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Atallah-Yunes SA, Khurana A, Maurer M. Challenges identifying DLBCL patients with poor outcomes to upfront chemoimmunotherapy and its impact on frontline clinical trials. Leuk Lymphoma 2024; 65:430-439. [PMID: 38180317 DOI: 10.1080/10428194.2023.2298705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024]
Abstract
Diffuse large B cell lymphoma (DLBCL) has a variable course of disease among patients as it consists of subgroups that are clinically, biologically and molecularly heterogeneous. In this review, we will discuss how this heterogeneity has likely hindered the ability of traditional prognostic models to identify DLBCL patients at high risk of having poor outcomes with conventional upfront chemoimmunotherapy. We will highlight the challenges and downsides of using these models for risk stratification in clinical trials. Also, we present some of the novel prognosticators that have shown a prognostic value independently or when incorporated into existing prognostic models. Additionally, since the failure of frontline clinical trials to improve outcomes beyond R-CHOP chemoimmunotherapy may be at least partially explained by the restrictive eligibility criteria, risk stratification methods and the selection bias encountered due to the complexed logistics of clinical trials; we will discuss strategies to refine and modernize clinical trial design.
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Affiliation(s)
| | - Arushi Khurana
- Mayo Clinic Rochester - Division of Hematology, Rochester, MN, USA
| | - Matthew Maurer
- Mayo Clinic Rochester - Division of Hematology, Rochester, MN, USA
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Peng X, Yu S, Kou Y, Dang J, Wu P, Yao Y, Shen J, Liu Y, Wang X, Cheng Z. Prediction nomogram based on 18F-FDG PET/CT and clinical parameters for patients with diffuse large B-cell lymphoma. Ann Hematol 2023; 102:3115-3124. [PMID: 37400729 DOI: 10.1007/s00277-023-05336-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
The objective of this study was to develop a nomogram including parameters assessed by 18F-FDG PET/CT and clinical parameters for patients with diffuse large B-cell lymphoma (DLBCL) to predict progression-free survival (PFS). A total of 181 patients with pathologically diagnosed DLBCL at Sichuan Cancer Hospital and Institute from March 2015 to December 2020 were enrolled in this retrospective study. The area under the receiver operating characteristic (ROC) curve (AUC) was used to calculate the optimal cutoff values of the semiquantitative parameters (SUVmax, TLG, MTV, and Dmax) for PFS. A nomogram was constructed according to multivariate Cox proportional hazards regression. The predictive and discriminatory capacities of the nomogram were then measured using the concordance index (C-index), calibration plots, and Kaplan-Meier curves. The predictive and discriminatory capacities of the nomogram and the International Prognostic Index of the National Comprehensive Cancer Network (NCCN-IPI) were compared via the C-index and AUC. Multivariate analysis demonstrated that male gender and pretreatment Ann Arbor stage III-IV, non-GCB, elevated lactate dehydrogenase (LDH), number of extranodal organ involvement (Neo)>1, MTV≥152.8 cm3, and Dmax ≥53.9 cm were associated with unfavorable PFS (all p<0.05). The nomogram, including gender, Ann Arbor stage, pathology type, Neo, LDH levels, MTV, and Dmax, showed good prediction accuracy, with a C-index of 0.760 (95% CI: 0.727-0.793), which was higher than that of NCCN-IPI (0.710; 95% CI: 0.669-751). The calibration plots for 2-year demonstrated good consistency between the predicted and observed probabilities for survival time. We established a nomogram including MTV, Dmax, and several clinical parameters to predict the PFS of patients with DLBCL, and the nomogram showed better predictability and higher accuracy than NCCN-IPI.
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Affiliation(s)
- Xiaojuan Peng
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China
- North Sichuan Medical College, Nanchong, China
| | - Sisi Yu
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China
| | - Ying Kou
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China
| | - Jun Dang
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China
- North Sichuan Medical College, Nanchong, China
| | - Ping Wu
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China
| | - Yutang Yao
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China
| | - Jiaqi Shen
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China
| | - Yongli Liu
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoxiong Wang
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhuzhong Cheng
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China.
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Geng H, Jia S, Zhang Y, Li J, Yang Q, Zeng L, Zong X, Lu Y, Lu S, Zhou J, Li C, Wu D. Efficacy and safety of zanubrutinib plus R-CHOP in treatment of non-GCB DLBCL with extranodal involvement. Front Immunol 2023; 14:1219167. [PMID: 37671152 PMCID: PMC10476090 DOI: 10.3389/fimmu.2023.1219167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/10/2023] [Indexed: 09/07/2023] Open
Abstract
Introduction Treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) shows poor response rates in non-germinal center B cell-like (non-GCB) diffuse large B-cell lymphoma (DLBCL) patients with multiple extranodal involvement. This study aims to evaluate anti-tumor activity and safety of zanubrutinib with R-CHOP (ZR-CHOP) in treatment naïve non-GCB DLBCL with extranodal involvement. Methods In this single-arm, phase 2, prospective, single-center study, patients with newly diagnosed non-GCB DLBCL with extranodal involvement enrolled between October 2020 to March 2022 received ZR-CHOP for 6 cycles followed by 2 cycles of maintenance treatment with rituximab and zanubrutinib. The primary endpoint included progression-free survival (PFS) in the intent-to-treat (ITT) population whereas the secondary endpoints included overall response rate (ORR), complete response (CR), and duration of response. Further, next-generation sequencing (NGS) was used for detection of different oncogenic mutations closely related to DLBCL pathogenesis. Results From October 2020 to March 2022, 26 patients were enrolled, and 23 of them were evaluated for efficacy after receiving 3 cycles of ZR-CHOP treatment. 1-year PFS and OS were 80.8% and 88.5% respectively while expected PFS and OS for 2-years are 74.0% and 88.5% respectively with median follow-up of 16.7 months and ORR was 91.3% (CR: 82.61%; PR: 8.70%). Oncogenic mutations closely related to DLBCL pathogenesis were assessed in 20 patients using NGS. B-cell receptor and NF-κB pathway gene mutations were detected in 10 patients, which occurred in MYD88 (7/19), CD79B (4/19), CARD11 (5/19), and TNFAIP3 (2/19). Hematological adverse events (AEs) ≥ grade 3 included neutropenia (50%), thrombocytopenia (23.1%), and anemia (7.7%) whereas non-hematological AEs ≥ grade 3 included pulmonary infection (19.2%). Conclusion ZR-CHOP is safe and effective for treating treatment naïve non-GCB DLBCL patients with extranodal involvement. Clinical Trial Registration Clinicaltrials.gov, NCT04835870.
