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Raunig DL, Pennello GA, Delfino JG, Buckler AJ, Hall TJ, Guimaraes AR, Wang X, Huang EP, Barnhart HX, deSouza N, Obuchowski N. Multiparametric Quantitative Imaging Biomarker as a Multivariate Descriptor of Health: A Roadmap. Acad Radiol 2023; 30:159-182. [PMID: 36464548 PMCID: PMC9825667 DOI: 10.1016/j.acra.2022.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 12/02/2022]
Abstract
Multiparametric quantitative imaging biomarkers (QIBs) offer distinct advantages over single, univariate descriptors because they provide a more complete measure of complex, multidimensional biological systems. In disease, where structural and functional disturbances occur across a multitude of subsystems, multivariate QIBs are needed to measure the extent of system malfunction. This paper, the first Use Case in a series of articles on multiparameter imaging biomarkers, considers multiple QIBs as a multidimensional vector to represent all relevant disease constructs more completely. The approach proposed offers several advantages over QIBs as multiple endpoints and avoids combining them into a single composite that obscures the medical meaning of the individual measurements. We focus on establishing statistically rigorous methods to create a single, simultaneous measure from multiple QIBs that preserves the sensitivity of each univariate QIB while incorporating the correlation among QIBs. Details are provided for metrological methods to quantify the technical performance. Methods to reduce the set of QIBs, test the superiority of the mp-QIB model to any univariate QIB model, and design study strategies for generating precision and validity claims are also provided. QIBs of Alzheimer's Disease from the ADNI merge data set are used as a case study to illustrate the methods described.
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Affiliation(s)
- David L Raunig
- Department of Statistical and Quantitative Sciences, Data Science Institute, Takeda Pharmaceuticals, Cambridge, Massachusetts.
| | - Gene A Pennello
- Center for Devices and Radiological Health, US Food and Drug Administration Division of Imaging, Diagnostic and Software Reliability, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Jana G Delfino
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | | | - Timothy J Hall
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
| | - Alexander R Guimaraes
- Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Oregon
| | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, Ohio
| | - Erich P Huang
- Biometric Research Program, Division of Cancer Treatment and Diagnosis - National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Huiman X Barnhart
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Nandita deSouza
- Division of Radiotherapy and Imaging, the Insitute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nancy Obuchowski
- Department of Quantitative Health Sciences, Lerner Research Institute Cleveland Clinic Foundation, Cleveland, Ohio
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Prognostic value of baseline and early response FDG-PET/CT in patients with refractory and relapsed aggressive B-cell lymphoma undergoing CAR-T cell therapy. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04587-4. [PMID: 36662305 PMCID: PMC10356653 DOI: 10.1007/s00432-023-04587-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023]
Abstract
PURPOSE Chimeric antigen receptor (CAR)-T cells are a viable treatment option for patients with relapsed or refractory (r/r) aggressive B-cell lymphomas. The prognosis of patients who relapse after CAR-T cell treatment is dismal and factors predicting outcomes need to be identified. Our aim was to assess the value of FDG-PET/CT in terms of predicting patient outcomes. METHODS Twenty-two patients with r/r B-cell lymphoma who received CAR-T cell treatment with tisagenlecleucel (n = 17) or axicabtagene ciloleucel (n = 5) underwent quantitative FDG-PET/CT before (PET-0) and 1 month after infusion of CAR-T cells (PET-1). PET-1 was classified as complete metabolic response (CMR, Deauville score 1-3) or non-CMR (Deauville score 4-5). RESULTS At the time of PET-1, 12/22 (55%) patients showed CMR, ten (45%) patients non-CMR. 7/12 (58%) CMR patients relapsed after a median of 223 days, three of them (25%) died. 9/10 (90%) non-CMR patients developed relapse or progressive disease after a median of 91 days, eight of them (80%) died. CMR patients demonstrated a significantly lower median total metabolic tumor volume (TMTV) in PET-0 (1 ml) than non-CMR patients (225 ml). CONCLUSION Our results confirm the prognostic value of PET-1. 42% of all CMR patients are still in remission 1 year after CAR T-cell treatment. 90% of the non-CMR patients relapsed, indicating the need for early intervention. Higher TMTV before CAR-T cell infusion was associated with lower chances of CMR.
