTV and TLG. Patient outcomes were analyzed based on Ann Arbor staging and the 5-PS score. A nomogram was developed to predict overall survival (OS). Results Patients with low baseline TLG exhibited significantly better outcomes compared to those with high baseline TLG in both Ann Arbor stages I-II and III-IV (1-year PFS: 78.9% vs. 40%, p=0.016; OS: 94.7% vs. 40%, p=0.005 for stage I-II; 1-year PFS: 74.1% vs. 46.8%, p=0.014; OS: 85.4% vs. 71.8%, p=0.007 for stage III-IV). In interim PET/CT patients with a 5-PS score >3, the high ΔTLG group had superior prognosis (1-year PFS: 82.3% vs. 35.7%, p=0.003; OS: 88.2% vs. 85.7%, p=0.003). The nomogram achieved a C-index of 0.9 for OS prediction. Discussion The findings suggest that baseline TLG is a robust prognostic indicator for patients with DLBCL, particularly in early stages, while ΔTLG effectively distinguishes those with favorable outcomes in higher-risk groups. These metabolic parameters from 18F-FDG PET/CT could enhance treatment decision-making and patient management strategies.
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Affiliation(s)
- Chengcheng Liao
- Department of Hematology/Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
- State Key Laboratory of Targeting Oncology, Guangxi Medical University, Nanning, Guangxi, China
| | - Qifeng Deng
- Department of Hematology/Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
- Oncology Prevention and Control Center, Guigang People’s Hospital, Guigang, Guangxi, China
| | - Lin Zeng
- Department of Hematology/Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Guangxi, Nanning, China
| | - Baoping Guo
- Department of Hematology/Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Zhe Li
- Department of Hematology/Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Da Zhou
- Department of Hematology/Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Qing Ke
- Department of Hematology/Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Mingyue Wang
- Department of Hematology/Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Mei Huang
- College of Oncology, Guangxi Medical University, Nanning, China
| | - Xiaohong Tan
- Department of Hematology/Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Hong Cen
- Department of Hematology/Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
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Detrait MY, Warnon S, Lagasse R, Dumont L, De Prophétis S, Hansenne A, Raedemaeker J, Robin V, Verstraete G, Gillain A, Depasse N, Jacmin P, Pranger D. A machine learning approach in a monocentric cohort for predicting primary refractory disease in Diffuse Large B-cell lymphoma patients. PLoS One 2024; 19:e0311261. [PMID: 39352921 PMCID: PMC11444388 DOI: 10.1371/journal.pone.0311261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 09/16/2024] [Indexed: 10/04/2024] Open
Abstract
INTRODUCTION Primary refractory disease affects 30-40% of patients diagnosed with DLBCL and is a significant challenge in disease management due to its poor prognosis. Predicting refractory status could greatly inform treatment strategies, enabling early intervention. Various options are now available based on patient and disease characteristics. Supervised machine-learning techniques, which can predict outcomes in a medical context, appear highly suitable for this purpose. DESIGN Retrospective monocentric cohort study. PATIENT POPULATION Adult patients with a first diagnosis of DLBCL admitted to the hematology unit from 2017 to 2022. AIM We evaluated in our Center five supervised machine-learning (ML) models as a tool for the prediction of primary refractory DLBCL. MAIN RESULTS One hundred and thirty patients with Diffuse Large B-cell lymphoma (DLBCL) were included in this study between January 2017 and December 2022. The variables used for analysis included demographic characteristics, clinical condition, disease characteristics, first-line therapy and PET-CT scan realization after 2 cycles of treatment. We compared five supervised ML models: support vector machine (SVM), Random Forest Classifier (RFC), Logistic Regression (LR), Naïve Bayes (NB) Categorical classifier and eXtreme Gradient Boost (XGboost), to predict primary refractory disease. The performance of these models was evaluated using the area under the receiver operating characteristic curve (ROC-AUC), accuracy, false positive rate, sensitivity, and F1-score to identify the best model. After a median follow-up of 19.5 months, the overall survival rate was 60% in the cohort. The Overall Survival at 3 years was 58.5% (95%CI, 51-68.5) and the 3-years Progression Free Survival was 63% (95%CI, 54-71) using Kaplan-Meier method. Of the 124 patients who received a first line treatment, primary refractory disease occurred in 42 patients (33.8%) and 2 patients (1.6%) experienced relapse within 6 months. The univariate analysis on refractory disease status shows age (p = 0.009), Ann Arbor stage (p = 0.013), CMV infection (p = 0.012), comorbidity (p = 0.019), IPI score (p<0.001), first line of treatment (p<0.001), EBV infection (p = 0.008) and socio-economics status (p = 0.02) as influencing factors. The NB Categorical classifier emerged as the top-performing model, boasting a ROC-AUC of 0.81 (95% CI, 0.64-0.96), an accuracy of 83%, a F1-score of 0.82, and a low false positive rate at 10% on the validation set. The eXtreme Gradient Boost (XGboost) model and the Random Forest Classifier (RFC) followed with a ROC-AUC of 0.74 (95%CI, 0.52-0.93) and 0.67 (95%CI, 0.46-0.88) respectively, an accuracy of 78% and 72% respectively, a F1-score of 0.75 and 0.67 respectively, and a false positive rate of 10% for both. The other two models performed worse with ROC-AUC of 0.65 (95%CI, 0.40-0.87) and 0.45 (95%CI, 0.29-0.64) for SVM and LR respectively, an accuracy of 67% and 50% respectively, a f1-score of 0.64 and 0.43 respectively, and a false positive rate of 28% and 37% respectively. CONCLUSION Machine learning algorithms, particularly the NB Categorical classifier, have the potential to improve the prediction of primary refractory disease in DLBCL patients, thereby providing a novel decision-making tool for managing this condition. To validate these results on a broader scale, multicenter studies are needed to confirm the results in larger cohorts.
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Affiliation(s)
- Marie Y Detrait
- Department of Technology and Information Systems, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Stéphanie Warnon
- Department of Clinical Research, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Raphaël Lagasse
- Department of Technology and Information Systems, Grand Hôpital de Charleroi, Charleroi, Belgium
- Department of Medico-Economic Information, Grand Hôpital de Charleroi, Charleroi, Belgium
- School of Public Health, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Laurent Dumont
- Department of Technology and Information Systems, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Stéphanie De Prophétis
- Division of Hematology, Hematology and oncology Department, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Amandine Hansenne
- Division of Hematology, Hematology and oncology Department, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Juliette Raedemaeker
- Division of Hematology, Hematology and oncology Department, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Valérie Robin
- Division of Hematology, Hematology and oncology Department, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Géraldine Verstraete
- Division of Hematology, Hematology and oncology Department, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Aline Gillain
- Department of Clinical Research, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Nicolas Depasse
- Department of Technology and Information Systems, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Pierre Jacmin
- Department of Technology and Information Systems, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Delphine Pranger
- Division of Hematology, Hematology and oncology Department, Grand Hôpital de Charleroi, Charleroi, Belgium
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Liu H, Xue F, Zhou R, Tian H, Mao J, Wu T. Chidamide in combination with azacitidine for an elderly patient with peripheral T cell lymphoma‑not otherwise specified: A case report. Oncol Lett 2024; 28:341. [PMID: 38855506 PMCID: PMC11157661 DOI: 10.3892/ol.2024.14474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/12/2024] [Indexed: 06/11/2024] Open
Abstract
Peripheral T cell lymphoma (PTCL) is a type of aggressive non-Hodgkin's lymphoma with poor prognosis. PTCL-not otherwise specified (PTCL-NOS) is one of its most common pathological types. PTCL is not sensitive to conventional chemotherapy regimens and treatment is particularly limited in elderly patients due to their poor tolerance to chemotherapy. The present report shares the treatment experience of one elderly PTCL-NOS case, which achieved complete remission by reduced-intensity chemotherapy with chidamide in combination with azacitidine following the onset of organ failure and chemotherapy insensitivity. The 9-month follow-up showed sustained remission and the long-term efficacy of this regimen is also promising.
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Affiliation(s)
- Heng Liu
- Department of Hematology, The 940th Hospital of Joint Logistic Support Force of The Chinese People's Liberation Army, Lanzhou, Gansu 730050, P.R. China
| | - Feng Xue
- Department of Hematology, The 940th Hospital of Joint Logistic Support Force of The Chinese People's Liberation Army, Lanzhou, Gansu 730050, P.R. China
| | - Rui Zhou
- Department of Hematology, The 940th Hospital of Joint Logistic Support Force of The Chinese People's Liberation Army, Lanzhou, Gansu 730050, P.R. China
| | - Hongjuan Tian
- Department of Hematology, The 940th Hospital of Joint Logistic Support Force of The Chinese People's Liberation Army, Lanzhou, Gansu 730050, P.R. China
| | - Junfeng Mao
- Department of Nuclear Medicine, The 940th Hospital of Joint Logistic Support Force of The Chinese People's Liberation Army, Lanzhou, Gansu 730050, P.R. China
| | - Tao Wu
- Department of Hematology, The 940th Hospital of Joint Logistic Support Force of The Chinese People's Liberation Army, Lanzhou, Gansu 730050, P.R. China
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Nielsen NB, Gerke O, Nielsen AL, Juul-Jensen K, Larsen TS, Møller MB, Hildebrandt MG. A retrospective head-to-head comparison of the Lugano classification and PERCIST for FDG-PET/CT response assessment in diffuse large B-cell lymphoma. Clin Physiol Funct Imaging 2024; 44:70-78. [PMID: 37501554 DOI: 10.1111/cpf.12851] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is the most common form of lymphoma. European guidelines recommend FDG-PET/CT for staging and end of treatment (EOT) response assessment, mid-treatment response assessment is optional. We compared the Lugano classification and PET Response Criteria In Solid Tumours (PERCIST) for FDG-PET/CT response assessment in DLBCL head-to-head. METHODS We retrospectively included patients with DLBCL who underwent first-line R-CHOP(-like) therapy (2013-2020). Interim and EOT FDG-PET/CT response were reevaluated using the Lugano classification and PERCIST. Response was dichotomized into complete metabolic response (CMR) versus non-CMR (interim and EOT) and responders versus nonresponders (interim only). The cutoff for nonresponse at interim was a Deauville score of 5 (DS5) with the Lugano classification and a partial metabolic response with ≤66% reduction in SULpeak using PERCIST (PERCIST66). RESULTS In multivariable Cox regression (N = 170), DS5 at interim, PERCIST66 at interim, non-CMR at EOT with the Lugano classification and non-CMR at EOT with PERCIST were predictive of progression-free survival (PFS). The Lugano classification and PERCIST agreed perfectly at interim and EOT and with 98.4% for the identification of nonresponders at interim. The accuracy for predicting events within 2 years of diagnosis was 84.2% for DS-5 at interim, 87.6% for PERCIST66 at interim, 86% for non-CMR with the Lugano classification at EOT and 83.3% for non-CMR with PERCIST at EOT. CONCLUSION The Lugano classification and PERCIST were equally predictive of PFS. Nonresponse at interim and non-CMR at EOT were predictive of poor PFS with comparable accuracy for predicting events within 2 years.