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Affiliation(s)
- Hongzhi Geng
- National Clinical Research Center for Hematologic Diseases, Suzhou, China
- Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Sixun Jia
- Department of Hematology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Ying Zhang
- National Clinical Research Center for Hematologic Diseases, Suzhou, China
- Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiaqi Li
- National Clinical Research Center for Hematologic Diseases, Suzhou, China
- Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Suzhou University Medical College, Suzhou, China
- Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Qin Yang
- National Clinical Research Center for Hematologic Diseases, Suzhou, China
- Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Liangyu Zeng
- National Clinical Research Center for Hematologic Diseases, Suzhou, China
- Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiangping Zong
- National Clinical Research Center for Hematologic Diseases, Suzhou, China
- Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Suzhou University Medical College, Suzhou, China
- Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Yutong Lu
- National Clinical Research Center for Hematologic Diseases, Suzhou, China
- Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Suzhou University Medical College, Suzhou, China
- Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Shuangzhu Lu
- National Clinical Research Center for Hematologic Diseases, Suzhou, China
- Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Suzhou University Medical College, Suzhou, China
- Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Jin Zhou
- National Clinical Research Center for Hematologic Diseases, Suzhou, China
- Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Suzhou University Medical College, Suzhou, China
- Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Caixia Li
- National Clinical Research Center for Hematologic Diseases, Suzhou, China
- Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Suzhou University Medical College, Suzhou, China
- Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Depei Wu
- National Clinical Research Center for Hematologic Diseases, Suzhou, China
- Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Suzhou University Medical College, Suzhou, China
- Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
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Xie Y, Teng Y, Jiang C, Ding C, Zhou Z. Prognostic value of 18F-FDG lesion dissemination features in patients with peripheral T-cell lymphoma (PTCL). Jpn J Radiol 2023:10.1007/s11604-023-01398-y. [PMID: 36752954 DOI: 10.1007/s11604-023-01398-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/23/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE To explore the prognostic value of the distance between the two lesions that were farthest apart (Dmax) on baseline 18F-FDG PET/CT in peripheral T lymphoma (PTCL) and establish a new prognostic model for predicting the survival outcomes of patients with PTCL. METHODS In this study, a retrospective analysis of 95 patients with PTCL who underwent baseline 18F-FDG PET/CT was performed to assess the predictive value of Dmax. The total metabolic tumour volume (TMTV), total lesion glycolysis (TLG), standardized uptake value (SUV), and Dmax were calculated with LIFEx software. Progression-free survival (PFS) and overall survival (OS) were used as endpoints. The prognostic model was developed based on the results of the multivariate analysis. The time-dependent area under the ROC curve (tdAUC), calibration curves, Harrell C-index, and decision curve analysis (DCA) were used to assess the model. RESULTS Patients were followed up for a median of 17.0 months. Multivariate analysis showed that bone marrow biopsy (BMB) and Dmax were independent predictors of PFS (HR: 1.889, P = 0.039; HR: 1.965, P = 0.047) and OS (HR: 1.923, P = 0.031; HR: 1.982, P = 0.034). The model consisting of Dmax, TMTV, and BMB had substantial prognostic value for survival outcomes of PTCL and could successfully identify four groups of patients with significantly different prognoses (χ2 = 13.731, P = 0.003 for PFS; χ2 = 11.841, P = 0.008 for OS). The tdAUC, C-index, calibration curves, and DCA supported that the model was superior to the prognostic index for T-cell lymphoma (PIT) and International Prognostic Index (IPI) scores. CONCLUSION BMB and Dmax were independent predictors of PTCL in our study. Moreover, a prognostic model based on the Dmax, TMTV, and BMB could be useful for predicting the survival outcomes of patients with PTCL.
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Affiliation(s)
- Yiting Xie
- Nanjing Drum Tower Hospital, Clinical College of Jiangsu University, Nanjing, China
| | - Yue Teng
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210000, China
| | - Chong Jiang
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210000, China
| | - Chongyang Ding
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, Clinical College of Jiangsu University, Nanjing, China.
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Ruiz IC, Martelli M, Sehn LH, Vitolo U, Nielsen TG, Sellam G, Bottos A, Klingbiel D, Kostakoglu L. Baseline Total Metabolic Tumor Volume is Prognostic for Refractoriness to Immunochemotherapy in DLBCL: Results From GOYA. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e804-e814. [PMID: 35595618 DOI: 10.1016/j.clml.2022.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION A good response to initial therapy is key to maximizing survival in patients with diffuse large B-cell lymphoma (DLBCL), but patients with chemorefractory disease and early progression have poor outcomes. PATIENTS AND METHODS Data from the GOYA study in patients with DLBCL who received first-line rituximab or obinutuzumab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) were analyzed. Positron emission tomography/computed tomography (PET/CT)-derived characteristics associated with total metabolic tumor volume (TMTV) and clinical risk factors for primary chemorefractory disease and disease progression within 12 months (POD12) were explored. RESULTS Of those patients fulfilling the criteria for analysis, 108/1126 (10%) were primary chemorefractory and 147/1106 (13%) had POD12. Primary chemorefractory and POD12 status were strongly associated with reduced overall survival. After multivariable analysis of clinical and imaging-based risk factors by backward elimination, only very high TMTV (quartile [Q] 1 vs. Q4 odds ratio [OR]: 0.45; P = .006) and serum albumin levels (low vs. normal OR of 1.86; P = .004) were associated with primary chemorefractoriness. After additionally accounting for BCL2/MYC translocation in a subset of patients, TMTV and BCL2/MYC double-hit status remained as significant predictors of primary chemorefractoriness (Q1 vs. Q4 OR: 0.32, P = .01 and double-hit vs. no-hit OR of 4.47, P = .02, respectively). Risk factors including very high TMTV, high sum of the product of the longest diameters (SPD), geographic region (Asia), short time since diagnosis, extranodal involvement and low serum albumin were retained for POD12. CONCLUSION PET-derived TMTV has prognostic value in identifying patients at risk of early treatment failure.