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Cherng HJJ, Xu G, Feng L, Steiner R, Fayad L, Strati P, Nair R, Nastoupil LJ, Lee HJ, Neelapu SS, Flowers CR, Rodriguez M, Wang M, Hagemeister F, Pinnix CC, Ramdial J, Srour S, Nieto Y, Rezvani K, Champlin R, Kebriaei P, Westin J, Macapinlac HA, Shpall E, Ahmed S. Positron emission tomography derived metrics in relapsed or refractory large B-cell lymphoma with residual disease before autologous stem cell transplant. Br J Haematol 2023; 200:35-44. [PMID: 36068929 PMCID: PMC9771924 DOI: 10.1111/bjh.18441] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 12/24/2022]
Abstract
Salvage chemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation (ASCT) is a potentially curative treatment for patients with relapsed or refractory large B-cell lymphoma (rrLBCL) with chemosensitive disease. A18 F-fluorodeoxyglucose positron emission tomography (PET) scan after salvage chemotherapy is used to assess response and eligibility for ASCT, but metrics for chemosensitivity in patients with residual disease are not well defined. We performed a single-centre retrospective analysis of 92 patients with a partial response or stable disease after salvage chemotherapy for rrLBCL who received ASCT to investigate PET-derived parameters and their prognostic utility. The Deauville 5-point Scale (D-5PS) score, maximum standardised uptake value (SUVmax ), total metabolic tumour volume (TMTV), and total lesion glycolysis (TLG) were calculated from the post-salvage/pre-ASCT PET scan. The 5-year progression-free survival (PFS) and overall survival (OS) rates were 40% and 54% respectively. A D-5PS score of 5 (p = 0.0082, hazard ratio [HR] 2.09), high SUVmax (p = 0.0015, HR 2.48), TMTV (p = 0.035, HR 1.83) and TLG (p = 0.0036, HR 2.27) were associated with inferior PFS. A D-5PS score of 5 (p = 0.030, HR 1.98) and high SUVmax (p = 0.0025, HR 2.55) were associated with inferior OS. PET-derived parameters may help prognosticate outcomes after ASCT in patients with rrLBCL with residual disease after salvage chemotherapy.
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Affiliation(s)
- Hua-Jay J. Cherng
- Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
- Division of Hematology and Oncology, Columbia University Irving Medical Center, New York, NY
| | - Guofan Xu
- Department of Nuclear Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lei Feng
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Raphael Steiner
- Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Luis Fayad
- Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paolo Strati
- Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ranjit Nair
- Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Loretta J. Nastoupil
- Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hun Ju Lee
- Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sattva S. Neelapu
- Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher R. Flowers
- Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Maria Rodriguez
- Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Wang
- Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Fredrick Hagemeister
- Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chelsea C. Pinnix
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center
| | - Jeremy Ramdial
- Department of Stem Cell Transplantation, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Samer Srour
- Department of Stem Cell Transplantation, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yago Nieto
- Department of Stem Cell Transplantation, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard Champlin
- Department of Stem Cell Transplantation, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Partow Kebriaei
- Department of Stem Cell Transplantation, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jason Westin
- Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Homer A. Macapinlac
- Department of Nuclear Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabeth Shpall
- Department of Stem Cell Transplantation, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sairah Ahmed
- Department of Lymphoma & Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Stem Cell Transplantation, University of Texas MD Anderson Cancer Center, Houston, TX
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Automatic classification of lymphoma lesions in FDG-PET–Differentiation between tumor and non-tumor uptake. PLoS One 2022; 17:e0267275. [PMID: 35436321 PMCID: PMC9015138 DOI: 10.1371/journal.pone.0267275] [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: 01/31/2022] [Accepted: 04/05/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction The automatic classification of lymphoma lesions in PET is a main topic of ongoing research. An automatic algorithm would enable the swift evaluation of PET parameters, like texture and heterogeneity markers, concerning their prognostic value for patients outcome in large datasets. Moreover, the determination of the metabolic tumor volume would be facilitated. The aim of our study was the development and evaluation of an automatic algorithm for segmentation and classification of lymphoma lesions in PET. Methods Pre-treatment PET scans from 60 Hodgkin lymphoma patients from the EuroNet-PHL-C1 trial were evaluated. A watershed algorithm was used for segmentation. For standardization of the scan length, an automatic cropping algorithm was developed. All segmented volumes were manually classified into one of 14 categories. The random forest method and a nested cross-validation was used for automatic classification and evaluation. Results Overall, 853 volumes were segmented and classified. 203/246 tumor lesions and 554/607 non-tumor volumes were classified correctly by the automatic algorithm, corresponding to a sensitivity, a specificity, a positive and a negative predictive value of 83%, 91%, 79% and 93%. In 44/60 (73%) patients, all tumor lesions were correctly classified. In ten out of the 16 patients with misclassified tumor lesions, only one false-negative tumor lesion occurred. The automatic classification of focal gastrointestinal uptake, brown fat tissue and composed volumes consisting of more than one tissue was challenging. Conclusion Our algorithm, trained on a small number of patients and on PET information only, showed a good performance and is suitable for automatic lymphoma classification.