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Affiliation(s)
- Nicklas B Nielsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Centre for Personalized Response Monitoring in Oncology, Odense University Hospital, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne L Nielsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Karen Juul-Jensen
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Thomas S Larsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Michael B Møller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Malene G Hildebrandt
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Centre for Personalized Response Monitoring in Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
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Lombion N, Robin P, Tempescul A, LE Roux PY, Schick U, Guillerm G, Ianotto JC, Berthou C, Salaün PY, Abgral R. Prognostic value of interim FDG PET-CT in patients older than 60 years with diffuse large B-cell lymphoma treated by PMitCEBO plus rituximab. Comparison between Deauville 5-point scale and International Harmonization Project criteria. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2021; 65:402-409. [PMID: 35133099 DOI: 10.23736/s1824-4785.16.02894-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Advanced age is an independent poor prognostic factor of diffuse large B-cell lymphoma (DLBCL). PMitCEBO (mitoxantrone, cyclophosphamide, etoposide, vincristine, bleomycin, and prednisolone) is an alternative to the cyclophosphamide, doxorubicin, vincristine, and prednisolone regimen to decrease side effects in elderly patients. Many studies have shown prognostic value of an interim FDG PET-CT to predict survival. A recent consensus (ICML, Lugano 2013) has suggested using the 5-point scale Deauville criteria instead of those of the International Harmonization Project (IHP) to visually assess the response on interim PET. The objective of this study was to evaluate the prognostic value of an interim FDG PET-CT in patients older than 60 with treated DLBCL and to compare IHP and 5-PS Deauville visual interpretation to predict survival. METHODS Forty-eight patients (mean age 73.2±5.2 years) treated by R-PMitCEBO for DLBCL undergoing FDG PET-CT before and after 3 cycles of treatment were retrospectively included. Event-free survival and overall survival were determined by Kaplan-Meier method and compared with interim PET-CT results using IHP and 5-PS Deauville criteria. RESULTS Interim PET results using 5-PS Deauville criteria were significantly correlated with EFS (P<0.0001) and OS (P=0.001) whereas they were moderately correlated with EFS (P=0.046) and not with OS (P=0.106) using IHP criteria. Two-year EFS and OS rates were 86.5% and 89.2%, respectively, for patients in 1-3 score group, and 27.3% and 36.4%, respectively, for patients in ≥4 score group using the Deauville criteria. CONCLUSIONS Our results confirmed the prognostic value of an interim PET-CT in elderly patients with DLBCL and the better performance of the 5-PS Deauville criteria.
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Affiliation(s)
- Naelle Lombion
- Department of Hematology, University Hospital of Brest, Brest, France
| | - Philippe Robin
- Department of Nuclear Medicine, University Hospital of Brest, Brest, France
| | - Adrian Tempescul
- Department of Hematology, University Hospital of Brest, Brest, France
| | | | - Ulrike Schick
- Department of Oncology-Radiotherapy, University Hospital of Brest, Brest, France
| | - Gaëlle Guillerm
- Department of Hematology, University Hospital of Brest, Brest, France
| | | | - Christian Berthou
- Department of Hematology, University Hospital of Brest, Brest, France
| | - Pierre-Yves Salaün
- Department of Nuclear Medicine, University Hospital of Brest, Brest, France
| | - Ronan Abgral
- Department of Nuclear Medicine, University Hospital of Brest, Brest, France -
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Abstract
Hematologic malignancies are a broad category of cancers arising from the lymphoid and myeloid cell lines. The 2016 World Health Organization classification system incorporated molecular markers as part of the diagnostic criteria and includes more than 100 subtypes. This article focuses on the subtypes for which imaging with positron emission tomography/computed tomography (PET/CT) has become an integral component of the patient's evaluation, that is, lymphoma and multiple myeloma. Leukemia and histiocytic and dendritic cell neoplasms are also discussed as these indications for PET/CT are less common, but increasingly seen in clinic.
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Uluköylü Mengüç M, Mehtap Ö, Dağlıöz Görür G, Birtaş Ateşoğlu E, Gedük A, Ünal S, Tarkun P, Hacıhanefioğlu A. The Role of Interim PET/CT on Survival in Diffuse Large B Cell Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e922-e927. [PMID: 34353778 DOI: 10.1016/j.clml.2021.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/12/2021] [Accepted: 06/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Diffuse large B cell lymphoma is the most frequent aggressive non-Hodgkin lymphoma. Predicting response and estimating prognosis earlier makes management of this heterogeneous lymphoma more satisfying. Interim PET response is established in Hodgkin Lymphoma to tailor the therapy but results for non-Hodgkin Lymphoma is unconvincing. In the current study evaluation of interim PET and survival outcomes of 103 DLBCL patients is performed. PATIENTS AND METHODS About 103 Patients with DLBCL followed up in a single center between 2009 and 2019 were enrolled the study. All patients received R-CHOP chemoimmunotherapy at first line. Interim PET was performed after at least one or more cycles. All PET scans were performed with 18F-FDG isotope as PET/CT. PET scoring results were evaluated according to the 5-Point Deauville Scoring system defined in the National Comprehensive Cancer Network clinical guidelines for iPET and eotPET. 5-P DS of scores of 1 to 3 were defined as negative scans, and scores of 4 to 5 were considered to be positive scans. RESULTS Forty-six (44.7%) Female and 57 (55.3%) male aged between 25 and 83 (median 57) years newly diagnosed DLBCL patients were enrolled in the study. Median PFS was 21 (interquartile range 8.5-53.7) months and median OS was 33.5 (interquartile range 12.5-62.9) months for the total cohort. Positive predictive value of interim PET according to Deauville scoring system was 65.4% and negative predictive value was 77.9%. CONCLUSION Our study showed that according to Deauville 5 point scale (D 5PS) scoring system, interim PET-positive patients have shorter both PFS and OS than iPET-negative patients.
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Affiliation(s)
| | - Özgür Mehtap
- Kocaeli Universitesi Tip Fakultesi, Izmit, Turkey
| | | | | | - Ayfer Gedük
- Kocaeli Universitesi Tip Fakultesi, Izmit, Turkey
| | - Serkan Ünal
- Kocaeli Universitesi Tip Fakultesi, Izmit, Turkey
| | - Pınar Tarkun
- Kocaeli Universitesi Tip Fakultesi, Izmit, Turkey
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Duclos V, Iep A, Gomez L, Goldfarb L, Besson FL. PET Molecular Imaging: A Holistic Review of Current Practice and Emerging Perspectives for Diagnosis, Therapeutic Evaluation and Prognosis in Clinical Oncology. Int J Mol Sci 2021; 22:4159. [PMID: 33923839 PMCID: PMC8073681 DOI: 10.3390/ijms22084159] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 02/06/2023] Open
Abstract
PET/CT molecular imaging has been imposed in clinical oncological practice over the past 20 years, driven by its two well-grounded foundations: quantification and radiolabeled molecular probe vectorization. From basic visual interpretation to more sophisticated full kinetic modeling, PET technology provides a unique opportunity to characterize various biological processes with different levels of analysis. In clinical practice, many efforts have been made during the last two decades to standardize image analyses at the international level, but advanced metrics are still under use in practice. In parallel, the integration of PET imaging with radionuclide therapy, also known as radiolabeled theranostics, has paved the way towards highly sensitive radionuclide-based precision medicine, with major breakthroughs emerging in neuroendocrine tumors and prostate cancer. PET imaging of tumor immunity and beyond is also emerging, emphasizing the unique capabilities of PET molecular imaging to constantly adapt to emerging oncological challenges. However, these new horizons face the growing complexity of multidimensional data. In the era of precision medicine, statistical and computer sciences are currently revolutionizing image-based decision making, paving the way for more holistic cancer molecular imaging analyses at the whole-body level.
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Affiliation(s)
- Valentin Duclos
- Department of Biophysics and Nuclear Medicine-Molecular Imaging, Hôpitaux Universitaires Paris Saclay, Assistance Publique-Hôpitaux de Paris, CHU Bicêtre, 94270 Le Kremlin-Bicêtre, France; (V.D.); (A.I.); (L.G.)
| | - Alex Iep
- Department of Biophysics and Nuclear Medicine-Molecular Imaging, Hôpitaux Universitaires Paris Saclay, Assistance Publique-Hôpitaux de Paris, CHU Bicêtre, 94270 Le Kremlin-Bicêtre, France; (V.D.); (A.I.); (L.G.)
| | - Léa Gomez
- Department of Biophysics and Nuclear Medicine-Molecular Imaging, Hôpitaux Universitaires Paris Saclay, Assistance Publique-Hôpitaux de Paris, CHU Bicêtre, 94270 Le Kremlin-Bicêtre, France; (V.D.); (A.I.); (L.G.)
| | - Lucas Goldfarb
- Service Hospitalier Frédéric Joliot-CEA, 91401 Orsay, France;
| | - Florent L. Besson
- Department of Biophysics and Nuclear Medicine-Molecular Imaging, Hôpitaux Universitaires Paris Saclay, Assistance Publique-Hôpitaux de Paris, CHU Bicêtre, 94270 Le Kremlin-Bicêtre, France; (V.D.); (A.I.); (L.G.)
- Université Paris Saclay, CEA, CNRS, Inserm, BioMaps, 91401 Orsay, France
- School of Medicine, Université Paris Saclay, 94720 Le Kremlin-Bicêtre, France
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To evaluate prognostic significance of metabolic-derived tumour volume at staging 18-flurodeoxyglucose PET-CT scan and to compare it with standardized uptake value-based response evaluation on interim 18-flurodeoxyglucose PET-CT scan in patients of non-Hodgkin's lymphoma (diffuse large B-cell lymphoma). Nucl Med Commun 2021; 41:395-404. [PMID: 32073552 DOI: 10.1097/mnm.0000000000001159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION To evaluate whether metabolic tumour volume (MTV) can be used as a prognostic indicator in patients with diffuse large B-cell lymphoma (DLBCL). MATERIALS AND METHODS Eighty-nine patients with DLBCL who underwent staging fluorodeoxyglucose PET-computed tomography (FDG PET-CT) scan were included in this study and followed up, up to a period of 5 years. Whole-body PET-CT was performed at staging and the total MTV of all FDG avid lesions was calculated for each patient at a threshold of 42% of SUVmax. Out of 89 patients studied, six patients had persistent disease after chemotherapy, 24 had recurrence during follow-up and 59 patients remained disease free. In this study, prognostic significance of the interim PET-CT scan was also analysed. Out of 89 patients, 81 underwent interim PET-CT scan. Receiver operator curve (ROC) analysis was done to determine MTV baseline cutoff along with sensitivity and specificity. For interim PET-CT scan prognostic evaluation, sensitivity and negative predictive value were calculated. RESULTS Among all 89 patients, the estimated area under the ROC curve was 0.851 and the MTV cutoff was 185.63 cm with sensitivity and specificity of 86.67% and 84.75%, respectively. In subset analysis of MTV cutoff, sensitivity and specificity were calculated for both the groups. For prognostic significance of the interim PET-CT scan, sensitivity and negative predictive value of staging MTV were much more than that of the interim PET-CT. CONCLUSION Baseline MTV can be used as a prognostic marker in DLBCL patients. Chemosensitive interim PET-CT scan is not a good prognostic marker compared with MTV.