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Affiliation(s)
| | - Maurizio Martelli
- Hematology Institute, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Laurie H Sehn
- Lymphoma Tumour Group, BC Cancer Centre for Lymphoid Cancer and the University of British Columbia, Vancouver, BC, Canada
| | - Umberto Vitolo
- Department of Medical Oncology, Candiolo Cancer Institute, Fondazione del Piemonte per l'Oncologia, IRCCS, Candiolo, Italy
| | | | - Gila Sellam
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | | | - Lale Kostakoglu
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA
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Hu Y, Zhang Q, Cui C, Zhang Y. Altered Regional Brain Glucose Metabolism in Diffuse Large B-Cell Lymphoma Patients Treated With Cyclophosphamide, Epirubicin, Vincristine, and Prednisone: An Fluorodeoxyglucose Positron Emission Tomography Study of 205 Cases. Front Neurosci 2022; 16:914556. [PMID: 35784854 PMCID: PMC9240384 DOI: 10.3389/fnins.2022.914556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background A growing number of neuroimaging studies reported that chemotherapy might impair brain functions, leading to persistent cognitive alterations in a subset of cancer patients. The present study aimed to investigate the regional brain glucose metabolism differences between diffuse large B cell lymphoma (DLBCL) patients treated with cyclophosphamide, epirubicin, vincristine, and prednisone and controls using positron emission tomography with 18F-labeled fluoro-2-deoxyglucose integrated with computed tomography (18F-FDG PET/CT) scanning. Methods We analyzed 18F-FDG PET data from 205 right-handed subjects (for avoiding the influence of handedness factors on brain function), including 105 post-chemotherapy DLBCL patients and 100 controls. The two groups had similar average age, gender ratio, and years of education. First, we compared the regional brain glucose metabolism using a voxel-based two-sample t-test. Second, we compared the interregional correlation. Finally, we investigated the correlations between the regional brain glucose metabolism and the number of chemotherapy cycles. Results Compared with the controls, the post-chemotherapy group showed higher metabolism in the right hippocampus and parahippocampal gyrus (region of interest (ROI) 1) and the left hippocampus (ROI 2), and lower metabolism in the left medial orbitofrontal gyrus (ROI 3), the left medial superior frontal gyrus (ROI 4), and the left superior frontal gyrus (ROI 5). The two groups had different interregional correlations between ROI 3 and ROI 5. In some brain regions—mainly located in the bilateral frontal gyrus—the number of chemotherapy cycles was positively correlated with the regional brain glucose metabolism. Meanwhile, in some bilateral hippocampus regions, these two parameters were negatively correlated. Conclusion The present study provides solid data on the regional brain glucose metabolism differences between post-chemotherapy DLBCL patients and controls. These results should improve our understanding of human brain functions alterations in post-chemotherapy DLBCL patients and suggest that 18F-FDG PET/CT scanning is a valuable neuroimaging technology for studying chemotherapy-induced brain function changes.
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Affiliation(s)
- Yuxiao Hu
- Department of PET/CT Center, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Yuxiao Hu,
| | - Qin Zhang
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
- Qin Zhang,
| | - Can Cui
- Department of PET/CT Center, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Yun Zhang
- Department of PET/CT Center, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
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Shi X, Liu X, Li X, Li Y, Lu D, Sun X, Li Y, Hu S, Zhang Y, Zhou X, Wang X, Chen H, Fang X. Risk Stratification for Diffuse Large B-Cell Lymphoma by Integrating Interim Evaluation and International Prognostic Index: A Multicenter Retrospective Study. Front Oncol 2021; 11:754964. [PMID: 34976802 PMCID: PMC8716489 DOI: 10.3389/fonc.2021.754964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/24/2021] [Indexed: 01/01/2023] Open
Abstract
The baseline International Prognostic Index (IPI) is not sufficient for the initial risk stratification of patients with diffuse large B-cell lymphoma (DLBCL) treated with R‐CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone). The aims of this study were to evaluate the prognostic relevance of early risk stratification in DLBCL and develop a new stratification system that combines an interim evaluation and IPI. This multicenter retrospective study enrolled 314 newly diagnosed DLBCL patients with baseline and interim evaluations. All patients were treated with R-CHOP or R-CHOP-like regimens as the first-line therapy. Survival differences were evaluated for different risk stratification systems including the IPI, interim evaluation, and the combined system. When stratified by IPI, the high-intermediate and high-risk groups presented overlapping survival curves with no significant differences, and the high-risk group still had >50% of 3-year overall survival (OS). The interim evaluation can also stratify patients into three groups, as 3-year OS and progression-free survival (PFS) rates in patients with stable disease (SD) and progressive disease (PD) were not significantly different. The SD and PD patients had significantly lower 3-year OS and PFS rates than complete remission and partial response patients, but the percentage of these patients was only ~10%. The IPI and interim evaluation combined risk stratification system separated the patients into low-, intermediate-, high-, and very high-risk groups. The 3-year OS rates were 96.4%, 86.7%, 46.4%, and 40%, while the 3-year PFS rates were 87.1%, 71.5%, 42.5%, and 7.2%. The OS comparison between the high-risk group and very high-risk group was marginally significant, and OS and PFS comparisons between any other two groups were significantly different. This combined risk stratification system could be a useful tool for the prognostic prediction of DLBCL patients.