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Messiou C, Porta N, Sharma B, Levine D, Koh DM, Boyd K, Pawlyn C, Riddell A, Downey K, Croft J, Morgan V, Stern S, Cheung B, Kyriakou C, Kaczmarek P, Winfield J, Blackledge M, Oyen WJG, Kaiser MF. Prospective Evaluation of Whole-Body MRI versus FDG PET/CT for Lesion Detection in Participants with Myeloma. Radiol Imaging Cancer 2021; 3:e210048. [PMID: 34559006 PMCID: PMC8489453 DOI: 10.1148/rycan.2021210048] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/29/2021] [Accepted: 08/10/2021] [Indexed: 05/22/2023]
Abstract
Purpose To compare disease detection of myeloma using contemporary whole-body (WB) MRI and fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT protocols and to correlate imaging with laboratory estimates of disease burden, including molecular characteristics. Materials and Methods In this observational, prospective study, participants were recruited from November 2015 to March 2018 who had a diagnosis of myeloma, who were planned to undergo chemotherapy and autologous stem cell transplantation, and who underwent baseline WB-MRI and FDG PET/CT (ClinicalTrials.gov identifier NCT02403102). Baseline clinical data, including genetics, were collected. Paired methods were used to compare burden and patterns of disease. Results Sixty participants (mean age, 60 years ± 9 [standard deviation]; 35 men) underwent baseline WB-MRI and FDG PET/CT. WB-MRI showed significantly higher detection for focal lesions at all anatomic sites (except ribs, scapulae, and clavicles) and for diffuse disease at all sites. Two participants presented with two or more focal lesions smaller than 5 mm only at WB-MRI but not FDG PET/CT. Participants with diffuse disease at MRI had higher plasma cell infiltration (percentage of nucleated cells: median, 60% [interquartile range {IQR}, 50%-61%] vs 15% [IQR, 4%-50%]; P = .03) and paraprotein levels (median, 32.0 g/L [IQR, 24.0-48.0 g/L] vs 20.0 g/L [IQR, 12.0-22.6 g/L]; P = .02) compared with those without diffuse disease. All genetically high-risk tumors showed diffuse infiltration at WB-MRI. Conclusion WB-MRI helped detect a higher number of myeloma lesions than FDG PET/CT, and diffuse disease detected at WB-MRI correlated with laboratory measures of disease burden and molecular markers of risk. Keywords: MR-Imaging, Skeletal-Appendicular, Skeletal-Axial, Bone Marrow, Hematologic Diseases, Oncology Clinical trial registration no. NCT02403102. Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Christina Messiou
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Nuria Porta
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Bhupinder Sharma
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Daniel Levine
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Dow-Mu Koh
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Kevin Boyd
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Charlotte Pawlyn
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Angela Riddell
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Katherine Downey
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - James Croft
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Veronica Morgan
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Simon Stern
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Betty Cheung
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Charalampia Kyriakou
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Pawel Kaczmarek
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Jessica Winfield
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Matthew Blackledge
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Wim J. G. Oyen
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Martin F. Kaiser
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
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6
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Zucca E, Cascione L, Ruberto T, Facchinelli D, Schär S, Hayoz S, Dirnhofer S, Giovanella L, Bargetzi M, Mamot C, Ceriani L. Prognostic models integrating quantitative parameters from baseline and interim positron emission computed tomography in patients with diffuse large B-cell lymphoma: post-hoc analysis from the SAKK38/07 clinical trial. Hematol Oncol 2020; 38:715-725. [PMID: 32947651 DOI: 10.1002/hon.2805] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 12/22/2022]
Abstract
Positron emission computed tomography (PET/CT) in patients with diffuse large B-cell lymphoma (DLBCL) enrolled in a prospective clinical trial were reviewed to test the impact of quantitative parameters from interim PET/CT scans on overall (OS) and progression-free (PFS) survival. We centrally reviewed baseline and interim PET/CT scans of 138 patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone given every 14 days (R-CHOP14) in the SAKK38/07 trial (ClinicalTrial.gov identifier: NCT00544219). Cutoff values for maximum standardized uptake value (SUVmax ), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and metabolic heterogeneity (MH) were defined by receiver operating characteristic analysis. Responses were scored using the Deauville scale (DS). Patients with DS 5 at interim PET/CT (defined by uptake >2 times higher than in normal liver) had worse PFS (P = 0.014) and OS (P < 0.0001). A SUVmax reduction (Δ) greater than 66% was associated with longer PFS (P = 0.0027) and OS (P < 0.0001). Elevated SUVmax , MTV, TLG, and MH at interim PET/CT also identified patients with poorer outcome. At multivariable analysis, ΔSUVmax and baseline MTV appeared independent outcome predictors. A prognostic model integrating ΔSUVmax and baseline MTV discriminated three risk groups with significantly (log-rank test for trend, P < 0.0001) different PFS and OS. Moreover, the integration of MH and clinical prognostic indices could further refine the prediction of OS. PET metrics-derived prognostic models perform better than the international indices alone. Integration of baseline and interim PET metrics identified poor-risk DLBCL patients who might benefit from alternative treatments.