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Zhu L, Meng Y, Guo L, Zhao H, Shi Y, Li S, Wang A, Zhang X, Shi J, Zhu J, Xu K. 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. Oncol Lett 2020; 21:132. [PMID: 33552253 PMCID: PMC7798034 DOI: 10.3892/ol.2020.12393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/27/2020] [Indexed: 12/18/2022] Open
Abstract
The present study aimed to investigate the prognostic value of baseline 18F-FDG PET/CT quantitative parameters and interim treatment response, and to assess whether the combination of these could improve the predictive efficacy in patients with diffuse large B-cell lymphoma (DLBCL) receiving R-CHOP chemotherapy. PET/CT images and clinical data of 64 patients with DLBCL who had undergone 18F-FDG PET/CT scan before and after 3 or 4 cycles of R-CHOP chemotherapy were retrospectively reviewed. The quantitative parameters including standardized uptake value (SUV), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and maximum diameter of the maximum lesion (Dmax) were measured on baseline PET/CT images. Cox proportional hazards model was used to evaluate the influence of baseline PET/CT parameters, clinical indicators and interim treatment response on prognosis. Survival analysis was performed using Kaplan-Meier method. Receiver operating characteristic (ROC) curve analysis was performed to estimate the predictive efficacy of the combination of baseline PET/CT parameters and interim treatment response. Ann Arbor stage, International Prognostic Index (IPI), lactate dehydrogenase (LDH), necrosis, MTVmax, TLGmax, Dmax and interim treatment response showed association with 2-year progression-free survival (PFS, P<0.05). LDH, necrosis, MTVmax, MTVsum, TLGmax, TLGsum, Dmax and interim treatment response showed association with 2-year overall survival (OS, P<0.05). Ann Arbor stage, Dmax and interim treatment response were found to be independent predictors of 2-year PFS (P<0.05), while Dmax and interim treatment response were found to be independent predictors of 2-year OS (P<0.05). The PFS and OS curves of Dmax <5.7 cm group and Dmax ≥5.7 cm group, complete response (CR) group and non-CR group were significantly different, respectively (P<0.05). The baseline 18F-FDG PET/CT parameters and interim treatment response have important prognostic values in DLBCL patients who received R-CHOP chemotherapy. Combined application of Dmax and interim treatment response improved the predictive efficacy of 2-year PFS. It may be helpful to identify patients who are at high-risk of relapse and to guide early clinical intervention of these patients.
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Affiliation(s)
- Lili Zhu
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China.,Department of Radiology, Huaihai Hospital Affiliated with Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Yankai Meng
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
| | - Lili Guo
- Department of Radiology, Huaihai Hospital Affiliated with Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Hanqing Zhao
- Department of Radiology, Huaihai Hospital Affiliated with Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Yue Shi
- Department of Radiology, Huaihai Hospital Affiliated with Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Shaodong Li
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
| | - Anming Wang
- Department of Radiology, Huaihai Hospital Affiliated with Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Xiaojun Zhang
- Department of Radiology, Huaihai Hospital Affiliated with Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Jing Shi
- Department of Radiology, Huaihai Hospital Affiliated with Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Jie Zhu
- Department of Radiology, Huaihai Hospital Affiliated with Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Kai Xu
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China.,Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
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Li X, Xie X, Zhang L, Li X, Li L, Wang X, Fu X, Sun Z, Zhang X, Li Z, Wu J, Yu H, Chang Y, Yan J, Zhou Z, Nan F, Wu X, Tian L, Zhang M. Research on the midterm efficacy and prognosis of patients with diffuse large B-cell lymphoma by different evaluation methods in interim PET/CT. Eur J Radiol 2020; 133:109301. [DOI: 10.1016/j.ejrad.2020.109301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/22/2020] [Accepted: 09/16/2020] [Indexed: 12/19/2022]
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12
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Li X, Sun X, Li J, Liu Z, Mi M, Zhu F, Wu G, Lan X, Zhang L. Interim PET/CT based on visual and semiquantitative analysis predicts survival in patients with diffuse large B-cell lymphoma. Cancer Med 2019; 8:5012-5022. [PMID: 31293092 PMCID: PMC6718551 DOI: 10.1002/cam4.2404] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 12/21/2022] Open
Abstract
Purpose The role of interim 18F‐FDG PET/CT (iPET/CT) in diffuse large B‐cell lymphoma (DLBCL) remains controversial. The purpose of this study was to assess the prognostic value of iPET/CT in patients with newly diagnosed DLBCL according to visual and semiquantitative interpretation methods. Methods A total of 129 newly diagnosed DLBCL patients with baseline PET/CT data were retrospectively screened. The iPET/CT findings were evaluated by the Deauville 5‐point scale (DS) and ΔSUVmax. Furthermore, the reduction in SUVmax incorporated with tumor size (ΔSUVmax*ΔSLD) was calculated. The optimal cutoff values of ΔSUVmax and ΔSUVmax*ΔSLD were determined by receiver operating characteristic (ROC) analysis. Kaplan‐Meier analysis was applied to test for the influence of prognostic values. Univariate and multivariate analyses were conducted to examine the potential independent impacts of iPET/CT. Results Seventy‐seven patients with PET/CT images acquired both at baseline and after four cycles of chemotherapy were finally enrolled. The optimal cutoff values for ΔSUVmax and ΔSUVmax*ΔSLD were 74% and 30%, respectively. After a median follow‐up of 23 months, iPET/CT findings were significant predictors of PFS and OS whenever iPET/CT was interpreted by DS, ΔSUVmax, or ΔSUVmax*ΔSLD methods. ΔSUVmax‐based methods were more accurate than those based on DS. The IPI, DS, ΔSUVmax, and ΔSUVmax*ΔSLD were predictive in univariate analyses. However, in the multivariate analysis, only IPI and ΔSUVmax remained independent predictors of PFS and OS. Conclusions Interim PET/CT may help to identify DLBCL patients with different prognoses. ΔSUVmax analysis shows the best accuracy and the strongest predictive value among these three methods. ΔSUVmax*ΔSLD may be a promising parameter to interpret iPET/CT images, reflecting both the changes in tumor size and metabolic activity.
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Affiliation(s)
- Xiaoqian Li
- Cancer CenterUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Xun Sun
- Department of Nuclear MedicineUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Juan Li
- Cancer CenterUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Zijian Liu
- Cancer CenterUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Mi Mi
- Cancer CenterUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Fang Zhu
- Cancer CenterUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Gang Wu
- Cancer CenterUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Xiaoli Lan
- Department of Nuclear MedicineUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Liling Zhang
- Cancer CenterUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
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[Prognostic significance of (18)F-fluorodeoxyglucose positron emission tomography in patients with diffuse large B cell lymphoma undergoing autologous stem cell transplantation]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 39:382-386. [PMID: 29779346 PMCID: PMC7342905 DOI: 10.3760/cma.j.issn.0253-2727.2018.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the prognostic value of (18)F-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) in patients with diffuse large B cell lymphoma (DLBCL) undergoing autologous hematopoietic stem cell transplantation (auto-HSCT). Methods: Forty-eight patients with DLBCL treated at Peking University Cancer Hospital between November 2010 and December 2014 were assessed. All patients underwent PET/CT scanning prior to or after auto-HSCT. Correlation analysis was done based upon patients characteristics, PET/CT scan results and survival. Results: ①Among 48 patients, 27 was male, 21 female, median age was 43 (17-59) years old. ② Patients with negative pre-auto-HSCT PET/CT assessment demonstrated significantly better 3-year progression free survival (PFS) (87.1% vs 53.3%, χ(2)=7.02, P=0.019) and overall survival (OS) (90.3% vs 60.0%, χ(2)=6.51,P=0.022) than patients with positive pre-auto-HSCT PET/CT assessment. Three-year PFS (94.1% vs 30.0%, χ(2)=22.75, P=0.001) and OS (97.1% vs 40.0%, χ(2)=21.09, P=0.002) were also significantly different between patients with negative and positive post-auto-HSCT PET/CT assessment. ③ Multivariate analysis indicated a significant association of PFS (HR=13.176, P=0.005) and OS (HR=20.221, P=0.007) with post-auto-HSCT PET/CT assessment. Number of prior treatment regimens was associated with PFS (HR=10.039, P=0.040). ④ Harrell's C index revealed that the value of combined use of number of prior treatment regimens and post-auto-HSCT PET/CT assessment was superior to either one used alone in PFS (Harrell's C values were 0.976, 0.869 and 0.927 in combined use, number of prior treatment regimens and post-auto-HSCT PET/CT assessment, respectively), and the combined use of ECOG performance status and post-auto-HSCT PET/CT assessment significantly increased the Harrell's C index in OS (Harrell's C values were 0.973, 0.711 and 0.919 in combined use, ECOG performance status and post-auto-HSCT PET/CT assessment, respectively). Conclusions: Post-auto-HSCT PET/CT assessment is the main predictor of outcomes in DLBCL patients receiving auto-HSCT. Combined use of post-auto-HSCT PET/CT assessment and number of prior treatment regimens and ECOG performance status is a better prognostic tool in patients with DLBCL undergoing transplantation.
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Bolukbasi Y, Sezen D, Saglam Y, Selek U. Lymphoma. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-97145-2_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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15
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Yuan L, Kreissl MC, Su L, Wu Z, Hacker M, Liu J, Zhang X, Bo Y, Zhang H, Li X, Li S. Prognostic analysis of interim 18F-FDG PET/CT in patients with diffuse large B cell lymphoma after one cycle versus two cycles of chemotherapy. Eur J Nucl Med Mol Imaging 2018; 46:478-488. [PMID: 30382301 PMCID: PMC6333726 DOI: 10.1007/s00259-018-4198-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/17/2018] [Indexed: 01/14/2023]
Abstract
Objectives 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is routinely used in diffuse large B cell lymphoma (DLBCL) for staging, assessment of remission and recurrence, and estimation of therapeutic efficacy. In this study, we aimed to assess the role of an early interim PET/computed tomography (CT) in the evaluation of response in DLBCL. Methods Sixty primary DLBCL patients (31 females) were analyzed. Baseline and follow-up 18F-FDG PET/CT was performed in patients after one cycle (n = 30) and two cycles (n = 30) of chemotherapy. The ΔSUVmax% was calculated. Patients were additionally evaluated using the conventional Deauville five-point scale (D-5PS) system. Fluorescence in situ hybridization (FISH) was employed to characterize the MYC gene status. We determined the optimum cutoff value of ΔSUVmax% using receiver operating characteristic (ROC) analysis. Kaplan–Meier analysis was applied to test for the influence of prognostic values. Results The optimal cutoff for the prediction of treatment outcome was a ΔSUVmax% of 57% (after one cycle) and 63% (after two cycles); we could not detect a difference in accuracy with respect to a PET scan performed after one cycle and two cycles of chemotherapy (P > 0.05). The ΔSUVmax% and the D-5PS (score 5) showed the highest prognostic value compared to a score of 3 and/or 4 (both after one cycle and two cycles). No significant difference in sensitivity, specificity, accuracy, or the area of under the curve (AUC) of ΔSUVmax% and D-5PS (score 5) was observed between PETs performed after one cycle or two cycles of therapy (P > 0.05). ΔSUVmax%, D-5PS (score 5), and MYC gene rearrangement correlated significantly (P < 0.001). Conclusion Interim 18F-FDG PET/CT after one cycle of chemotherapy is feasible and yields similar predictive results as compared to an interim 18F-FDG PET/CT after two cycles of chemotherapy in patients suffering from DLBCL. The combination of interim 18F-FDG PET/CT with the MYC gene diagnosis might provide increased prognostic value for DLBCL.