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Affiliation(s)
- Xue Shi
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaoqian Liu
- Department of Hematology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Xiaomei Li
- Dongying People’s Hospital, Medical Records Department, Dongying, China
| | - Yahan Li
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Dongyue Lu
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xue Sun
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ying Li
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shunfeng Hu
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuanfeng Zhang
- Department of Hematology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Xiangxiang Zhou
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xin Wang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
| | - Haiping Chen
- Department of Infectious Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- *Correspondence: Haiping Chen, ; Xiaosheng Fang,
| | - Xiaosheng Fang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- *Correspondence: Haiping Chen, ; Xiaosheng Fang,
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De Paepe KN, Van Keerberghen CA, Agazzi GM, De Keyzer F, Gheysens O, Bechter O, Wolter P, Dierickx D, Janssens A, Verhoef G, Oyen R, Koole M, Vandecaveye V. Quantitative Whole-Body Diffusion-weighted MRI after One Treatment Cycle for Aggressive Non-Hodgkin Lymphoma Is an Independent Prognostic Factor of Outcome. Radiol Imaging Cancer 2021; 3:e200061. [PMID: 33817648 DOI: 10.1148/rycan.2021200061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/12/2020] [Accepted: 01/22/2021] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the prognostic utility of apparent diffusion coefficient (ADC) changes at whole-body diffusion-weighted (WB-DW) MRI after one treatment cycle for aggressive non-Hodgkin lymphoma (NHL) compared with response assessment at interim and end-of-treatment fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT. Materials and Methods This was a secondary analysis of a prospective study (ClinicalTrials.gov identifier: NCT01231269) in which participants with aggressive NHL were recruited between March 2011 and April 2015 and underwent WB-DW MRI before and after one cycle of immunochemotherapy. Volunteers were recruited for test-retest WB-DW MRI (ClinicalTrials.gov identifier: NCT01231282) to assess ADC measurement repeatability. Response assessment was based on ADC change after one treatment cycle at WB-DW MRI and Deauville criteria at 18F-FDG PET/CT. To evaluate prognostic factors of disease-free survival (DFS), Kaplan-Meier survival analysis and univariable and multivariable Cox regression were performed; intraclass correlation coefficient (ICC) and mean difference with limits of agreement were calculated to determine inter- and intraobserver repeatability of ADC measurements. Results Forty-five patients (mean age, 58 years ± 17 [standard deviation]; 31 men) and nine volunteers (mean age, 22 years ± 3; seven men) were enrolled. Median DFS was 48 months (range, 2-48 months). Outcome prediction accuracy was 86.7% (39 of 45), 71.4% (30 of 42), and 73.8% (31 of 42) for WB-DW MRI and interim and end-of-treatment 18F-FDG PET/CT, respectively. WB-DW MRI (hazard ratio [HR], 17.8; P < .001) and interim (HR, 5; P = .008) and end-of-treatment (HR, 4.3; P = .017) 18F-FDG PET/CT were prognostic of DFS. After multivariable analysis, WB-DW MRI remained an independent predictor of outcome (HR, 26.8; P = .002). Intra- and interobserver agreement for ADC measurements were excellent (ICC = 0.85-0.99). Conclusion Quantitative WB-DW MRI after only one cycle of immunochemotherapy predicts DFS in aggressive NHL and is noninferior to routinely performed interim and end-of-treatment 18F-FDG PET/CT.Keywords: MR-Diffusion Weighted Imaging, Lymphoma, Oncology, Tumor Response, Whole-Body ImagingSupplemental material is available for this article.© RSNA, 2021.
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Affiliation(s)
- Katja N De Paepe
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Ciska-Anne Van Keerberghen
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Giorgio M Agazzi
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Frederik De Keyzer
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Olivier Gheysens
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Oliver Bechter
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Pascal Wolter
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Daan Dierickx
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Ann Janssens
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Gregor Verhoef
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Raymond Oyen
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Michel Koole
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Vincent Vandecaveye
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
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9
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Tokola S, Kuitunen H, Turpeenniemi-Hujanen T, Kuittinen O. Interim and end-of-treatment PET-CT suffers from high false-positive rates in DLBCL: Biopsy is needed prior to treatment decisions. Cancer Med 2021; 10:3035-3044. [PMID: 33792190 PMCID: PMC8085947 DOI: 10.1002/cam4.3867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/17/2021] [Accepted: 03/08/2021] [Indexed: 11/06/2022] Open
Abstract
The application of positron emission tomography (PET)-computed tomography (CT) in treatment response evaluation has increased in diffuse large B-cell lymphoma (DLBCL), although its predictive value is controversial. We retrospectively analyzed the rate of false-positive PET-CTs performed as interim (n = 94) and end-of-treatment (n = 8) assessments among 102 DLBCL patients treated during 2010-2017 at Oulu University Hospital. In PET-CT Deauville score ≥4 was regarded as positive. A biopsy was performed on 35 patients, and vital lymphoma tissue was detected from nine patients. Positive biopsy findings were associated with poor disease outcomes in this study. This difference was statistically significant: 2-year failure-free survival (FFS) was 44% in patients with a positive biopsy versus 83% for those with a negative biopsy (p = 0.003). The corresponding overall survival (OS) rates were 53% versus 95% (p = 0.010). In the multivariate analyses, a negative biopsy was an independent protective factor in FFS (Hazard Ratio (HR) 0.093 (95% confidence interval [CI] 0.017-0.511); p = 0.006) unrelated to the International Prognostic Index (IPI) (HR 1.139 [95% CI 0.237-5.474] p = 0.871) or stage (HR 1.365 [95% CI 0.138-13.470]; p = 0.790). There was no statistically significant difference in OS according to the PET results, but the FFS rate was significantly higher in patients with a negative PET. The value of PET-CT as an evaluation method suffers from a high false-positive rate, and it is inadequate alone for the justification of treatment decisions. Biopsy results provide more reliable prognostic information for the evaluation of treatment response and outcome and should be used to assess patients with positive PET-CT scans.
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Affiliation(s)
- Susanna Tokola
- Department of Oncology and Medical Research Center, Oulu University Hospital, Oulu, Finland.,Unit of Cancer and Translational Medicine Research, Oulu University, Oulu, Finland
| | - Hanne Kuitunen
- Department of Oncology and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Taina Turpeenniemi-Hujanen
- Department of Oncology and Medical Research Center, Oulu University Hospital, Oulu, Finland.,Unit of Cancer and Translational Medicine Research, Oulu University, Oulu, Finland
| | - Outi Kuittinen
- Department of Oncology and Medical Research Center, Oulu University Hospital, Oulu, Finland.,Institute of Clinical Medicine, Faculty of Health Medicine, University of Eastern Finland, Kuopio, Finland.,Faculty of Health Medicine, Kuopio University Hospital, Kuopio, Finland
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10
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Zhao P, Zhu L, Li L, Zhou S, Qiu L, Qian Z, Xu W, Zhang H. A modified prognostic model in patients with diffuse large B-cell lymphoma treated with immunochemotherapy. Oncol Lett 2021; 21:218. [PMID: 33613707 PMCID: PMC7856694 DOI: 10.3892/ol.2021.12479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 11/26/2020] [Indexed: 11/05/2022] Open
Abstract
In the era of immunochemotherapy, the traditional international prognostic index (IPI) has partially lost its predictive value in diffuse large B-cell lymphoma (DLBCL) and the National Comprehensive Cancer Network-IPI (NCCN-IPI) is unable to effectively identify high-risk patients. Thus, the present study aimed to develop a modified prognostic model (M-PM) to identify high-risk patients that require aggressive treatment. The present study included 169 patients with newly diagnosed DLBCL treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (RCHOP) or RCHOP-like regimens, between 2011-2017. The results demonstrated that the risk discrimination was improved in the NCCN-IPI compared with the IPI, and patients were divided into four risk groups with a 5-year overall survival rate of 93.8, 76.5, 54.3 and 39.4%, respectively. However, the NCCN-IPI failed to identify the high-risk DLBCL population. The newly developed M-PM presented here included four parameters: Age (≥65 years), an elevated lactate dehydrogenase level, Eastern Cooperative Oncology Group score ≥2 and total metabolic tumor volume ≥300 cm3. The M-PM also divided patients into four risk groups that comprised 40.8, 23.1, 26.0 and 10.1% of the patients, and the 5-year survival rates of these groups were 92.4, 70.6, 52.3 and 24.5%, respectively. Taken together, the results of the present study demonstrated that the M-PM was more accurate compared with the IPI and the NCCN-IPI, which served as an effective tool for identifying patients with DLBCL at high risk of an adverse prognosis.