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Affiliation(s)
- Emanuele Zucca
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,Institute of Oncology Research, Università della Svizzera italiana, Bellinzona, Switzerland.,Department of Medical Oncology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luciano Cascione
- Institute of Oncology Research, Università della Svizzera italiana, Bellinzona, Switzerland.,SIB-Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Teresa Ruberto
- Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Davide Facchinelli
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Sämi Schär
- Coordinating Center, SAKK-Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Stefanie Hayoz
- Coordinating Center, SAKK-Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Luca Giovanella
- Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland.,Division of Nuclear Medicine, University Hospital, University of Zurich, Zurich, Switzerland
| | - Mario Bargetzi
- Oncology Center, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Christoph Mamot
- Oncology Center, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Luca Ceriani
- Institute of Oncology Research, Università della Svizzera italiana, Bellinzona, Switzerland.,Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
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7
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Glucose Metabolism Quantified by SUVmax on Baseline FDG-PET/CT Predicts Survival in Newly Diagnosed Multiple Myeloma Patients: Combined Harmonized Analysis of Two Prospective Phase III Trials. Cancers (Basel) 2020; 12:cancers12092532. [PMID: 32899991 PMCID: PMC7564454 DOI: 10.3390/cancers12092532] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Multiple myeloma (MM) is associated with high morbidity and mortality and variable survival that requires early identification of high-risk patients in order to quickly adapt treatment. FDG-PET/CT is a promising technique for initial staging of symptomatic MM. The aim of our retrospective study was to asses the prognostic value of this technique at baseline in symptomatic MM patients included in two large European prospective studies. After harmonization of data by and ad-hoc approach called M-Combat, we confirmed the prognostic value of FDG-PET/CT in a population of 227 MM patients, by integrating a new prognostic biomarker named “bone SUVmax” (including the maximum intensity of fixation of focal lesions and bone marrow) which is strongly correlated with a poorer prognosis of MM patients. Prognostic patient stratification is currently based on laboratory tests and genomic abnormalities, but FDG-PET/CT is likely to be an important method of defining high-risk patients, and thus, to potentially better adapt future therapeutic management. Abstract Background: Multiple myeloma is a hematological neoplasm characterized by a clonal proliferation of malignant plasma cells in the bone marrow, and is associated with high morbidity and mortality and variable survival. Positron emission tomography combined with computed tomography using 18F-deoxyfluoroglucose (FDG-PET/CT) is a promising technique for initial staging of symptomatic multiple myeloma patients. The objective of this study was to assess the prognostic value of this technique at baseline in symptomatic multiple myeloma patients included in two large European prospective studies (French and Italian). Methods: We retrospectively performed a combined harmonized analysis of 227 newly diagnosed transplant eligible multiple myeloma patients from two separate phase III trials. All images were centrally reviewed and analyzed using visual criteria and maximal standardized uptake value. An ad-hoc approach (called modified Combat) was applied to harmonize the data and then remove the “country effect” in order to strengthen the reliability of the final conclusions. Results: Using a multivariate analysis including treatment arm, R-ISS score, presence of extra-medullary disease and bone SUVmax, only bone SUVmax (p = 0.016) was an independent prognosis factor with an OS threshold of 7.1. For PFS, treatment arm and presence of extra-medullary disease were both independent prognosis biomarkers (p = 0.022 and 0.006 respectively). Conclusions: Our results show that bone SUVmax is a simple and reliable biomarker to analyze FDG-PET/CT at baseline that strongly correlates with a poorer prognosis for MM patients.
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8
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Lasnon C, Coudrais N, Houdu B, Nganoa C, Salomon T, Enilorac B, Aide N. How fast can we scan patients with modern (digital) PET/CT systems? Eur J Radiol 2020; 129:109144. [PMID: 32593080 DOI: 10.1016/j.ejrad.2020.109144] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/13/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To seek for the minimal duration per bed position with a digital PET system without compromising image quality and lesion detection in patients requiring fast 18F-FDG PET imaging. MATERIALS AND METHODS 19 cancer patients experiencing pain or dyspnea and 9 pediatric patients were scanned on a Vereos system. List mode data were reconstructed with decreasing time frame down to 10 s per bed position. Noise was evaluated in the liver, blood pool and muscle, and using target-to-background ratios. Five PET readers recorded image quality, number of clinically relevant foci and of involved anatomical sites in reconstructions ranging from 60 to 10 s per bed position, compared to the standard 90 s reconstruction. RESULTS The following reconstructions, which harboured a noise not significantly higher than that of the standard reconstruction, were selected for clinical evaluation: 1iterations/10 subsets/20sec (1i10 s20sec), 1i10 s30sec, and 2i10 sPSF60sec. Only the 60 s per bed acquisition displayed similar target-to-background ratios compared to the standard reconstruction, but mean ratios were still higher than 2.0 for the 30 s reconstruction. Inter-rater agreement for the number of involved anatomical sites and detected lesion was good or almost perfect (Kappa: 0.64-0.91) for all acquisitions. In particular, kappa for the 30 s per bed acquisition was 0.78 and 0.91 for lesion and anatomical sites number, respectively. Intra-rater agreement was also excellent for the 30 s reconstruction (kappa = 0.72). Median estimated total PET acquisition time for the 1i10 s30sec, and the standard reconstruction were 4 and 12 min, respectively. CONCLUSIONS Fast imaging is feasible with state-of-the-art PET systems. Acquisitions of 30 s per bed position are feasible with the Vereos system, requiring optimization of reconstruction parameters.
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Affiliation(s)
- Charline Lasnon
- Centre François Baclesse, Nuclear Medicine Department, Caen, France; INSERM ANTICIPE, Normandie University, Caen, France
| | | | - Benjamin Houdu
- CHU de Caen, Nuclear Medicine Department, Caen, France; Normandie University, France
| | | | | | | | - Nicolas Aide
- CHU de Caen, Nuclear Medicine Department, Caen, France; INSERM ANTICIPE, Normandie University, Caen, France; Normandie University, France.