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Affiliation(s)
- Ling Yuan
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, No. 85, Jiefang Road, Taiyuan, 030001, Shanxi, China.,Department of PET/CT, Tumor Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Michael C Kreissl
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Liping Su
- Department of Hematology, Tumor Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhifang Wu
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, No. 85, Jiefang Road, Taiyuan, 030001, Shanxi, China
| | - Marcus Hacker
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, No. 85, Jiefang Road, Taiyuan, 030001, Shanxi, China.,Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürthel 18-20, Floor 3L, 1090, Vienna, Austria
| | - Jianzhong Liu
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, No. 85, Jiefang Road, Taiyuan, 030001, Shanxi, China
| | - Xi Zhang
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, No. 85, Jiefang Road, Taiyuan, 030001, Shanxi, China
| | - Yunfeng Bo
- Department of Pathology, Tumor Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hongyu Zhang
- Department of PET/CT, Tumor Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xiang Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürthel 18-20, Floor 3L, 1090, Vienna, Austria.
| | - Sijin Li
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, No. 85, Jiefang Road, Taiyuan, 030001, Shanxi, China.
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Predictive value of interim positron emission tomography in diffuse large B-cell lymphoma: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 2018; 46:65-79. [PMID: 30141066 PMCID: PMC6267696 DOI: 10.1007/s00259-018-4103-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/18/2018] [Indexed: 01/08/2023]
Abstract
Purpose Diffuse large B-cell lymphoma (DLBCL) represents the most common subtype of non-Hodgkin lymphoma. Most relapses occur in the first 2 years after diagnosis. Early response assessment with 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET) may facilitate early change of treatment, thereby preventing ineffective treatment and unnecessary side effects. We aimed to assess the predictive value of visually-assessed interim 18F-FDG PET on progression-free survival (PFS) or event-free survival (EFS) in DLBCL patients treated with first-line immuno-chemotherapy regimens. Methods For this systematic review and meta-analysis Pubmed, Embase, and the Cochrane Library were searched until July 11, 2017. Prospective and retrospective studies investigating qualitative interim PET response assessment without treatment adaptation based on the interim PET result were eligible. The primary outcome was two-year PFS or EFS. Prognostic and diagnostic measures were extracted and analysed with pooled hazard ratios and Hierarchical Summary Receiver Operator Characteristic Curves, respectively. Meta-regression was used to study covariate effects. Results The pooled hazard ratio for 18 studies comprising 2,255 patients was 3.13 (95%CI 2.52–3.89) with a 95% prediction interval of 1.68–5.83. In 19 studies with 2,366 patients, the negative predictive value for progression generally exceeded 80% (64–95), but sensitivity (33–87), specificity (49–94), and positive predictive values (20–74) ranged widely. Conclusions These findings showed that interim 18F-FDG PET has predictive value in DLBCL patients. However, (subgroup) analyses were limited by lack of information and small sample sizes. Some diagnostic test characteristics were not satisfactory, especially the positive predictive value should be improved, before a successful risk stratified treatment approach can be implemented in clinical practice. Electronic supplementary material The online version of this article (10.1007/s00259-018-4103-3) contains supplementary material, which is available to authorized users.
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Cherng HJJ, Sargent RL, Nasta SD, Svoboda J, Schuster SJ, Mato AR, Schrank-Hacker A, Morrissette JJD, Landsburg DJ. Interim PET/CT Result Is Not Predictive of Survival in Patients With MYC-rearranged Non-Burkitt Aggressive B-cell Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:673-678. [PMID: 30033208 DOI: 10.1016/j.clml.2018.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/03/2018] [Accepted: 06/11/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with a diagnosis of MYC-rearranged non-Burkitt aggressive B-cell lymphoma (MYC-R), including those with double hit lymphoma, are at high risk of developing relapsed/refractory disease, even if treated with intensive front-line immunochemotherapy. It is common in clinical practice and clinical trials to perform an interim positron emission tomography (PET)/computed tomography (CT) scan (iPET) during front-line therapy for diffuse large B-cell lymphoma. However, the utility of the iPET result for MYC-R patients for predicting outcomes is unclear. PATIENTS AND METHODS We performed a single-center retrospective study with centralized pathologic review and PET/CT image acquisition and interpretation for 28 MYC-R patients. The patients received front-line therapy with R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin [doxorubicin], Oncovin [vincristine], prednisone) or intensive immunochemotherapy. RESULTS Eight patients had iPET-positive (iPET+) and 20 patients had iPET-negative (iPET-) results using the Deauville visual assessment criteria. At a median follow-up length of 30.4 months, progression-free survival was 65% and overall survival was 76%, neither of which differed significantly between the iPET- and iPET+ patients. The positive predictive value of iPET for progression at 30 months was 25%, and the negative predictive value was 65%. CONCLUSION Although patients with MYC-R lymphoma have been reported to be at high risk of primary treatment failure, this was not predicted by iPET+ results. Thus, the iPET result should not be used to guide changes in front-line or consolidative therapy for these patients.
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Affiliation(s)
- Hua-Jay J Cherng
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
| | - Rachel Lynn Sargent
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sunita Dwivedy Nasta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Jakub Svoboda
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Anthony R Mato
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - April Schrank-Hacker
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Daniel J Landsburg
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
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18
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Oñate-Ocaña LF, Cortés V, Castillo-Llanos R, Terrazas A, Garcia-Perez O, Pitalúa-Cortes Q, Ponce M, Dueñas-Gonzalez A, Candelaria M. Metabolic tumor volume changes assessed by interval 18fluorodeoxyglucose positron emission tomography-computed tomography for the prediction of complete response and survival in patients with diffuse large B-cell lymphoma. Oncol Lett 2018; 16:1411-1418. [PMID: 30008818 PMCID: PMC6036479 DOI: 10.3892/ol.2018.8817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 12/13/2017] [Indexed: 01/19/2023] Open
Abstract
An early discrimination of survival probability is required for patients with diffuse large B cell lymphoma (DLBCL), which may identify patients that require other treatment options, for example clinical trials. To the best of our knowledge, the impact of interim evaluation with 18fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) has not yet been determined in this type of neoplasia. The aim of the present study was to determine the role of changes in metabolic tumor volume (MTV) between baseline and interim 18F-FDG PET/CT scans, following three courses of chemotherapy in order to predict complete response (CR) and overall survival (OS) in patients with DLBCL. Patients with previously untreated DLBCL who had received the standard 6–8 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone were included in the present study. A predictive model was constructed using changes in MTV and other clinical factors including age, gender, East Cooperative Oncology Group (ECOG) status, clinical stage, B symptoms, the presence of bulky disease and elevated lactate dehydrogenase levels, and data were analyzed using logistic regression analysis. In total, 50 patients with DLBCL were included in the present study. The majority of patients presented with stage III/IV disease (64%), B symptoms (72%) and bulky disease (58%). According to the International Prognostic Index score, 44% of patients were in the intermediate-high or high-risk categories for risk of relapse, and therefore considered to have poor prognosis. In total, ≥94% of patients achieving a decrease in total MTV had a 2-year OS rate of 95%, compared with the 58% OS rate of those with a suboptimal response. A multivariate model, including a change in MTV (a decrease of ≥94%), the ECOG performance status ≥2, a change in leukocyte counts and age, was used to predict CR. This model was used to define two groups according to the predicted probability of recurrence (cutoff, 0.69). The 2-year survival rates of the two groups were 95 and 59%, respectively. Analysis of changes in MTV in the interim 18F-FDG PET/CT revealed significant prognostic value for the prediction of CR and OS in patients with DLBCL.
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Affiliation(s)
| | - Violeta Cortés
- Department of Nuclear Medicine, National Cancer Institute, Mexico City 14080, Mexico
| | | | - Andrea Terrazas
- Department of Hematology, National Cancer Institute, Mexico City 14080, Mexico
| | - Osvaldo Garcia-Perez
- Department of Nuclear Medicine, National Cancer Institute, Mexico City 14080, Mexico
| | | | - Mayra Ponce
- Research Division, National Cancer Institute, Mexico City 14080, Mexico
| | - Alfonso Dueñas-Gonzalez
- Research Division, National Cancer Institute, Mexico City 14080, Mexico.,Biomedical Research Unit on Cancer, Institute of Biomedical Research, National Autonomous University of Mexico, Mexico City 04510, Mexico
| | - Myrna Candelaria
- Research Division, National Cancer Institute, Mexico City 14080, Mexico.,Department of Hematology, National Cancer Institute, Mexico City 14080, Mexico
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Adams HJA, Kwee TC. An evidence-based review on the value of interim FDG-PET in assessing response to therapy in lymphoma. Semin Oncol 2018; 44:404-419. [PMID: 29935902 DOI: 10.1053/j.seminoncol.2018.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/11/2018] [Accepted: 01/21/2018] [Indexed: 11/11/2022]
Abstract
Assessing response to therapy in lymphoma is important for determining patients' prognosis, guiding subsequent treatment, and may be used as an outcome measure of prognostic and therapeutic trials. Traditionally, computed tomography was the mainstay for response assessment and was predominantly performed at the end of treatment, whereas the most recent guidelines propose 18F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) for this purpose. However, the value of FDG-PET performed during treatment (interim FDG-PET) is still a topic of debate. The purpose of this scientific communication is to provide an evidence-based overview of the value of interim FDG-PET in patients with lymphoma. The article first describes the development of imaging-based response assessment in lymphoma, the rationale and limitations of using FDG-PET for this purpose, and continues with the evidence-based clinical utility of interim FDG-PET in three major lymphoma subtypes (Hodgkin lymphoma, diffuse large B-cell lymphoma, and follicular lymphoma), and finishes with conclusions and recommendations for standard care and future research.
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Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, Deventer Ziekenhuis, Deventer, The Netherlands.
| | - Thomas C Kwee
- Department of Radiology and Nuclear Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Liu T, Chen L, Pan J, Pan L, Hu J, Ji Z. Retrospective Analysis of a New Prognostic Score for Diffuse Large B-Cell Lymphoma Based on Interim Positron Emission Tomography-Computed Tomography. Acta Haematol 2018; 139:148-157. [PMID: 29550822 DOI: 10.1159/000479486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/17/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND The International Prognostic Index (IPI) scoring system is the most widely used prognostic tool for diffuse large B-cell lymphoma (DLBCL); however, it fails to consistently identify patients with poor outcomes. This retrospective study was undertaken to confirm the clinical value of a new prognostic score and compare it with the IPI. METHODS The aim of this single-center study was to confirm the clinical value of a new prognostic score and its association with various clinical features, disease progression, and death in 70 patients with DLBCL who had undergone at least 6 cycles of chemotherapy. RESULTS The IPI and the new prognostic index were both associated with 3-year mortality (p ≤ 0.032); however, only the new prognostic index was associated with 3-year progression (p ≤ 0.036). Multivariate analysis showed that the new prognostic index was associated with 3-year progression but not overall survival. The new prognostic score also distinguished 3-year progression-free survival and overall survival in the low- and low-intermediate-risk groups as well as in the low-intermediate- and high-intermediate-risk groups. CONCLUSIONS The new prognostic score represents a comprehensive prognostic model superior to the IPI. Prospective studies are necessary to explore whether treatment strategies may be adjusted using this new prognostic score.