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Affiliation(s)
- Peiqi Zhao
- Department of Lymphoma, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University, Tianjin 300060, P.R. China
| | - Lei Zhu
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, P.R. China
| | - Lanfang Li
- Department of Lymphoma, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University, Tianjin 300060, P.R. China
| | - Shiyong Zhou
- Department of Lymphoma, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University, Tianjin 300060, P.R. China
| | - Lihua Qiu
- Department of Lymphoma, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University, Tianjin 300060, P.R. China
| | - Zhengzi Qian
- Department of Lymphoma, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University, Tianjin 300060, P.R. China
| | - Wengui Xu
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, P.R. China
| | - Huilai Zhang
- Department of Lymphoma, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University, Tianjin 300060, P.R. China
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11
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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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12
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Zaman MU, Fatima N, Zaman A, Zaman U, Zaman S, Tahseen R. Progression Free Survival and Predictor of Recurrence in DLBCL patients with Negative Interim 18FDG PET/CT Using Standardized Imaging and Reporting Protocols. Asian Pac J Cancer Prev 2020; 21:2343-2348. [PMID: 32856864 PMCID: PMC7771914 DOI: 10.31557/apjcp.2020.21.8.2343] [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: 05/11/2020] [Indexed: 11/28/2022] Open
Abstract
Background: To determine progression free survival (PFS) and predictor of recurrence in patients with diffuse large B-cell lymphoma (DLBCL) with negative interim 18FDG PET/CT (iPET) using standardized imaging and reporting protocols. Materials and Methods: This prospective study was conducted at PET/CT Section of a JCIA accredited healthcare facility from December 2015 till February 2020. Patients with DLBCL having complete metabolic response (CMR; Deauville score: 1-3) on iPET were selected and followed for a median period of 11 months (4-144 months). End point response on follow-up PET/CT (either end of treatment or surveillance) was categorized as sustained CMR (sCMR) and disease recurrence. Kaplan Meier survival curve was used to measure PFS and receiver operating characteristics (ROC) was plotted for age, largest lesion size, highest standardized uptake value (SUVmax), disease stage and body mass index (BMI) on baseline scan to find their impact on recurrence. Results: Total 185 patients with DLBCL who had achieved CMR on iPET with a median age 55 years (19 – 88 yr.) with male predominance (63% male) were selected. On follow-up, 123 (66%) had sCMR while recurrence was found in 34% (p <0.05). No significant difference in demographics was found between two groups. Median PFS time was 34 months (22.8 – 45.1 months). On ROC analysis, only baseline highest SUVmax was found as a significant independent predictor of disease recurrence at a cut off >22.6 (highest area under curve: 0.595; SE 0.046; p <0.05). Conclusion: We conclude that recurrence is found in 34% of DLBCL patients with a negative interim 18FDG PET/CT using standardized imaging and reporting protocols. Despite of early response, these patients need continued intensive follow-up especially those with a baseline SUVmax > 22.6.
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Affiliation(s)
- Maseeh Uz Zaman
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Nosheen Fatima
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Areeba Zaman
- Department of Medicine, Dr Ruth Pfau Hospital, Karachi, Pakistan
| | - Unaiza Zaman
- Department of Medicine, SUNY Downstate, Hospital, New York, USA
| | - Sidra Zaman
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Rabia Tahseen
- Department of Radiation Oncology, Aga Khan University Hospital, Karachi, Pakistan
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13
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Baek DW, Cho HJ, Kim JH, Sohn SK, Song GY, Ahn SY, Jung SH, Ahn JS, Lee JJ, Kim HJ, Jeong SY, Hong CM, Min JJ, Moon JH, Yang DH. Quantitative Assessment of Interim PET/CT Could Have More Prognostic Relevance than Visual Assessment for Predicting Clinical Outcome of Extranodal Diffuse Large B Cell Lymphoma. In Vivo 2020; 34:2127-2134. [PMID: 32606193 DOI: 10.21873/invivo.12018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIM The present study retrospectively investigated the predictive accuracy of interim positron emission tomography/computed tomography (iPET/CT) based on the Deauville 5-point scale (5-PS) and a quantitative SUV-based assessment in patients with extranodal (EN) diffuse large B cell lymphoma (DLBCL). PATIENTS AND METHODS The Deauville 5-PS and the SUVmax reduction (ΔSUVmax) assessment for interpreting the response to iPET/CT were used. RESULTS A total of 163 patients were enrolled in this study. With a median follow-up of 52.5 months, ΔSUVmax successfully predicted the survival outcomes of patients with one extranodal (EN) involvement in terms of overall survival (OS) (p=0.012) and progression-free survival (PFS) (p<0.001). Visual assessment using the Deauville 5-PS did not predict survival outcomes in patients with one or more EN involvements in terms of OS and PFS. CONCLUSION The quantitative SUV-based assessment with iPET/CT was a significant prognosticator for long-term survival outcomes, especially in patients with one EN involvement.