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9
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Georgi TW, Kurch L, Hasenclever D, Warbey VS, Pike L, Radford J, Sabri O, Kluge R, Barrington SF. Quantitative assessment of interim PET in Hodgkin lymphoma: An evaluation of the qPET method in adult patients in the RAPID trial. PLoS One 2020; 15:e0231027. [PMID: 32240248 PMCID: PMC7117720 DOI: 10.1371/journal.pone.0231027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/15/2020] [Indexed: 01/15/2023] Open
Abstract
Aim qPET is a quantitative method used to assess FDG-PET response in lymphoma. qPET was developed using 898 scans from children with Hodgkin Lymphoma (HL) in the EuroNet-PHL-C1 (C1) trial. The aim of this study was to determine if qPET could be applied as an alternative response method in adults in the RAPID trial. Methods PET-CT scans performed after 3 cycles of ABVD in RAPID were re-evaluated by an independent reader, blinded to PET results and outcome in RAPID. All initially involved regions were assessed visually and by qPET. The distribution of qPET measurements was compared for RAPID and C1 patients. Previously published qPET thresholds corresponding to visual DS (vDS) of 1–5 in C1 were used to derive quantitative DS (qDS) for RAPID patients. Results PET-CT scans were available for 450 patients from RAPID. vDS were 1 (171 scans), 2 (153 scans), 3 (72 scans), 4 (31 scans) and 5 (23 scans) respectively. The distribution of qPET values was similar to C1 patients, with a unimodal ‘normal’ distribution and a long tail to the right, suggestive of favorable response in the majority and less favorable response in the minority with outlying values. qPET thresholds from C1 applied in RAPID patients gave 86% concordance for vDS and qDS. There was 97% concordance for complete metabolic response (CMR; DS 1–3) vs. no-CMR using the Lugano classification. Conclusion qPET which was developed in pediatric patients receiving more intensive OEPA chemotherapy, was a suitable quantitative method for assessing response in adult patients treated with ABVD in a response-adapted setting in the RAPID trial.
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Affiliation(s)
- Thomas W. Georgi
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
- * E-mail:
| | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Victoria S. Warbey
- King's College London and Guy's & St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Lucy Pike
- King's College London and Guy's & St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - John Radford
- University of Manchester and Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Sally F. Barrington
- King's College London and Guy's & St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
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10
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Ceriani L, Gritti G, Cascione L, Pirosa MC, Polino A, Ruberto T, Stathis A, Bruno A, Moccia AA, Giovanella L, Hayoz S, Schär S, Dirnhofer S, Rambaldi A, Martinelli G, Mamot C, Zucca E. SAKK38/07 study: integration of baseline metabolic heterogeneity and metabolic tumor volume in DLBCL prognostic model. Blood Adv 2020; 4:1082-1092. [PMID: 32196557 PMCID: PMC7094027 DOI: 10.1182/bloodadvances.2019001201] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/01/2020] [Indexed: 01/07/2023] Open
Abstract
Several functional parameters from baseline (18)F-fluorodeoxyglucose positron emission tomography (PET)/computed tomography have been proposed as promising biomarkers of treatment efficacy in diffuse large B-cell lymphoma (DLBCL). We tested their ability to predict outcome in 2 cohorts of DLBCL patients receiving conventional immunochemotherapy (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone [R-CHOP] regimen), either every 14 (R-CHOP14) or 21 days (R-CHOP21). Baseline PET analysis was performed in 141 patients with DLBCL treated with R-CHOP14 in the prospective SAKK38/07 study (NCT00544219) of the Swiss Group for Clinical Cancer Research (testing set). Reproducibility was examined in a validation set of 113 patients treated with R-CHOP21. In the SAKK38/07 cohort, progression-free survival (PFS) at 5 years was 83% for patients with low metabolic tumor volume (MTV) and 59% for those with high MTV (hazard ratio [HR], 3.4; 95% confidence interval [CI], 1.6-7.0; P = .0005), whereas overall survival (OS) was 91% and 64%, respectively (HR, 4.4; 95% CI, 1.9-10; P = .0001). MTV was the most powerful predictor of outcome also in the validation set. Elevated metabolic heterogeneity (MH) significantly predicted poorer outcomes in the subgroups of patients with elevated MTV. A model integrating MTV and MH identified high-risk patients with shorter PFS (testing set: HR, 5.6; 95% CI, 1.8-17; P < .0001; validation set: HR, 5.6; 95% CI, 1.7-18; P = .0002) and shorter OS (testing set: HR, 9.5; 95% CI, 1.7-52; P < .0001; validation set: HR, 7.6; 95% CI, 2.0-28; P = .0003). This finding was confirmed by an unsupervised regression tree analysis indicating that prognostic models based on MTV and MH may allow early identification of refractory patients who might benefit from treatment intensification. This trial was registered at www.clinicaltrials.gov as #NCT00544219.