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Affiliation(s)
- TingBo Liu
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - LiHong Chen
- Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Jie Pan
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - LiLi Pan
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - JianDa Hu
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - ZhongYou Ji
- Fujian Institute of PET-CT, Fujian Medical University Union Hospital, Fuzhou, China
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21
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Ying Z, Mi L, Wang X, Zhang Y, Yang Z, Song Y, Wang X, Zheng W, Lin N, Tu M, Xie Y, Ping L, Zhang C, Liu W, Deng L, Zhu J. Prognostic value of pre- and post-transplantation 18F-fluorodeoxyglucose positron emission tomography results in non-Hodgkin lymphoma patients receiving autologous stem cell transplantation. Chin J Cancer Res 2018; 29:561-571. [PMID: 29353979 DOI: 10.21147/j.issn.1000-9604.2017.06.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective High-dose chemotherapy (HDC) followed by autologous stem cell transplantation (ASCT) is the standard of care in the upfront or relapsed/refractory setting in some patients with non-Hodgkin lymphoma (NHL). However, a proportion of patients do not respond to ASCT. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) has been widely used for staging, response evaluation, and prognosis prediction. Here, we investigated the prognostic role of PET/CT in NHL patients before and after ASCT. Methods A retrospective study was conducted at Peking University Cancer Hospital. All NHL patients who underwent ASCT between March 2010 and July 2016 were identified. Patients who had PET/CT scan before and after ASCT were included. Deauville criteria (5-point scale) were used to interpret PET scans. Univariate and multivariate survival analyses were performed using Cox regression. The predictive value of PET scanning was estimated by comparing the area under the receiver operating characteristic (ROC) curve. Results In total, 79 patients were enrolled in this study. In univariate analysis, pre- and post-ASCT PET result was identified as prognostic factors for 3-year progression-free survival (PFS) and overall survival (OS). Patients with negative pre-ASCT PET result demonstrated significantly better PFS (84.2% vs. 54.2%) and OS (89.2% vs. 63.6%) than patients with positive pre-ASCT PET result. PFS (91.6% vs. 25.3%) and OS (96.5% vs. 36.8%) were also significantly different between patients with negative and positive post-ASCT PET result. Multivariate analysis also showed a significant association between survival and post-ASCT PET result. ROC analysis revealed that the predictive value of post-ASCT PET result was superior to that of pre-ASCT PET result alone. Combined pre- and post-ASCT PET result is better for predicting outcomes in patients with NHL receiving transplantation. Deauville criteria score >3 was identified as the best cutoff value for post-ASCT PET. Conclusions Post-ASCT PET result was more important than pre-ASCT PET result in predicting outcomes for NHL patients who underwent ASCT. The prognostic significance can be improved when combining pre-ASCT PET result with post-ASCT PET result. Deauville criteria can be used for interpreting PET scans in this scenario.
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Affiliation(s)
- Zhitao Ying
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Lan Mi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xuejuan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yuewei Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Zhi Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yuqin Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiaopei Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Wen Zheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ningjing Lin
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Meifeng Tu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yan Xie
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Lingyan Ping
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Chen Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Weiping Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Lijuan Deng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jun Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
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22
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Jiang M, Chen P, Ruan X, Xu W, Li T, Wu L, Zhou W, Wu H, Wang Q. Interim 18F-FDG PET/CT and BCL2 for predicting the prognosis of patients with diffuse large B-cell lymphoma in the rituximab era. Nucl Med Commun 2017; 39:147-153. [PMID: 29189488 DOI: 10.1097/mnm.0000000000000784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In this study, we investigated the prognostic role of interim fluorine-18-fluorodeoxyglucose PET/computed tomography (I-PET/CT) and BCL2 in diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab-containing chemotherapy. MATERIALS AND METHODS A total of 106 patients with newly diagnosed DLBCL underwent PET/CT scans at baseline and a subsequent I-PET/CT after the fourth cycle of chemotherapy. I-PET/CT was analyzed using the Deauville five-point score. The prognostic significance of I-PET/CT and BCL2 was evaluated by predicting progression-free survival (PFS) and overall survival (OS). RESULTS With a median follow-up of 25 months, the 2-year PFS and OS were 78 and 95% in the I-PET/CT-negative group and 33 and 57% in the I-PET/CT-positive group (P<0.001). Patients with BCL2 positivity showed a shorter PFS than the BCL2-negative patients (P=0.002), but not in OS (P=0.068). In multivariate analysis, I-PET/CT and BCL2 were independent variables in assessing the outcome of PFS. I-PET/CT was also an independent factor for OS. Irrespective of the results of BCL2, patients with I-PET/CT positivity had a significant inferior outcome than the I-PET/CT-negative patients. In the I-PET/CT-negative group, patients with BCL2 positivity had a significantly shorter PFS than the BCL2-negative patients (P=0.005). CONCLUSION I-PET/CT and BCL2 were two significant independent indicators of outcome for patients with DLBCL in the rituximab era. I-PET/CT was much better than BCL2 for patient stratification. BCL2 showed its supplementary role for further patient stratification when I-PET/CT was negative.
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Affiliation(s)
- Maoqing Jiang
- Department of Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou.,Department of Nuclear Medicine
| | - Ping Chen
- Department of Nephrology, Ningbo First Hospital, Ningbo, Zhejiang, China
| | | | | | | | | | - Wenlan Zhou
- Department of Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou
| | - Hubing Wu
- Department of Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou
| | - Quanshi Wang
- Department of Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou
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Interim PET-CT may predict PFS and OS in T-ALL/LBL adult patients. Oncotarget 2017; 8:99104-99111. [PMID: 29228756 PMCID: PMC5716796 DOI: 10.18632/oncotarget.19572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/29/2017] [Indexed: 11/25/2022] Open
Abstract
T lymphoblastic leukemia/lymphoma (T-ALL/LBL) is highly aggressive. Although intensive chemotherapies such as ALL-type regimens are commonly used, about half adult patients eventually relapse and die of T-ALL/LBL. Overwhelming evidences have confirmed that interim PET can predict survival outcomes and guide subsequent treatments in Hodgkin lymphoma. However, whether interim PET-CT can predict survival outcomes or not in T-ALL/LBL patients remains unclear. 47 adult patients of T-ALL/LBL were retrospectively reviewed. Interim PET-CT was done after induction therapy and evaluated according to the International Harmonization Project criteria. After induction therapy, interim PET-CT was positive in 19 patients (40.4%). After a median follow up time of 34 months, the 2-year and 3-year progression free survival (PFS) rate were 39% and 30%, respectively, and the 2-year and 3-year overall survival (OS) rate were 54% and 45%, respectively. Using Kaplan-Meier survival analysis, it was found that interim PET-CT positivity correlated with significantly inferior PFS and OS (2-year PFS rate for patients with positive or negative interim PET were 21.1% or 56.0%, respectively, p = 0.002; 2-year OS rate for patients with positive or negative interim PET were 31.6% or 63.7%, respectively, p = 0.010). However, there was no significant relationship between PFS, OS and bone marrow infiltration, lactate dehydrogenase level, and stages (p > 0.05). Interim PET-CT may predict PFS and OS in adult patients of T-ALL/LBL, which needs to be validated in prospective clinical trials. The optimal criteria for interim PET-CT evaluation and risk-adapted treatment strategy determined by interim PET-CT should be investigated in future clinical practice.
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Jiang M, Chen P, Ruan X, Ye X, Pan Y, Zhang J, Huang Q, Zhou W, Wu H, Wang Q. Interim 18F-FDG PET/CT improves the prognostic value of S-IPI, R-IPI and NCCN-IPI in patients with diffuse large B-cell lymphoma. Oncol Lett 2017; 14:6715-6723. [PMID: 29344120 PMCID: PMC5754843 DOI: 10.3892/ol.2017.7093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/08/2017] [Indexed: 12/14/2022] Open
Abstract
The current study aimed to explore whether the efficiency of the standard International Prognostic Index (S-IPI), revised-IPI (R-IPI) and enhanced-IPI (NCCN-IPI) in evaluating the prognosis of patients with diffuse large B-cell lymphoma (DLBCL) may be improved by interim 18F-FDG PET/CT. A total of 185 patients with newly diagnosed DLBCL were enrolled in the current study. All patients underwent interim PET/CT following the 4th cycle of chemotherapy. Patients were divided into different risk groups using S-IPI, R-IPI and NCCN-IPI and further subdivided into risk groups using interim PET/CT. Interpretations were evaluated for 2-year progression-free survival (PFS) and overall survival (OS). With a median follow-up time of 44 months, the 2-year PFS and OS were 60% [95% confidence interval (CI) 53–67%] and 81% (95% CI 74–86%), respectively. Analysis of S-IPI and NCCN-IPI identified no significant difference in PFS and OS between high intermediate and high risk groups. However, there were significant differences in the PFS and OS between the low and low intermediate risk groups (P<0.01). Interim PET/CT was used to redistribute patients in the higher risk group into PET negative and positive groups (P<0.01) and arallel results were observed in the lower risk group. In R-IPI, interim PET/CT identified a significant difference between PFS and OS in the good and poor risk groups but not in the very good risk group. Therefore, the results of the current study indicate that S-IPI, R-IPI and NCCN-IPI are three clinically useful prognostic indexes for patients with DLBCL. Interim PET/CT may improve the prognostic value of S-IPI, R-IPI and NCCN-IPI in predicting 2-year PFS and OS, particularly in patients with a high IPI score.
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Affiliation(s)
- Maoqing Jiang
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Ping Chen
- Department of Nephrology, Ningbo First Hospital, Ningbo, Zhejiang 315010, P.R. China
| | - Xinzhong Ruan
- Department of Radiology, Ningbo First Hospital, Ningbo, Zhejiang 315010, P.R. China
| | - Xianwang Ye
- Department of Radiology, Ningbo First Hospital, Ningbo, Zhejiang 315010, P.R. China
| | - Yuning Pan
- Department of Radiology, Ningbo First Hospital, Ningbo, Zhejiang 315010, P.R. China
| | - Jie Zhang
- Department of Radiology, Ningbo First Hospital, Ningbo, Zhejiang 315010, P.R. China
| | - Qiuli Huang
- Department of Radiology, Ningbo First Hospital, Ningbo, Zhejiang 315010, P.R. China
| | - Wenlan Zhou
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Hubing Wu
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Quanshi Wang
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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25
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Optimization of metabolic criteria in the prognostic assessment of patients with lymphoma. A multicenter study. Rev Esp Med Nucl Imagen Mol 2017. [DOI: 10.1016/j.remnie.2017.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Du W, Ling W, Ma X, Jiang C, Wang J, Zhu C, Xia X. Contrast-enhanced ultrasound in the therapeutic assessment of diffuse large B-cell lymphoma: A case report. Oncol Lett 2017; 14:4593-4598. [PMID: 29085458 PMCID: PMC5649538 DOI: 10.3892/ol.2017.6758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 07/17/2017] [Indexed: 02/05/2023] Open
Abstract
Contrast-enhanced computed tomography (CECT) has been extensively used in the restaging and assessment of treatment response for diffuse large B-cell lymphoma (DLBCL). However, CECT does not provide information regarding the specific functionality of lesions. A patient (56 years old, female) was previously admitted to the present institution, with bilateral cervical masses. Following numerous cycles of chemotherapy, a stable disease status was confirmed using CECT. In conjunction with CECT imaging results, contrast-enhanced ultrasound (CEUS) demonstrated important semi-functional information regarding blood perfusion, during the revision of treatment assessment. 18F-fluoro-2-deoxyglucose (FDG)-positron emission tomography-computed tomography imaging demonstrated no increase in FDG uptake of the same tumor lesion, consistent with the results of CEUS. CEUS exhibited the potential to present complementary results to CECT, in the therapeutic assessment of DLBCL, which, to the best of our knowledge, has not previously been reported.