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Affiliation(s)
- Dong Won Baek
- Department of Hematology/Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hee Jeong Cho
- Department of Hematology/Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ju-Hyung Kim
- Department of Hematology/Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sang Kyun Sohn
- Department of Hematology/Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ga-Young Song
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, School of Medicine, Chonnam National University, Hwasun, Republic of Korea
| | - Seo-Yeon Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, School of Medicine, Chonnam National University, Hwasun, Republic of Korea
| | - Sung-Hoon Jung
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, School of Medicine, Chonnam National University, Hwasun, Republic of Korea
| | - Jae Sook Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, School of Medicine, Chonnam National University, Hwasun, Republic of Korea
| | - Je-Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, School of Medicine, Chonnam National University, Hwasun, Republic of Korea
| | - Hyeoung-Joon Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, School of Medicine, Chonnam National University, Hwasun, Republic of Korea
| | - Shin-Young Jeong
- Department of Nuclear Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chae Moon Hong
- Department of Nuclear Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jung-Joon Min
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, School of Medicine, Chonnam National University, Hwasun, Republic of Korea
| | - Joon-Ho Moon
- Department of Hematology/Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Deok-Hwan Yang
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, School of Medicine, Chonnam National University, Hwasun, Republic of Korea
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14
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Prognostic Values of Baseline 18F-FDG PET/CT in Patients with Peripheral T-Cell Lymphoma. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9746716. [PMID: 32185229 PMCID: PMC7061150 DOI: 10.1155/2020/9746716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/07/2020] [Indexed: 12/16/2022]
Abstract
Purpose In the present study, we aimed to investigate whether the metabolic parameters on baseline 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) could be used to predict prognosis in peripheral T-cell lymphomas (PTCL). Methods A total of 51 nodal PTCL patients who underwent baseline 18F-FDG PET/CT were retrospectively evaluated in the present study. Total metabolic tumor volume (TMTV), total lesion glycolysis (TLG), and maximum standardized uptake value (SUVmax) were also assessed. Besides, the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) was also included. Log-rank test and Cox regression analysis were used to evaluate progression-free survival (PFS) and overall survival (OS). Results The median follow-up was 18 months. Patients with low TLG, TMTV, and SUVmax levels had a significantly better clinical outcome than those with high TLG, TMTV, and SUVmax levels. The 2-year PFS rates of the high- and low-TMTV groups were 34.62% and 80%, respectively (p < 0.001), whereas the corresponding 2-year OS rates were 46.15% and 84.00%, respectively (p < 0.001), whereas the corresponding 2-year OS rates were 46.15% and 84.00%, respectively (p < 0.001), whereas the corresponding 2-year OS rates were 46.15% and 84.00%, respectively (p < 0.001), whereas the corresponding 2-year OS rates were 46.15% and 84.00%, respectively (p < 0.001), whereas the corresponding 2-year OS rates were 46.15% and 84.00%, respectively (p < 0.001), whereas the corresponding 2-year OS rates were 46.15% and 84.00%, respectively (p < 0.001), whereas the corresponding 2-year OS rates were 46.15% and 84.00%, respectively (p < 0.001), whereas the corresponding 2-year OS rates were 46.15% and 84.00%, respectively (p < 0.001), whereas the corresponding 2-year OS rates were 46.15% and 84.00%, respectively (p < 0.001), whereas the corresponding 2-year OS rates were 46.15% and 84.00%, respectively (p < 0.001), whereas the corresponding 2-year OS rates were 46.15% and 84.00%, respectively (p < 0.001), whereas the corresponding 2-year OS rates were 46.15% and 84.00%, respectively (n = 10), intermediate-risk group with TMTV > 62.405 or NCCN-IPI score of 4-8 (2-year PFS and OS were 52.4% and 66.7%, respectively, n = 10), intermediate-risk group with TMTV > 62.405 or NCCN-IPI score of 4-8 (2-year PFS and OS were 52.4% and 66.7%, respectively, n = 10), intermediate-risk group with TMTV > 62.405 or NCCN-IPI score of 4-8 (2-year PFS and OS were 52.4% and 66.7%, respectively, Conclusions Baseline TMTV and TLG were independent predictors of PFS and OS in PTCL patients, and SUVmax and NCCN-IPI scores were also independent predictors of OS. Moreover, the combination of TMTV and NCCN-IPI scores improved patient risk-stratification at the initial stage and might contribute to the adjustment of the therapeutic regime. This trial is registered with ChiCTR1900025526.
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15
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Sun H, Yu Z, Ma N, Zhou J, Tian R, Zhao M, Wang T. Risk Stratification Of Diffuse Large B-Cell Lymphoma With Interim PET/CT By Combining Deauville Scores And International Prognostic Index. Cancer Manag Res 2019; 11:9449-9457. [PMID: 31807074 PMCID: PMC6842747 DOI: 10.2147/cmar.s218678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 10/24/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose Prognostic evaluation using interim positron emission tomography/computed tomography (interim PET/CT; I-PET) remains controversial. For any predictor, the prognosis of patients around its cutoff value is most uncertain. If the patients around the cutoff value could be subdivided by another factor, like the international prognostic index (IPI), it may improve the predictive power of I-PET. The combination of I-PET and IPI for risk stratification of patients was explored in this study. Patients and methods One hundred and eleven diffuse large B-cell lymphoma (DLBCL) patients treated with R-CHOP therapy were included retrospectively, 59 of whom underwent PET/CT after three or four cycles of treatment (I-PET). Fifty-two patients underwent PET/CT after five or six cycles of treatment (end of treatment; E-PET). Results When Deauville 5-point scale (5-DS) scores of 4–5 were classified as a positive scan (denoted by DS [score 4]), there was no significant difference in progression-free survival (PFS) between I-PET positive and negative patients (P=0.151). Further, patients with 5-DS score 3 and high IPI were stratified into I-PET positive-, whereas those with 5-DS score 3 and low IPI were classified into I-PET negative scan groups. Under this stratification, there was a significant difference in PFS between I-PET positive and negative patients (P=0.001). The sensitivity, positive predictive value, and negative predictive value for 2-year PFS for the combination score were higher than DS (score 4) alone (66.7% vs 33.3%, 50.0%vs 37.5%, 93.6% vs 88.2%) whereas specificity was almost the same (90.0% vs 88.0%). Conclusion Subdivision of patients with 5-DS score 3 by IPI improved prognostic prediction accuracy. The IPI adds strength to 5-DS in I-PET to detect patients with good or poor prognosis. Compared with other combinations of I-PET and IPI, dividing the patients around the cutoff value of 5-DS by IPI was easily accepted by clinicians and allowed them to decide on further treatment practically.