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Affiliation(s)
- Luca Ceriani
- Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Giuseppe Gritti
- Hematology Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Luciano Cascione
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, Switzerland
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Maria Cristina Pirosa
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Angela Polino
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Teresa Ruberto
- Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Anastasios Stathis
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Andrea Bruno
- Department of Nuclear Medicine, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Alden A Moccia
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luca Giovanella
- Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Division of Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Stefanie Hayoz
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland
| | - Sämi Schär
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Switzerland
| | - Alessandro Rambaldi
- Hematology Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | | | - Emanuele Zucca
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, Switzerland
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
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11
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Bailly C, Carlier T, Touzeau C, Arlicot N, Kraeber-Bodéré F, Le Gouill S, Bodet-Milin C. Interest of FDG-PET in the Management of Mantle Cell Lymphoma. Front Med (Lausanne) 2019; 6:70. [PMID: 31024918 PMCID: PMC6465510 DOI: 10.3389/fmed.2019.00070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/20/2019] [Indexed: 01/05/2023] Open
Abstract
FDG-PET changed response assessment and therapy strategy in diffuse large B-cell lymphoma and Hodgkin disease lymphoma. The value of FDG-PET evaluation in MCL has not been extensively studied and a recent expert consensus highlighted the need for more studies addressing this question. Data of the literature show the value of FDG-PET at baseline in patients with MCL, underlining the good sensitivity of this examination for the initial staging of this pathology, but also the potential impact of semi-quantitative analysis in this indication. The determination of SUVmax at diagnosis might indeed provide important prognostic information. Some studies also suggest the potential value of early and end-of-treatment metabolic assessment in MCL, but these results need to be validated in standardized prospective studies. These results also underlie the need to integrate FDG-PET results into MCL treatment strategy to improve disease management in identifying patients who might benefit from more intensive therapy.
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Affiliation(s)
- Clément Bailly
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,Department of Nuclear Medicine, CHU de Nantes, Nantes, France
| | - Thomas Carlier
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,Department of Nuclear Medicine, CHU de Nantes, Nantes, France
| | | | - Nicolas Arlicot
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France
| | - Françoise Kraeber-Bodéré
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,Department of Nuclear Medicine, CHU de Nantes, Nantes, France.,Department of Nuclear Medicine, ICO-René Gauducheau, Saint-Herblain, France
| | | | - Caroline Bodet-Milin
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,Department of Nuclear Medicine, CHU de Nantes, Nantes, France
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12
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Vaxman I, Bernstine H, Kleinstern G, Hendin N, Shimony S, Domachevsky L, Gurion R, Groshar D, Raanani P, Gafter‐Gvili A. FDG PET/CT as a diagnostic and prognostic tool for the evaluation of marginal zone lymphoma. Hematol Oncol 2019; 37:168-175. [DOI: 10.1002/hon.2578] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/28/2019] [Accepted: 02/04/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Iuliana Vaxman
- Institute of HematologyDavidoff Cancer Center, Rabin Medical Center Petah‐Tikva Israel
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Hanna Bernstine
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
- Department of Nuclear MedicineRabin Medical Center Petah‐Tikva Israel
| | - Geffen Kleinstern
- Department of Health Sciences ResearchMayo Clinic Rochester Minnesota
| | - Natav Hendin
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Shai Shimony
- Institute of HematologyDavidoff Cancer Center, Rabin Medical Center Petah‐Tikva Israel
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Liran Domachevsky
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
- Department of Nuclear MedicineRabin Medical Center Petah‐Tikva Israel
| | - Ronit Gurion
- Institute of HematologyDavidoff Cancer Center, Rabin Medical Center Petah‐Tikva Israel
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - David Groshar
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
- Department of Nuclear MedicineRabin Medical Center Petah‐Tikva Israel
| | - Pia Raanani
- Institute of HematologyDavidoff Cancer Center, Rabin Medical Center Petah‐Tikva Israel
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Anat Gafter‐Gvili
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
- Medicine ARabin Medical Center Petah‐Tikva Israel
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13
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Campiotti L, DE Palma D, Guasti L, Proserpio I, Casagrande S, Schiorlin I, Bolzacchini E, Suter M, Ogliari F, Squizzato A. Baseline PET as prognostic index in diffuse large B-cell lymphoma and grade IIIb follicular lymphoma: a retrospective study of a single-center experience. 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 RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2019; 65:59-63. [PMID: 30781938 DOI: 10.23736/s1824-4785.19.03130-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND International guidelines support performing baseline positron emission tomography (PET) in lymphoma. Metabolic tumor volume (MTV) measurement has been proposed as a good measurement of disease burden. We investigated if MTV at baseline PET can be predictive of complete response (CR) to first line standard chemotherapy in diffuse large B-cell lymphoma (DLBCL) and in follicular lymphoma (FL) grade IIIb. METHODS We retrospectively analyzed data on 54 consecutive patients with DLBCL and FL grade IIIb treated in our institution. Dedicated software automatically estimated the SUV<inf>max</inf> of the most active lesion and the MTV of the entire lesion burden using an isocontour threshold method set at 42% (MTV42) and 28% (MTV28) of the SUV<inf>max</inf>. In addition, the ratio value (MTV28/MTV42) was calculated. Every group of lesions was evaluated separately. All patients were treated with R-CHOP-21. We performed a univariate and a multivariate logistic regression analysis to explore any possible association between PET parameters and CR. RESULTS At the univariate logistic regression analysis, patients with a MTV28 lower than the median value (173.1) had an odds ratio (OR) of 4 (95% CI: 0.94-16.9) of obtaining a CR in comparison to patients with a MTV 28 higher than the median value; patients with a MTV42 lower than the median value (i.e. 85.6) had an OR of 3.63 (95% CI: 0.85-15.34) of obtaining a CR in comparison to patients with a MTV 42 equal or higher than the median value. Using MTV28/MTV42 value with median as cut-off instead of MTV28, patients with a MTV28/MTV42 lower than the median value (i.e. 1.81) had an OR of 4.26 (95% CI: 0.72-25.07) and of 7.54 (95% CI: 0.70-80.91) of obtaining a CR in comparison to patients with a MTV28/MTV42 equal or higher than the median value in the two models, respectively. CONCLUSIONS The results of our study suggest that MTV could be a useful tool to predict response to R-CHOP in patients affected with DLBCL and FL grade IIIb and that a multi-parameters evaluation should be considered.