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Affiliation(s)
- Wei Du
- West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Wenwu Ling
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xuelei Ma
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Chong Jiang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Jianchao Wang
- West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Chenjin Zhu
- West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xueming Xia
- Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Elevated tumor-to-liver uptake ratio (TLR) from 18F-FDG-PET/CT predicts poor prognosis in stage IIA colorectal cancer following curative resection. Eur J Nucl Med Mol Imaging 2017; 44:1958-1968. [PMID: 28812134 PMCID: PMC5656694 DOI: 10.1007/s00259-017-3779-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/11/2017] [Indexed: 02/06/2023]
Abstract
Purpose The prognostic value of the tumor-to-liver uptake ratio (TLR) from 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F–FDG-PET/CT) in the early stage of colorectal cancer (CRC) is unclear. Notably, some stage IIA CRC patients experience early recurrence even after curative resection and might benefit from neoadjuvant or adjuvant chemotherapy. This study aims to evaluate whether elevated TLR from 18F–FDG-PET/CT can predict poor prognosis in stage IIA CRC patients undergoing curative resection. Methods From April 2010 to December 2013, 504 consecutive CRC patients with different TNM stages (I-IV) underwent 18F–FDG-PET/CT scans at the 6th Affiliated Hospital of Sun Yat-Sen University. Among the patients, 118 with stage IIA CRC who accepted preoperative 18F–FDG-PET/CT scanning and were treated with curative surgery alone were reviewed retrospectively. The maximum standardized uptake value (SUVmax) in the primary tumor, TLR, and demographic, clinical, histopathological, and laboratory data were analyzed. Receiver operating characteristic (ROC) curve, univariate and multivariate analyses were performed to identify prognostic factors associated with patient disease-free survival (DFS) and overall survival (OS). Results ROC curve analysis demonstrated that TLR was superior to primary tumor SUVmax in predicting the risk of recurrence in stage IIA CRC. The optimal TLR cutoff was 6.2. Univariate analysis indicated that elevated TLR, tumor size, and lymphovascular/neural invasion correlated with DFS (P = 0.001, P = 0.002, and P = 0.001, respectively) and OS (P = 0.001, P = 0.003, and P < 0.001, respectively). The 1-, 3-, and 5-year DFS rates were 98.4%, 96.9%, and 96.9% for stage IIA CRC patients with lower TLR (≤6.2) versus 77.8%, 60.6%, and 60.6% for those with elevated TLR (>6.2), respectively. The 1-, 3-, and 5-year OS rates were 100.0%, 100.0%, and 98.3% for the patients with lower TLR versus 98.1%, 83.3%, and 74.3% for those with elevated TLR. Cox regression analysis showed that elevated TLR [>6.2; hazard ratio (HR): 3.109–57.463; P < 0.001] and tumor size (>4.4 cm; HR: 1.636–19.155; P = 0.006) were independent risk factors for DFS. Meanwhile, elevated TLR (>6.2; HR: 1.398–84.945; P = 0.023) and lymphovascular/neural invasion (positive; HR: 1.278–12.777; P = 0.017) were independent risk factors for OS. Conclusion Elevated TLR predicted worse DFS and OS for stage IIA CRC patients and might serve as a potential radiological index to identify candidates for neoadjuvant or adjuvant chemotherapy. Stage IIA CRC patients with elevated TLR should be monitored carefully for early detection of possible recurrence.
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Barrington SF, Kluge R. FDG PET for therapy monitoring in Hodgkin and non-Hodgkin lymphomas. Eur J Nucl Med Mol Imaging 2017; 44:97-110. [PMID: 28411336 PMCID: PMC5541086 DOI: 10.1007/s00259-017-3690-8] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 12/15/2022]
Abstract
PET using 18F-FDG for treatment monitoring in patients with lymphoma is one of the most well-developed clinical applications. PET/CT is nowadays used during treatment to assess chemosensitivity, with response-adapted therapy given according to 'interim' PET in clinical practice to adults and children with Hodgkin lymphoma. PET is also used to assess remission from disease and to predict prognosis in the pretransplant setting. Mature data have been reported for the common subtypes of aggressive B-cell lymphomas, with more recent data also supporting the use of PET for response assessment in T-cell lymphomas. The Deauville five-point scale incorporating the Deauville criteria (DC) is recommended for response assessment in international guidelines. FDG uptake is graded in relation to the reference regions of normal mediastinum and liver. The DC have been validated in most lymphoma subtypes. The DC permit the threshold for adequate or inadequate response to be adapted according to the clinical context or research question. It is important for PET readers to understand how the DC have been applied in response-adapted trials for correct interpretation and discussion with the multidisciplinary team. Quantitative methods to perform PET in standardized ways have also been developed which may further improve response assessment including a quantitative extension to the DC (qPET). This may have advantages in providing a continuous scale to refine the threshold for adequate/inadequate response in specific clinical situations or treatment optimization in trials. qPET is also less observer-dependent and limits the problem of optical misinterpretation due to the influence of background activity.
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Affiliation(s)
- Sally F Barrington
- PET Imaging Centre, King's College London and Guy's, King's Health Partners, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, 0410, Leipzig, Germany
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29
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Del Puig Cózar-Santiago M, García-Garzón JR, Moragas-Freixa M, Soler-Peter M, Bassa Massanas P, Sánchez-Delgado M, Sanchez-Jurado R, Aguilar-Barrios JE, Sanz-Llorens R, Ferrer-Rebolleda J. Optimisation of metabolic criteria in the prognostic assessment in patients with lymphoma. A multicentre study. Rev Esp Med Nucl Imagen Mol 2017; 36:304-311. [PMID: 28483373 DOI: 10.1016/j.remn.2017.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 02/24/2017] [Accepted: 03/01/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare sensitivity, specificity and predictive value of Deauville score (DS) vs. ΔSUVmax in interim-treatment PET (iPET) and end-treatment PET (ePET), in patients with diffuse large B cell lymphoma (DLBCL), Hodgkin lymphoma (HL), and follicular lymphoma (FL). METHOD Retrospective longitudinal multicentre study including 138 patients (46 DLBCL, 46 HL, 46 FL), on whom 3 18F-FDG PET/CT were performed: baseline, iPET, and ePET. Visual (DS) and semi-quantitative (ΔSUVmax) parameters were determined for iPET and ePET. Predictive value was determined in relation to disease-free interval. RESULTS Statistical analysis. iPET for DLBCL, HL, and FL: 1) sensitivity of DS: 76.92/83.33/61.53%; specificity: 78.78/85/81.81%; 2) sensitivity of ΔSUVmax: 53.84/83.33/61.53%; specificity: 87.87/87.50/78.78%. ePET for DLBCL, HL and FL: 1) sensitivity of DS: 61.53/83.33/69.23%; specificity: 90.90/85/87.87%; 2) sensitivity of ΔSUVmax: 69.23/83.33/69.23%; specificity: 90.90/87.50/84.84%. Predictive assessment. iPET study: in DLBCL, DS resulted in 10.3% recurrence of negative iPET, and 17.1% in ΔSUVmax at disease-free interval; in HL, both parameters showed a 2.8% recurrence of negative iPET; in FL, DS resulted in 15.6% recurrence of negative iPET, and 16.1% in ΔSUVmax, with no statistical significance. ePET study: in DLBCL, DS resulted in 14.3% recurrence of negative ePET, and 11.8% in ΔSUVmax at disease-free interval; in HL and FL, both methods showed 2.8 and 12.5% recurrence in negative ePET, respectively. CONCLUSION DS and ΔSUVmax did not show significant differences in DLBCL, HL and FL. Their predictive value also did not show significant differences in HL and FL. In DLBCL, DS was higher in iPET, and ΔSUVmax in ePET.
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Affiliation(s)
| | - J R García-Garzón
- Unidad PET Esplugues, Cetir-ERESA, Esplugues de Llobregat, Barcelona, España
| | - M Moragas-Freixa
- Unidad PET Esplugues, Cetir-ERESA, Esplugues de Llobregat, Barcelona, España
| | - M Soler-Peter
- Unidad PET Esplugues, Cetir-ERESA, Esplugues de Llobregat, Barcelona, España
| | - P Bassa Massanas
- Unidad PET Esplugues, Cetir-ERESA, Esplugues de Llobregat, Barcelona, España
| | - M Sánchez-Delgado
- Servicio de Hematología, Hospital General Universitario de Valencia, Valencia, España
| | - R Sanchez-Jurado
- Servicio de Medicina Nuclear, ERESA-Hospital General Universitario de Valencia, Valencia, España
| | - J E Aguilar-Barrios
- Servicio de Medicina Nuclear, ERESA-Hospital General Universitario de Valencia, Valencia, España
| | - R Sanz-Llorens
- Servicio de Medicina Nuclear, ERESA-Hospital General Universitario de Valencia, Valencia, España
| | - J Ferrer-Rebolleda
- Servicio de Medicina Nuclear, ERESA-Hospital General Universitario de Valencia, Valencia, España
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Interim fluorine-18 fluorodeoxyglucose PET-computed tomography and cell of origin by immunohistochemistry predicts progression-free and overall survival in diffuse large B-cell lymphoma patients in the rituximab era. Nucl Med Commun 2017; 37:1095-101. [PMID: 27281359 PMCID: PMC5004620 DOI: 10.1097/mnm.0000000000000553] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Supplemental Digital Content is available in the text. Objective The aim of this study was to analyze the prognostic value of the interim PET (iPET)-computed tomography (CT) (iPET-CT) after two cycles of immunochemotherapy with the R-CHOP protocol in patients with diffuse large B-cell non-Hodgkin lymphoma (DLBCL) treated with a curative intent in combination with the neoplastic cell origin defined by Hans’s immunohistochemstry algorithm followed in a reference center for cancer treatment in Brazil. Materials and methods We prospectively evaluated 147 DLBCL patients treated with R-CHOP-21 to assess the value of the International Prognostic Index, iPET-CT, and cell of origin by immunohistochemistry as prognostic markers in the rituximab era. Fluorine-18 fluorodeoxyglucose PET-CT was performed after two cycles (iPET-CT) and at the end of treatment in 111 patients. Lymphoma cases were categorized into germinal center (GC) and nongerminal center subtypes by immunohistochemistry according to Hans’s algorithm. Results The median age of GC-DLBCL patients (52.7 years) was lower than that of nongerminal center-DLBCL patients (59.4 years) (P=0.021); in addition, it was lower in patients with negative iPET-CT findings (52.7 years) versus positive findings (59.4 years) (P=0.031). The overall survival at 48 months was 100% for iPET-CT-negative GC-DLBCL patients and 61.2% for iPET-CT-positive GC-DLBCL patients (P=0.002). Progression-free survival at 30 months was 100% for iPET-CT-negative GC-DLBCL patients and 60.3% for iPET-CT-positive GC-DLBCL patients (P=0.001). Conclusion We conclude that iPET-CT associated with cell origin identified a very good prognostic group in DLBCL patients treated with R-CHOP. Video Abstract: http://links.lww.com/NMC/A59
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Role of Positron Emission Tomography in Diffuse Large B-cell Lymphoma. Hematol Oncol Clin North Am 2016; 30:1215-1228. [DOI: 10.1016/j.hoc.2016.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hertzberg M, Gandhi MK, Trotman J, Butcher B, Taper J, Johnston A, Gill D, Ho SJ, Cull G, Fay K, Chong G, Grigg A, Lewis ID, Milliken S, Renwick W, Hahn U, Filshie R, Kannourakis G, Watson AM, Warburton P, Wirth A, Seymour JF, Hofman MS, Hicks RJ. Early treatment intensification with R-ICE and 90Y-ibritumomab tiuxetan (Zevalin)-BEAM stem cell transplantation in patients with high-risk diffuse large B-cell lymphoma patients and positive interim PET after 4 cycles of R-CHOP-14. Haematologica 2016; 102:356-363. [PMID: 28143954 DOI: 10.3324/haematol.2016.154039] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/03/2016] [Indexed: 01/11/2023] Open
Abstract
In the treatment of diffuse large B-cell lymphoma, a persistently positive [18F]fluorodeoxyglucose positron emission tomography (PET) scan typically carries a poor prognosis. In this prospective multi-center phase II study, we sought to establish whether treatment intensification with R-ICE (rituximab, ifosfamide, carboplatin, and etoposide) chemotherapy followed by 90Y-ibritumomab tiuxetan-BEAM (BCNU, etoposide, cytarabine, and melphalan) for high-risk diffuse large B-cell lymphoma patients who are positive on interim PET scan after 4 cycles of R-CHOP-14 (rituximab, cyclophosphamide, doxorubicin, and prednisone) can improve 2-year progression-free survival from a historically unfavorable rate of 40% to a rate of 65%. Patients received 4 cycles of R-CHOP-14, followed by a centrally-reviewed PET performed at day 17-20 of cycle 4 and assessed according to International Harmonisation Project criteria. Median age of the 151 evaluable patients was 57 years, with 79% stages 3-4, 54% bulk, and 54% International Prognostic Index 3-5. Among the 143 patients undergoing interim PET, 101 (71%) were PET-negative (96 of whom completed R-CHOP), 42 (29%) were PET-positive (32 of whom completed R-ICE and 90Y-ibritumomab tiuxetan-BEAM). At a median follow up of 35 months, the 2-year progression-free survival for PET-positive patients was 67%, a rate similar to that for PET-negative patients treated with R-CHOP-14 (74%, P=0.11); overall survival was 78% and 88% (P=0.11), respectively. In an exploratory analysis, progression-free and overall survival were markedly superior for PET-positive Deauville score 4 versus score 5 (P=0.0002 and P=0.001, respectively). Therefore, diffuse large B-cell lymphoma patients who are PET-positive after 4 cycles of R-CHOP-14 and who switched to R-ICE and 90Y-ibritumomab tiuxetan-BEAM achieved favorable survival outcomes similar to those for PET-negative R-CHOP-14-treated patients. Further studies are warranted to confirm these promising results. (Registered at: ACTRN12609001077257).