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Affiliation(s)
- Hongwei Sun
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan City, Shanxi 030001, People's Republic of China.,Department of Health Statistics, School of Public Health And Management, Binzhou Medical University, Yantai City, Shandong 264003, People's Republic of China
| | - Zhan Yu
- Department of PET/CT Center, The Tumor Hospital of Shanxi Province, Taiyuan City, Shanxi 030000, People's Republic of China
| | - Ning Ma
- Department of PET/CT Center, The Tumor Hospital of Shanxi Province, Taiyuan City, Shanxi 030000, People's Republic of China
| | - Jie Zhou
- Department of PET/CT Center, The Tumor Hospital of Shanxi Province, Taiyuan City, Shanxi 030000, People's Republic of China
| | - Rongrong Tian
- Department of PET/CT Center, The Tumor Hospital of Shanxi Province, Taiyuan City, Shanxi 030000, People's Republic of China
| | - Ming Zhao
- Department of PET/CT Center, The Tumor Hospital of Shanxi Province, Taiyuan City, Shanxi 030000, People's Republic of China
| | - Tong Wang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan City, Shanxi 030001, People's Republic of China
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Harkins RA, Chang A, Patel SP, Lee MJ, Goldstein JS, Merdan S, Flowers CR, Koff JL. Remaining challenges in predicting patient outcomes for diffuse large B-cell lymphoma. Expert Rev Hematol 2019; 12:959-973. [PMID: 31513757 PMCID: PMC6821591 DOI: 10.1080/17474086.2019.1660159] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/22/2019] [Indexed: 12/28/2022]
Abstract
Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma and is an aggressive malignancy with heterogeneous outcomes. Diverse methods for DLBCL outcomes assessment ranging from clinical to genomic have been developed with variable predictive and prognostic success.Areas covered: The authors provide an overview of the various methods currently used to estimate prognosis in DLBCL patients. Models incorporating cell of origin, genomic features, sociodemographic factors, treatment effectiveness measures, and machine learning are described.Expert opinion: The clinical and genetic heterogeneity of DLBCL presents distinct challenges in predicting response to therapy and overall prognosis. Successful integration of predictive and prognostic tools in clinical trials and in a standard clinical workflow for DLBCL will likely require a combination of methods incorporating clinical, sociodemographic, and molecular factors with the aid of machine learning and high-dimensional data analysis.
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Affiliation(s)
- R. Andrew Harkins
- Emory University School of Medicine, Atlanta, Georgia 30322-1007, USA
| | - Andres Chang
- Winship Cancer Institute of Emory University, Atlanta, Georgia 30322-1007, USA
| | | | - Michelle J. Lee
- Emory University School of Medicine, Atlanta, Georgia 30322-1007, USA
| | | | - Selin Merdan
- Winship Cancer Institute of Emory University, Atlanta, Georgia 30322-1007, USA
- Georgia Institute of Technology, Atlanta, Georgia 30332-0002, USA
| | | | - Jean L. Koff
- Winship Cancer Institute of Emory University, Atlanta, Georgia 30322-1007, USA
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Zhang YY, Song L, Zhao MX, Hu K. A better prediction of progression-free survival in diffuse large B-cell lymphoma by a prognostic model consisting of baseline TLG and %ΔSUV max. Cancer Med 2019; 8:5137-5147. [PMID: 31343111 PMCID: PMC6718622 DOI: 10.1002/cam4.2284] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 05/09/2019] [Accepted: 05/14/2019] [Indexed: 01/19/2023] Open
Abstract
In the era of rituximab, the International Prognostic Index (IPI) has been inefficient in initial risk stratification for patients with R‐CHOP‐treated diffuse large B‐cell lymphoma (DLBCL). To estimate the predictive values of PET/CT quantitative parameters and three prognostic models consisting of baseline and interim parameters for three‐year progression‐free survival (PFS), we conducted an analysis of 85 patients in China with DLBCL underwent baseline and interim PET/CT scans and treated at the Department of Hematology of Peking University Third Hospital from November 2012 to November 2017. The PET/CT parameters, viz. the baseline and interim values of standardized uptake value (SUVmax), total metabolic tumor volume (TMTV), and total lesion glycolysis (TLG), and their rates of change, were analyzed by a receiver operating characteristics curve, Kaplan‐Meier analysis, and log‐rank test. Besides, the National Comprehensive Cancer Network International Prognostic Index (NCCN‐IPI) was also included in the multivariate Cox hazards model. Owing to the strong correlation between TMTV and TLG at baseline and interim (Pearson's correlation coefficient, r = 0.823, P‐value = 0.000, and 0.988, P‐value = 0.000, respectively), only TLG was included in the multivariate Cox hazards model, where TLG0 > 1036.61 g and %ΔSUVmax < 86.02% showed predictive value independently (HR = 10.42, 95% CI 2.35‐46.30, P = 0.002, and HR = 4.86, 95% CI 1.27‐18.54, P = 0.021, respectively). Replacing TLG in the equation, TMTV0 and TMTV1 both showed significantly predictive abilities like TLG (HR = 8.22, 95% CI 1.86‐32.24, P = 0.005, and HR = 2.96, 95% CI 1.16‐7.54, P = 0.023, respectively). After dichotomy, NCCN‐IPI also gave a significant performance (P = 0.035 and P = 0.010, respectively, in TLG and TMTV models). The baseline variables, that is, TMTV0, TLG0 and dichotomized NCCN‐IPI, and the interim variables TMTV1 and %ΔSUVmax, presented independent prognostic value for PFS. In prognostic model 2 (TLG0 + %ΔSUVmax), the group with TLG0 > 1036.61 g and %ΔSUVmax < 86.02% recognized 19 (82.6%) of the relapse or progression events, which showed the best screening ability among three models consisting of baseline and interim PET/CT parameters.
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Affiliation(s)
- Yi-Yang Zhang
- Department of Hematology, Peking University Third Hospital, Beijing, China
| | - Le Song
- Department of Nuclear Medicine, Peking University Third Hospital, Beijing, China
| | - Mei-Xin Zhao
- Department of Nuclear Medicine, Peking University Third Hospital, Beijing, China
| | - Kai Hu
- Department of Hematology, Peking University Third Hospital, Beijing, China
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Le Bihan T, Navarro AS, Le Bris N, Le Saëc P, Gouard S, Haddad F, Gestin JF, Chérel M, Faivre-Chauvet A, Tripier R. Synthesis of C-functionalized TE1PA and comparison with its analogues. An example of bioconjugation on 9E7.4 mAb for multiple myeloma 64Cu-PET imaging. Org Biomol Chem 2019; 16:4261-4271. [PMID: 29701218 DOI: 10.1039/c8ob00499d] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In view of the excellent copper(ii) and 64-copper(ii) complexation of a TE1PA ligand, a monopicolinate cyclam, in both aqueous medium and in vivo, we looked for a way to make it bifunctional, while maintaining its chelating properties. Overcoming the already known drawback of grafting via its carboxyl group, which is essential to the overall properties of the ligand, a TE1PA bifunctional derivative bearing an additional isothiocyanate coupling function on a carbon atom of the macrocyclic ring was synthesized. This led to an architecture that is comparable to that of other commercially available bifunctional copper(ii) chelators such as p-SCN-Bn-DOTA already used in clinical trials for 64Cu-immuno-PET imaging. The C-functionalization of TE1PA on one carbon atom in the β-N position of the cyclam backbone was successfully achieved by adapting our patented methodology to the huge challenge, allowing the regiospecific mono-N-functionalization of the unsymmetrical ligand. The obtained ligand p-SCN-Bn-TE1PA was coupled to a 9E7.4 murine antibody (mAb), an IgG2a anti CD-138 for multiple myeloma (MM) targeting. The conjugation efficiency was assessed by looking at the 64Cu radiolabeling and the radiopharmaceutical 64Cu-9E7.4-p-SCN-Bn-TE1PA immunoreactivity, and in particular by comparing with 9E7.4-p-SCN-Bn-NOTA and 9E7.4-p-SCN-Bn-DOTA obtained from commercial and presumably highly efficient chelators NOTA and DOTA, respectively. The results are quite clear, showing that p-SCN-Bn-TE1PA has a coupling rate 5 times higher and an immunoreactivity 1.5 to 2 times greater than those of its two competitors. p-SCN-Bn-TE1PA also outperforms TE1PA conjugated via its carboxylic function on the same antibody. The first 64Cu-immuno-PET preclinical study in a syngeneic model of MM was performed, confirming the good in vivo properties of 64Cu-9E7.4-p-SCN-Bn-TE1PA for PET imaging, considering the high clearance even after 24 h and the particularly important tumor-to-liver ratio that was increasing at 48 h.