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Affiliation(s)
- Leonardo Campiotti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy -
| | - Diego DE Palma
- Department of Nuclear Medicine, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Luigina Guasti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Ilaria Proserpio
- Department of Medical Oncology, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Sabrina Casagrande
- Department of Nuclear Medicine, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Ilaria Schiorlin
- Department of Nuclear Medicine, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Elena Bolzacchini
- Department of Medical Oncology, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Matteo Suter
- Department of Medical Oncology, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - Francesca Ogliari
- Department of Medical Oncology, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
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14
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Bailly C, Carlier T, Jamet B, Touzeau C, Moreau P, Kraeber-Bodéré F, Bodet-Milin C. 18F-FDG PET/CT in multiple myeloma: critical insights and future directions. Eur J Nucl Med Mol Imaging 2019; 46:1048-1050. [PMID: 30770949 DOI: 10.1007/s00259-019-04279-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/31/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Clément Bailly
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,Department of Nuclear Medicine, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | - Thomas Carlier
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,Department of Nuclear Medicine, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | - Bastien Jamet
- Department of Nuclear Medicine, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | - Cyrille Touzeau
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,Department of Hematology, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | - Philippe Moreau
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,Department of Hematology, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | - Françoise Kraeber-Bodéré
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,Department of Nuclear Medicine, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France.,Department of Nuclear Medicine, ICO-René Gauducheau, Boulevard Jacques Monod, 44805, Saint-Herblain, France
| | - Caroline Bodet-Milin
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France. .,Department of Nuclear Medicine, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France.
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15
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Lopci E, Meignan M. Deauville score: the Phoenix rising from ashes. Eur J Nucl Med Mol Imaging 2018; 46:1043-1045. [DOI: 10.1007/s00259-018-4215-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/07/2018] [Indexed: 12/20/2022]
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16
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Bailly C, Carlier T, Jamet B, Eugene T, Touzeau C, Attal M, Hulin C, Facon T, Leleu X, Perrot A, Garderet L, Macro M, Caillot D, Moreau P, Kraeber-Bodéré F, Bodet-Milin C. Interim PET Analysis in First-Line Therapy of Multiple Myeloma: Prognostic Value of ΔSUVmax in the FDG-Avid Patients of the IMAJEM Study. Clin Cancer Res 2018; 24:5219-5224. [PMID: 30068709 DOI: 10.1158/1078-0432.ccr-18-0741] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/08/2018] [Accepted: 07/25/2018] [Indexed: 11/16/2022]
Abstract
Purpose: To assess the prognostic value of interim 18F-fluorodeoxyglucose (FDG)-PET analysis using decrease in maximum standardized uptake value (SUVmax) versus visual analysis in patients with multiple myeloma.Patients and Methods: We evaluated the prognostic value of FDG-PET after three cycles of lenalidomide, bortezomib, and dexamethasone (RVD) in patients with FDG-avid multiple myeloma included in the French prospective multicenter IMAJEM study. All images were centrally reviewed and interpreted using visual criteria and maximal standardized uptake value reduction (ΔSUVmax). Known prognostic factors, such as the revised International Staging System and biochemical response after three cycles of chemotherapy, were also evaluated.Results: In the multivariate analysis, only ΔSUVmax [P < 0.001, HR = 5.56; 95% confidence interval (CI), 1.96-15.81] and biochemical response after three cycles of RVD (P = 0.025, HR = 0.29; 95% CI, 0.1-0.85) appeared as independent prognostic factors, with a more discriminative HR for ΔSUVmax. ΔSUVmax analysis (>-25% vs. ≤-25%) identified patients with improved median progression-free survival (22.6 months and not reached, respectively).Conclusions: ΔSUVmax appears to be a powerful tool for the prediction of long-term outcome in patients with FDG-avid multiple myeloma. Other prospective studies are needed to further validate this prognostic biomarker. Clin Cancer Res; 24(21); 5219-24. ©2018 AACR.