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Affiliation(s)
- Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital and University of NSW, Randwick, NSW, Australia
| | - Maher K Gandhi
- The University of Queensland Diamantina Institute Woolloongabba, Brisbane, QLD, Australia.,Department of Haematology, Princess Alexandra Hospital Brisbane, QLD, Australia
| | - Judith Trotman
- Department of Haematology, Repatriation General Hospital Concord and University of Sydney, NSW, Australia
| | | | - John Taper
- Nepean Cancer Care Centre, Nepean Hospital Nepean, NSW, Australia
| | - Amanda Johnston
- Department of Haematology, Westmead Hospital, NSW, Australia
| | - Devinder Gill
- Department of Haematology, Princess Alexandra Hospital Brisbane, QLD, Australia
| | - Shir-Jing Ho
- Department of Haematology, St George Hospital Kogarah, NSW, Australia
| | - Gavin Cull
- Department of Haematology, Sir Charles Gairdner Hospital Perth, WA, Australia
| | - Keith Fay
- Department of Haematology, Royal North Shore Hospital, St Leonard's, NSW, Australia
| | - Geoff Chong
- Olivia Newton John Cancer & Wellness Centre, Austin Hospital, Heidelberg, VIC, Australia
| | - Andrew Grigg
- Department of Haematology, Austin Hospital, Heidelberg, VIC, Australia
| | - Ian D Lewis
- Department of Haematology, Royal Adelaide Hospital Adelaide, SA, Australia
| | - Sam Milliken
- Department of Haematology, St Vincent's Hospital Darlinghurst, NSW, Australia
| | - William Renwick
- Department of Haematology, Royal Melbourne Hospital Parkville, VIC, Australia
| | - Uwe Hahn
- Department of Haematology, The Queen Elizabeth Hospital, SA, Australia
| | - Robin Filshie
- Department of Haematology, St Vincent's Hospital Melbourne, VIC, Australia
| | - George Kannourakis
- Ballarat Oncology and Haematology Service and Fiona Elsey Cancer Research Institute, Ballarat, VIC, Australia
| | - Anne-Marie Watson
- Department of Haematology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Pauline Warburton
- Department of Haematology, Wollongong Hospital, Wollongong, NSW, Australia
| | - Andrew Wirth
- Department of Radiation Oncology, Peter MacCallum Cancer Centre East Melbourne, VIC, Australia
| | - John F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre East Melbourne and University of Melbourne, Parkville, VIC, Australia
| | - Michael S Hofman
- Department of Cancer Imaging, Peter MacCallum Cancer Centre East Melbourne, VIC, Australia
| | - Rodney J Hicks
- Department of Cancer Imaging, Peter MacCallum Cancer Centre East Melbourne, VIC, Australia
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Primary mediastinal B-cell lymphoma - metabolic and anatomical features in 18FDG-PET/CT and response to therapy. Contemp Oncol (Pozn) 2016; 20:297-301. [PMID: 27688726 PMCID: PMC5032157 DOI: 10.5114/wo.2016.61849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 06/22/2016] [Indexed: 11/17/2022] Open
Abstract
Aim of the study Determining the role of PET/CT imaging in the evaluation of treatment efficacy in primary mediastinal B-cell lymphoma (PMBCL). Material and methods Retrospective analysis of seven PMBCL patients, treated at the University Hospital in Krakow, with interim PET/CT after the third course of chemo-immunotherapy.The analysis was based on the calculation of exact tumour volume and metabolic activity, compared with initial values (directly after diagnosis). Results Patients (five females, two males, average age 26.2 years, range 18–40 years), in clinical stage IIBX at diagnosis, were treated with eight cycles of R-CHOP-14 regimen, with radiotherapy consolidation (7/7) and central nervous system prophylaxis (6/7). The observed decrease in tumour volume between the initial staging and the interim PET ranged 72–89%. The mean ΔSUVmax reduction between initial (when available) and interim PET was 87% (range 84–89%). In 3/7 cases in the interim PET/CT, the uptake of the tumour was higher than the liver (Deauville Criteria score 4–5), and in 4/7 it was lower than the liver but higher than mediastinal blood pool structures (score 3 according to Deauville Criteria). After a median follow-up of 58 months – OS and EFS is 100%. Conclusions The excellent clinical outcome in the study group corresponds with very good metabolic and volumetric response in the interim PET. The ΔSUVmax seems to be easier in implementation and has a more significant impact than other measurements.
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Adams HJA, Kwee TC. Prognostic value of interim FDG-PET in R-CHOP-treated diffuse large B-cell lymphoma: Systematic review and meta-analysis. Crit Rev Oncol Hematol 2016; 106:55-63. [PMID: 27637352 DOI: 10.1016/j.critrevonc.2016.07.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/18/2016] [Accepted: 07/07/2016] [Indexed: 10/21/2022] Open
Abstract
This study aimed to systematically review and meta-analyze the prognostic value of interim (18)F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) in diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). MEDLINE and EMBASE were systematically searched for suitable studies. Included studies were methodologically appraised, and results were summarized both descriptively and meta-analytically. Nine studies, comprising a total of 996 R-CHOP-treated DLBCL patients, were included. Overall, studies were of moderate methodological quality. The area under the summary receiver operating curve (AUC) of interim FDG-PET in predicting treatment failure and death were 0.651 and 0.817, respectively. There was no heterogeneity in diagnostic odds ratios across available studies (I(2)=0.0%). At multivariable analysis, 2 studies reported interim FDG-PET to have independent prognostic value in addition to the International Prognostic Index (IPI) in predicting treatment failure, whereas 3 studies reported that this was not the case. One study reported interim FDG-PET to have independent prognostic value in addition to the IPI in predicting death, whereas 2 studies reported that this was not the case. In conclusion, interim FDG-PET in R-CHOP-treated DLBCL has some correlation with outcome, but its prognostic value is homogeneously suboptimal across studies and it has not consistently proven to surpass the prognostic potential of the IPI. Moreover, there is a lack of studies that compared interim FDG-PET to the recently developed and superior National Comprehensive Cancer Network-IPI. Therefore, at present there is no scientific base to support the clinical use of interim FDG-PET in R-CHOP-treated DLBCL.
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Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Thomas C Kwee
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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Kwon S, Kang D, Kim J, Yoon JK, Lee S, Jeong S, Lee H, An YS. Prognostic value of negative interim 2-[18F]-fluoro-2-deoxy-d-glucose PET/CT in diffuse large B-cell lymphoma. Clin Radiol 2016; 71:280-6. [DOI: 10.1016/j.crad.2015.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 11/17/2015] [Accepted: 11/24/2015] [Indexed: 12/01/2022]
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Kong Y, Qu L, Li Y, Liu D, Lv X, Han J. Predictive Significance of a New Prognostic Score for Patients With Diffuse Large B-Cell Lymphoma in the Interim-Positron Emission Tomography Findings. Medicine (Baltimore) 2016; 95:e2808. [PMID: 26871850 PMCID: PMC4753946 DOI: 10.1097/md.0000000000002808] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We hypothesized that the objective treatment response of patients with diffuse large B-cell lymphoma (DLBCL) was affected by many factors such as pathophysiological, biological, and pharmaceutical mechanisms. This retrospective study aimed to evaluate the predictive significance of clinical prognostic factors and interim fluorine-18-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT), and to find a new prognostic predictor significantly associated with DLBCL patients' outcome. A total of 105 adult patients with DLBCL were reviewed. Each patient underwent an interim F-FDG PET/CT scan after the second chemotherapy cycle. The visual method based on the Deauville 5-point scale was used to evaluate the interim-PET/CT scans. The relationships among the prognostic factors, the 3-year progression-free survival (PFS) rate and overall survival (OS) rate were analyzed with Kaplan-Meier plots. The predictive value of the newly constructed prognostic score was analyzed with multivariate analysis (Cox proportional hazard regression model). The visual analysis showed statistically significant differences in both PFS and OS between the patients with a negative interim-PET/CT and those with a positive interim-PET/CT. Advanced age, advanced stage, and DLBCL subtype were also significantly associated with outcome. A new prognostic score that composed of the above 4 factors was obtained. New prognostic score stratified patients into 4 risk groups with 3-year PFS of 98.5%, 73.9%, 11.1%, and 0%, and 3-year OS of 100%, 91.3%, 55.6%, and 0% (P < 0.001 for PFS and OS). Multivariate analysis showed that the new prognostic score had the greatest ability to predict relapse (P < 0.001) and death (P < 0.001). In DLBCL patients, interim F-FDG PET/CT can provide significant independent prognostic information. Our work illustrates that the new prognostic score has the strongest potential for accurately prognostication, for stratification in clinical trials, and for design of novel strategies for DLBCL patients in the high-risk group.
