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Draye-Carbonnier S, Camus V, Becker S, Tonnelet D, Lévêque E, Zduniak A, Jardin F, Tilly H, Vera P, Decazes P. Prognostic value of the combination of volume, massiveness and fragmentation parameters measured on baseline FDG pet in high-burden follicular lymphoma. Sci Rep 2024; 14:8033. [PMID: 38580734 PMCID: PMC10997640 DOI: 10.1038/s41598-024-58412-0] [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: 01/02/2024] [Accepted: 03/28/2024] [Indexed: 04/07/2024] Open
Abstract
The prognostic value of radiomic quantitative features measured on pre-treatment 18F-FDG PET/CT was investigated in patients with follicular lymphoma (FL). We conducted a retrospective study of 126 FL patients (grade 1-3a) diagnosed between 2006 and 2020. A dozen of PET/CT-derived features were extracted via a software (Oncometer3D) from baseline 18F-FDG PET/CT images. The receiver operating characteristic (ROC) curve, Kaplan-Meier method and Cox analysis were used to assess the prognostic factors for progression of disease within 24 months (POD24) and progression-free survival at 24 months. Four different clusters were identified among the twelve PET parameters analyzed: activity, tumor burden, fragmentation-massiveness and dispersion. On ROC analyses, TMTV, the total metabolic tumor volume, had the highest AUC (0.734) followed by medPCD, the median distance between the centroid of the tumors and their periphery (AUC: 0.733). Patients with high TMTV (HR = 4.341; p < 0.001), high Tumor Volume Surface Ratio (TVSR) (HR = 3.204; p < 0.003) and high medPCD (HR = 4.507; p < 0.001) had significantly worse prognosis in both Kaplan-Meier and Cox univariate analyses. Furthermore, a synergistic effect was observed in Kaplan-Meier and Cox analyses combining these three PET/CT-derived parameters (HR = 12.562; p < 0.001). Having two or three high parameters among TMTV, TVSR and medPCD was able to predict POD24 status with a specificity of 68% and a sensitivity of 75%. TMTV, TVSR and baseline medPCD are strong prognostic factors in FL and their combination better predicts disease prognosis.
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Affiliation(s)
| | - V Camus
- Department of Hematology, Centre Henri Becquerel, Rouen, France
- INSERM U1245, Université de Rouen, IRIB, Rouen, France
| | - S Becker
- Department of Nuclear Medicine, Centre Henri Becquerel, Rouen, France
- QuantIF-LITIS (EA 4108-FR CNRS 3638), Faculty of Medicine, University of Rouen, Rouen, France
| | - D Tonnelet
- Department of Nuclear Medicine, Centre Henri Becquerel, Rouen, France
| | - E Lévêque
- Department of Statistics and Clinical Research Unit, Centre Henri Becquerel, Rouen, France
| | - A Zduniak
- Department of Hematology, Centre Henri Becquerel, Rouen, France
| | - F Jardin
- Department of Hematology, Centre Henri Becquerel, Rouen, France
- INSERM U1245, Université de Rouen, IRIB, Rouen, France
| | - H Tilly
- Department of Hematology, Centre Henri Becquerel, Rouen, France
- INSERM U1245, Université de Rouen, IRIB, Rouen, France
| | - P Vera
- Department of Nuclear Medicine, Centre Henri Becquerel, Rouen, France
- QuantIF-LITIS (EA 4108-FR CNRS 3638), Faculty of Medicine, University of Rouen, Rouen, France
| | - P Decazes
- Department of Nuclear Medicine, Centre Henri Becquerel, Rouen, France.
- QuantIF-LITIS (EA 4108-FR CNRS 3638), Faculty of Medicine, University of Rouen, Rouen, France.
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Song GY, Jung SH, Ahn SY, Kim M, Ahn JS, Lee JJ, Kim HJ, Moon JB, Yoo SW, Kwon SY, Min JJ, Bom HS, Kang SR, Yang DH. Prognostic Significance Of Sequential 18f-fdg Pet/Ct During Frontline Treatment Of Peripheral T Cell Lymphomas. Korean J Intern Med 2024; 39:327-337. [PMID: 38268194 PMCID: PMC10918377 DOI: 10.3904/kjim.2023.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/03/2023] [Accepted: 10/19/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND/AIMS The prognostic significance of 18F-fluorodeoxyglucose (FDG)-positron emission tomography-computed tomography (PET/CT) in peripheral T-cell lymphomas (PTCLs) are controversial. We explored the prognostic impact of sequential 18F-FDG PET/CT during frontline chemotherapy of patients with PTCLs. METHODS In total, 143 patients with newly diagnosed PTCLs were included. Sequential 18F-FDG PET/CTs were performed at the time of diagnosis, during chemotherapy, and at the end of chemotherapy. The baseline total metabolic tumor volume (TMTV) was calculated using the the standard uptake value with a threshold method of 2.5. RESULTS A baseline TMTV of 457.0 cm3 was used to categorize patients into high and low TMTV groups. Patients with a requirehigh TMTV had shorter progression-free survival (PFS) and overall survival (OS) than those with a low TMTV (PFS, 9.8 vs. 26.5 mo, p = 0.043; OS, 18.9 vs. 71.2 mo, p = 0.004). The interim 18F-FDG PET/CT response score was recorded as 1, 2-3, and 4-5 according to the Deauville criteria. The PFS and OS showed significant differences according to the interim 18F-FDG PET/CT response score (PFS, 120.7 vs. 34.1 vs. 5.1 mo, p < 0.001; OS, not reached vs. 61.1 mo vs. 12.1 mo, p < 0.001). CONCLUSION The interim PET/CT response based on visual assessment predicts disease progression and survival outcome in PTCLs. A high baseline TMTV is associated with a poor response to anthracycline-based chemotherapy in PTCLs. However, TMTV was not an independent predictor for PFS in the multivariate analysis.