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Affiliation(s)
- Thomas Le Bihan
- Université de Brest, UMR-CNRS 6521/IBSAM, UFR Sciences et Techniques, 6 Avenue Victor le Gorgeu, C.S. 93837, 29238 Brest, France.
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Performance of advanced imaging modalities at diagnosis and treatment response evaluation of patients with post-transplant lymphoproliferative disorder: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2018; 132:27-38. [DOI: 10.1016/j.critrevonc.2018.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/20/2018] [Accepted: 09/11/2018] [Indexed: 01/03/2023] Open
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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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21
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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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22
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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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Zhang Y, Fan Y, Ying Z, Song Y, Zhu J, Yang Z, Wang X. Can the SUVmax-liver-based interpretation improve prognostic accuracy of interim and posttreatment 18F-FDG PET/CT in patients with diffuse large B-cell lymphoma? Leuk Lymphoma 2017; 59:660-669. [PMID: 28771052 DOI: 10.1080/10428194.2017.1357171] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Yuewei Zhang
- Department of Nuclear Medicine, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Yang Fan
- Department of Nuclear Medicine, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Zhitao Ying
- Department of Lymphoma, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Yuqin Song
- Department of Lymphoma, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Jun Zhu
- Department of Lymphoma, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Zhi Yang
- Department of Nuclear Medicine, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Xuejuan Wang
- Department of Nuclear Medicine, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, P.R. China
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Lazarovici J, Terroir M, Arfi-Rouche J, Michot JM, Mussot S, Florea V, Ghigna MR, Dartigues P, Petrovanu C, Danu A, Fermé C, Ribrag V, Ghez D. Poor predictive value of positive interim FDG-PET/CT in primary mediastinal large B-cell lymphoma. Eur J Nucl Med Mol Imaging 2017. [DOI: 10.1007/s00259-017-3758-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Fan Y, Zhang Y, Yang Z, Ying Z, Zhou N, Liu C, Song Y, Zhu J, Wang X. Evaluating early interim fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography with the SUV max-liver-based interpretation for predicting the outcome in diffuse large B-cell lymphoma. Leuk Lymphoma 2017; 58:1-9. [PMID: 28535082 DOI: 10.1080/10428194.2016.1277384] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Interim 18F-FDG PET/CT is an effective predictor in patients with DLBCL, but the standard evaluating criteria were controversial. In this study, investigators tried to investigate whether the liver SUVmax (SUVmax-liver)-based interpretation could improve the accuracy of predicting the outcomes, comparing with the Deauville five-point scale (5-PS) and the reduction rate of the maximum standardized uptake value (ΔSUVmax) criteria. In 119 patients, PET/CT after two chemotherapy cycles (PET2) were evaluated with the SUVmax-liver-based interpretation, 5-PS, and ΔSUVmax criteria. Uni- and multivariate analyses were performed. The optimal threshold for the SUVmax-liver-based interpretation was 1.6 fold of SUVmax-liver. Using the SUVmax-liver-based interpretation, the 3-year PFS and OS were 19.9% and 33.0% for patients with a positive residue while 78.2% and 86.4% for patients with negative results (p < .001). SUVmax-liver-based interpretation demonstrated slightly superior accuracy, and was independent predictor for PFS and OS (p ≤ .001). Thus, early interim 18F-FDG PET/CT effectively predicts the outcome in patients with DLBCL using SUVmax-liver-based interpretation.
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Affiliation(s)
- Yang Fan
- a Department of Nuclear Medicine , Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute , Beijing , China
| | - Yuewei Zhang
- a Department of Nuclear Medicine , Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute , Beijing , China
| | - Zhi Yang
- a Department of Nuclear Medicine , Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute , Beijing , China
| | - Zhitao Ying
- b Department of Lymphoma , Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute , Beijing , China
| | - Nina Zhou
- a Department of Nuclear Medicine , Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute , Beijing , China
| | - Chen Liu
- a Department of Nuclear Medicine , Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute , Beijing , China
| | - Yuqin Song
- b Department of Lymphoma , Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute , Beijing , China
| | - Jun Zhu
- b Department of Lymphoma , Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute , Beijing , China
| | - Xuejuan Wang
- a Department of Nuclear Medicine , Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute , Beijing , China
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Adams HJA, Kwee TC. Reply: Interim PET in Hodgkin Lymphoma: Is It So Useless? J Nucl Med 2017; 58:1180-1182. [PMID: 28280222 DOI: 10.2967/jnumed.117.192294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Hugo J A Adams
- Deventer Ziekenhuis Nico Bolkesteinlaan 75 7416 SE Deventer, The Netherlands E-mail:
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Adams HJA, Kwee TC. Fact Sheet About Interim and End-of-Treatment 18F-FDG PET/CT in Lymphoma. J Nucl Med 2017; 58:1178-1179. [PMID: 28062598 DOI: 10.2967/jnumed.116.187815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Hugo J A Adams
- Deventer Ziekenhuis Nico Bolkesteinlaan 75 7416 SE Deventer, The Netherlands E-mail:
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