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Affiliation(s)
- Yu Kong
- From the Department of Nuclear Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China
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Carlier T, Bailly C. State-Of-The-Art and Recent Advances in Quantification for Therapeutic Follow-Up in Oncology Using PET. Front Med (Lausanne) 2015; 2:18. [PMID: 26090365 PMCID: PMC4370108 DOI: 10.3389/fmed.2015.00018] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 03/09/2015] [Indexed: 12/28/2022] Open
Abstract
18F-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET) is an important tool in oncology. Its use has greatly progressed from initial diagnosis to staging and patient monitoring. The information derived from 18F-FDG-PET allowed the development of a wide range of PET quantitative analysis techniques ranging from simple semi-quantitative methods like the standardized uptake value (SUV) to “high order metrics” that require a segmentation step and additional image processing. In this review, these methods are discussed, focusing particularly on the available methodologies that can be used in clinical trials as well as their current applications in international consensus for PET interpretation in lymphoma and solid tumors.
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Affiliation(s)
- Thomas Carlier
- Nuclear Medicine Department, University Hospital , Nantes , France ; CRCNA, INSERM U892, CNRS UMR 6299 , Nantes , France
| | - Clément Bailly
- Nuclear Medicine Department, University Hospital , Nantes , France
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38
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Barrington SF, Mikhaeel NG, Kostakoglu L, Meignan M, Hutchings M, Müeller SP, Schwartz LH, Zucca E, Fisher RI, Trotman J, Hoekstra OS, Hicks RJ, O'Doherty MJ, Hustinx R, Biggi A, Cheson BD. Role of imaging in the staging and response assessment of lymphoma: consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J Clin Oncol 2015; 32:3048-58. [PMID: 25113771 DOI: 10.1200/jco.2013.53.5229] [Citation(s) in RCA: 1075] [Impact Index Per Article: 119.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Recent advances in imaging, use of prognostic indices, and molecular profiling techniques have the potential to improve disease characterization and outcomes in lymphoma. International trials are under way to test image-based response–adapted treatment guided by early interim positron emission tomography (PET)–computed tomography (CT). Progress in imaging is influencing trial design and affecting clinical practice. In particular, a five-point scale to grade response using PET-CT, which can be adapted to suit requirements for early- and late-response assessment with good interobserver agreement, is becoming widely used both in practice- and response-adapted trials. A workshop held at the 11th International Conference on Malignant Lymphomas (ICML) in 2011 concluded that revision to current staging and response criteria was timely. METHODS An imaging working group composed of representatives from major international cooperative groups was asked to review the literature, share knowledge about research in progress, and identify key areas for research pertaining to imaging and lymphoma. RESULTS A working paper was circulated for comment and presented at the Fourth International Workshop on PET in Lymphoma in Menton, France, and the 12th ICML in Lugano, Switzerland, to update the International Harmonisation Project guidance regarding PET. Recommendations were made to optimize the use of PET-CT in staging and response assessment of lymphoma, including qualitative and quantitative methods. CONCLUSION This article comprises the consensus reached to update guidance on the use of PET-CT for staging and response assessment for [18F]fluorodeoxyglucose-avid lymphomas in clinical practice and late-phase trials.
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Predictive value of interim PET/CT in DLBCL treated with R-CHOP: meta-analysis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:648572. [PMID: 25710013 PMCID: PMC4331162 DOI: 10.1155/2015/648572] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 11/17/2014] [Accepted: 11/30/2014] [Indexed: 11/18/2022]
Abstract
Objective. We conducted a meta-analysis to evaluate the predictive value of interim 18F-FDG PET/CT in patients with DLBCL treated with R-CHOP chemotherapy. Methods. We searched for articles published in PubMed, ScienceDirect, Wiley, Scopus, and Ovid database from inception to March 2014. Articles related to interim PET/CT in patients with DLBCL treated with R-CHOP chemotherapy were selected. PFS with or without OS was chosen as the endpoint to evaluate the prognostic significance of interim PET/CT. Results. Six studies with a total of 605 cases were included. The sensitivity of interim PET/CT ranged from 21.2% to 89.7%, and the pooled sensitivity was 52.4%. The specificity of interim PET/CT ranged from 37.4% to 90.7%, and the pooled specificity was 67.8%. The pooled positive likelihood ratio and negative likelihood ratio were 1.780 and 0.706, respectively. The explained AUC was 0.6978 and the Q* was 0.6519. Conclusions. The sensitivity and specificity of interim PET/CT in predicting the outcome of DLBCL patients treated with R-CHOP chemotherapy were not satisfactory (52.4% and 67.8%, resp.). To improve this, some more work should be done to unify the response criteria and some more research to assess the prognostic value of interim PET/CT with semiquantitative analysis.
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Hagtvedt T, Seierstad T, Lund KV, Løndalen AM, Bogsrud TV, Smith HJ, Geier OM, Holte H, Aaløkken TM. Diffusion-weighted MRI compared to FDG PET/CT for assessment of early treatment response in lymphoma. Acta Radiol 2015; 56:152-8. [PMID: 24585944 DOI: 10.1177/0284185114526087] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND 18F fluoro-deoxyglucose (FDG) positron emission tomography / computed tomography (PET/CT) is a well-recognized diagnostic tool used for staging and monitoring of therapy response for lymphomas. During the past decade diffusion-weighted (DW) magnetic resonance imaging (MRI) is increasingly being included in the assessment of tumor response for various cancers. PURPOSE To compare the change in maximum standardized uptake value (ΔSUVmax) from FDG PET/CT with the change in apparent diffusion coefficient (ΔADC) from DW MRI after initiation of the first cycle of chemotherapy in patients with Hodgkin's lymphoma (HL) and in patients with diffuse large B-cell lymphoma (DLBCL). MATERIAL AND METHODS Twenty-seven consecutive patients with histologically proven lymphoma and lymphomatous lymph nodes (LLN) of the neck (19 with HL, 8 with DLBCL) underwent FDG PET/CT and MRI of the neck before and after initiation of the first cycle of chemotherapy. The mean time interval from initiation of chemotherapy to imaging was 19 days and 2 days for FDG PET/CT and MRI, respectively. For each patient ΔSUVmax, ΔADC, and change in volume of the same LLN were compared. RESULTS There was a significant mean decrease of SUVmax by 70%, but no significant change in ADC. There was no significant reduction in LLN volume. CONCLUSION There was no significant correlation between ΔSUVmax and ΔADC. Thus, our data do not support that FDG PET/CT can be replaced by early DW MRI for response evaluation in lymphoma patients.
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Affiliation(s)
- Trond Hagtvedt
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
- University of Oslo, Norway
| | - Therese Seierstad
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | - Kjersti V Lund
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | - Ayca M Løndalen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | - Trond V Bogsrud
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Hans-Jørgen Smith
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
- University of Oslo, Norway
| | - Oliver M Geier
- The Intervention Centre, Oslo University Hospital, Norway
| | - Harald Holte
- Department of Oncology, Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital, Norway
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Mylam KJ, Nielsen AL, Pedersen LM, Hutchings M. Fluorine-18-fluorodeoxyglucose Positron Emission Tomography in Diffuse Large B-cell Lymphoma. PET Clin 2014; 9:443-55, vi. [DOI: 10.1016/j.cpet.2014.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Ishii Y, Tomita N, Tateishi U, Ishiyama Y, Yamamoto E, Hattori Y, Hagihara M, Yamazaki E, Ishigatsubo Y. The rate of reduction in the maximum standardized uptake value from the initial to the post-R-CHOP therapy in positron emission tomography scan predicts disease progression in diffuse large B cell lymphoma patients. Med Oncol 2014; 31:880. [PMID: 24504845 DOI: 10.1007/s12032-014-0880-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 01/30/2014] [Indexed: 11/26/2022]
Abstract
[18F]fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) is useful for primary staging and evaluation of treatment outcome in diffuse large B cell lymphoma (DLBCL) patients. The reduction in the maximum standardized uptake value (ΔSUVmax) from the initial to the interim 18F-FDG PET scan has been reported to predict survival in DLBCL patients. We retrospectively evaluated ΔSUVmax obtained by PET or PET-computed tomography before and after initial therapy in 31 newly diagnosed DLBCL patients who were treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) therapy. Receiver observation characteristic curve analysis was used to evaluate the optimal cutoff value for the ΔSUVmax for disease progression. The 3-year progression-free survival rate of patients with ΔSUVmax≥83 and <83% was found to be 91 and 25%, respectively (P<0.001). The 4-year overall survival rate of patients with ΔSUVmax≥83 and <83% was found to be 100 and 83%, respectively (P=0.046). The ΔSUVmax observed before and after R-CHOP therapy could be useful in the prediction of disease progression and survival in newly diagnosed DLBCL patients.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/administration & dosage
- Disease Progression
- Doxorubicin/administration & dosage
- Female
- Fluorodeoxyglucose F18
- Follow-Up Studies
- Humans
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Positron-Emission Tomography/methods
- Prednisolone/administration & dosage
- Prognosis
- Radiopharmaceuticals
- Retrospective Studies
- Rituximab
- Survival Rate
- Vincristine/administration & dosage
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Affiliation(s)
- Yoshimi Ishii
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, 236-0004, Japan
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Barrington SF, Mikhaeel NG. When should FDG-PET be used in the modern management of lymphoma? Br J Haematol 2013; 164:315-28. [PMID: 24131306 DOI: 10.1111/bjh.12601] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 09/04/2013] [Indexed: 12/01/2022]
Abstract
Positron Emission Tomography (PET) is a functional imaging technique that, combined with computerized tomography (PET-CT), is increasingly used in lymphoma. Most subtypes accumulate fluorodeoxyglucose (FDG) and the increased sensitivity of PET-CT, especially for extranodal disease, compared to CT, makes PET-CT an attractive staging tool. The availability of a staging PET-CT scan also improves the accuracy of subsequent response assessment. 'Interim' PET-CT can be used to assess early response and end-of-treatment PET-CT assesses remission. Clinical trials are currently seeking to establish whether the predictive value of PET-CT can be successfully used to guide individual treatment to reduce toxicity and/or to improve outcomes. Standardized methods for performing and reporting PET have been developed in the context of trials. The role of PET in transplantation selection is currently evolving, as it appears to be more accurate and prognostic than CT. The role of FDG PET-CT throughout the management course in patients with lymphoma is explored in this review, with areas discussed that may limit the use of PET-CT imaging which clinicians should be familiar with to inform practice.
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Affiliation(s)
- Sally Fiona Barrington
- Division of Imaging and Biomechanical Engineering, PET Imaging Centre at St Thomas' Hospital, King's College, London, UK
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Herrmann KA, Kohan AA, Gaeta MC, Rubbert C, Vercher-Conejero JL, Paspulati RM, Antonis K, Mansoori B, Faulhaber PF, Avril N, Ros PR. PET/MRI: Applications in Clinical Imaging. CURRENT RADIOLOGY REPORTS 2013. [DOI: 10.1007/s40134-013-0021-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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