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Affiliation(s)
- Clément Bailly
- Nantes-Angers Cancer Research Center (CRCINA), University of Nantes, Inserm UMR1232, Nantes, France.,Department of Nuclear Medicine, CHU de Nantes, Nantes, France
| | - Thomas Carlier
- Nantes-Angers Cancer Research Center (CRCINA), University of Nantes, Inserm UMR1232, Nantes, France.,Department of Nuclear Medicine, CHU de Nantes, Nantes, France
| | - Bastien Jamet
- Department of Nuclear Medicine, CHU de Nantes, Nantes, France
| | - Thomas Eugene
- Department of Nuclear Medicine, CHU de Nantes, Nantes, France
| | - Cyrille Touzeau
- Nantes-Angers Cancer Research Center (CRCINA), University of Nantes, Inserm UMR1232, Nantes, France.,Department of Hematology, CHU de Nantes, Nantes, France
| | - Michel Attal
- Department of Hematology, IUCT Oncopole, Toulouse, France
| | - Cyrille Hulin
- Department of Hematology, CHU Haut Leveque, Pessac, France
| | | | - Xavier Leleu
- Department of Hematology, CHU de Poitiers, Poitiers, France
| | - Aurore Perrot
- Department of Hematology, CHU de Nancy, Nancy, France
| | | | | | - Denis Caillot
- Department of Hematology, CHU de Dijon, Dijon, France
| | - Philippe Moreau
- Nantes-Angers Cancer Research Center (CRCINA), University of Nantes, Inserm UMR1232, Nantes, France.,Department of Hematology, CHU de Nantes, Nantes, France
| | - Françoise Kraeber-Bodéré
- Nantes-Angers Cancer Research Center (CRCINA), University of Nantes, Inserm UMR1232, Nantes, France.,Department of Nuclear Medicine, CHU de Nantes, Nantes, France.,Department of Nuclear Medicine, ICO-René Gauducheau, Saint-Herblain, France
| | - Caroline Bodet-Milin
- Nantes-Angers Cancer Research Center (CRCINA), University of Nantes, Inserm UMR1232, Nantes, France. .,Department of Nuclear Medicine, CHU de Nantes, Nantes, France
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17
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Reply to the Letter to the Editor from Peters et al: On the use of the liver as a reference organ for Deauville scoring in lymphoma patients and how it may be affected by liver steatosis. Eur J Nucl Med Mol Imaging 2018; 45:2233-2234. [DOI: 10.1007/s00259-018-4087-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
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18
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Aide N, Lasnon C, Damaj G. Combining baseline TMTV and gene profiling for a better risk stratification in diffuse large B cell lymphoma. Eur J Nucl Med Mol Imaging 2018; 45:677-679. [PMID: 29455312 DOI: 10.1007/s00259-018-3966-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 01/25/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Nicolas Aide
- Nuclear Medicine Department, Caen University Hospital, Caen, France. .,Normandie University, Caen, France. .,INSERM 1086 ANTICIPE, Normandie University, Caen, France.
| | - Charline Lasnon
- INSERM 1086 ANTICIPE, Normandie University, Caen, France.,Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France
| | - Gandhi Damaj
- Normandie University, Caen, France.,Haematology Institute, Caen University Hospital, Caen, France.,MICAH INSERM U1245, Rouen University, Rouen, France
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19
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Interpretation criteria for FDG PET/CT in multiple myeloma (IMPeTUs): final results. IMPeTUs (Italian myeloma criteria for PET USe). Eur J Nucl Med Mol Imaging 2017; 45:712-719. [PMID: 29270787 DOI: 10.1007/s00259-017-3909-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Abstract
ᅟ: FDG PET/CT (18F-fluoro-deoxy-glucose positron emission tomography/computed tomography) is a useful tool to image multiple myeloma (MM). However, simple and reproducible reporting criteria are still lacking and there is the need for harmonization. Recently, a group of Italian nuclear medicine experts defined new visual descriptive criteria (Italian Myeloma criteria for Pet Use: IMPeTUs) to standardize FDG PET/CT evaluation in MM patients. The aim of this study was to assess IMPeTUs reproducibility on a large prospective cohort of MM patients. MATERIALS AND METHODS Patients affected by symptomatic MM who had performed an FDG PET/CT at baseline (PET0), after induction (PET-AI), and the end of treatment (PET-EoT) were prospectively enrolled in a multicenter trial (EMN02)(NCT01910987; MMY3033). After anonymization, PET images were uploaded in the web platform WIDEN® and hence distributed to five expert nuclear medicine reviewers for a blinded independent central review according to the IMPeTUs criteria. Consensus among reviewers was measured by the percentage of agreement and the Krippendorff's alpha. Furthermore, on a patient-based analysis, the concordance among all the reviewers in terms of positivity or negativity of the FDG PET/CT scan was tested for different thresholds of positivity (Deauville score (DS 2, 3, 4, 5) for the main parameters (bone marrow, focal score, extra-medullary disease). RESULTS Eighty-six patients (211 FDG PET/CT scans) were included in this analysis. Median patient age was 58 years (range, 35-66 years), 45% were male, 15% of them were in stage ISS (International Staging System) III, and 42% had high-risk cytogenetics. The percentage agreement was superior to 75% for all the time points, reaching 100% of agreement in assessing the presence skull lesions after therapy. Comparable results were obtained when the agreement analysis was performed using the Krippendorff's alpha coefficient, either in every single time point of scanning (PET0, PET-AI or PET-EoT) or overall for all the scans together. DS proved highly reproducible with the highest reproducibility for score 4. CONCLUSIONS IMPeTUs criteria proved highly reproducible and could therefore be considered as a base for harmonizing PET interpretation in multiple myeloma. A prospective clinical validation of IMPeTUs criteria is underway.
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Adams HJA, Kwee TC. Interim FDG-PET in lymphoma, a questionable practice in hematology. Eur J Nucl Med Mol Imaging 2017; 44:2014-2017. [PMID: 28761975 DOI: 10.1007/s00259-017-3783-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/16/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, Deventer Ziekenhuis, Nico Bolkesteinlaan 75, 7416 SE, Deventer, The Netherlands.
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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21
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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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