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Affiliation(s)
- Ga-Young Song
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Sung-Hoon Jung
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Seo-Yeon Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Mihee Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Jae-Sook Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Je-Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Hyeoung-Joon Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Jang Bae Moon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Su Woong Yoo
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Seong Young Kwon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Jung-Joon Min
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Sae-Ryung Kang
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Deok-Hwan Yang
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
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Burton JS, Foley NC, Mehta-Shah N. SOHO State-of-the-Art Updates and Next Questions: Treatment for Newly Diagnosed Peripheral T-Cell Lymphomas. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:65-76. [PMID: 37973458 DOI: 10.1016/j.clml.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/16/2023] [Accepted: 10/21/2023] [Indexed: 11/19/2023]
Abstract
Although a rare subset of non-Hodgkin lymphomas, peripheral T-cell lymphomas (PTCL) account for a disproportionate proportion of patient mortality. Conventional therapies are derived from experience treating aggressive B-cell lymphomas and center around CHOP-based chemotherapy. However, due to the unique biology and diverse subtypes of PTCL, most patients fail to durably respond to this approach and 5-year survival is only 20% to 30%. There have been multiple attempts to improve outcomes for patients with PTCL. Among the more successful strategies are the use of consolidative autologous stem cell transplant, the augmentation of CHOP with etoposide (CHOEP), and the use of brentuximab vedotin in CD30-positive PTCL. Advances in the understanding of histology-specific biology has cultivated enthusiasm to evaluate hypomethylating agents, histone deacetylate inhibitors, and phosphoinositol-3-kinase inhibitors in the frontline setting. Improvements in monitoring disease response and prognostication including the use of cell-free DNA, mutational profiling, and interim PET/CT imaging are also on the horizon. For patients with acute T-cell leukemia/lymphoma, the use of mogamulizumab-based therapy in the frontline setting may lead to advances in care. The true impact of these new-era therapies will only be elucidated as clinical practices incorporate the rapidly changing evidence.
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Affiliation(s)
- Jackson S Burton
- Department of Medicine, Division of Oncology, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Nicole C Foley
- Department of Medicine, Division of Oncology, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Neha Mehta-Shah
- Department of Medicine, Division of Oncology, Washington University in St. Louis School of Medicine, St. Louis, MO.
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4
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Cordoba R, Sánchez-García J, Domingo-Domenech E, López Jiménez J, Martínez Pozo A, Carpio C, Bendaña Á, González AJ, González de Villambrosia S, Gómez Codina J, Navarro B, Rodríguez G, Naves A, Baeza L, Martín García-Sancho A. 18F-FDG-PET/CT response after first-line treatment as a prognostic factor for survival in peripheral T-cell lymphoma: a Spanish retrospective study. Expert Rev Hematol 2024; 17:95-100. [PMID: 38299464 DOI: 10.1080/17474086.2024.2313457] [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: 06/20/2023] [Accepted: 01/25/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND An accurate assessment of tumor viability after first-line treatment is critical for predicting treatment failure in peripheral T-cell lymphomas (PTCLs). 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) has been adopted as the preferred assessment method in clinical trials, but its impact in clinical practice should be examined. This study aims to determine the prognostic significance of18F-FDG-PET/CT for survival following first-line treatment in PTCL patients. RESEARCH DESIGN AND METHODS Retrospective observational study including 175 patients diagnosed with PTCL between 2008 and 2013 in 13 Spanish sites. RESULTS Fifty patients were evaluated with18F-FDG-PET/CT following first-line therapy: 58% were18F-FDG-PET/CT-negative and 42% were18F-FDG-PET/CT-positive. Disease progression occurred in 37.9% of18F-FDG-PET/CT-negative patients and in 80.9% of18F-FDG-PET/CT-positive patients (p = 0.0037). Median progression-free survival and overall survival were 67 and 74 months for18F-FDG-PET/CT-negative patients, and 5 (p < 0.0001) and 10 months (p < 0.0001), respectively, in18F-FDG-PET/CT-positive patients. After multivariate analysis, only B symptoms emerged as a negative predictive factor of complete response (RR 7.08; 95% CI 1.60-31.31; p = 0.001). CONCLUSIONS 18F-FDG-PET/CT identifies high-risk PTCL patients who will have poor prognosis and survival following first-line treatment. However, more research is needed to confirm the best treatment options for PTCL patients.
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Affiliation(s)
- Raul Cordoba
- Lymphoma Unit, Department of Haematology, Health Research Institute IIS-FJD, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Joaquín Sánchez-García
- Hematology Department Department, IMIBIC Hospital Universitario Reina Sofía, UCO, Cordoba, Andalucía, Spain
| | - Eva Domingo-Domenech
- Hematology Department, Institut Català D'oncologia, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Antonio Martínez Pozo
- Pathology Department, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), CIBERONC, Universitat de Barcelona, Barcelona, Spain
| | - Cecilia Carpio
- Department of Haematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital (HUVH), Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángeles Bendaña
- Hematology Department, Complexo Hospitalario Universitario de Santiago de Compostela, La Coruña, Spain
| | - Ana Julia González
- Hematology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - José Gómez Codina
- Medical Oncology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Belén Navarro
- Hematology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Guillermo Rodríguez
- Hematology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/Universidad de Sevilla, Seville, Spain
| | - Andrea Naves
- Medical Department, Takeda Farmacéutica España S.A, Madrid, Spain
| | - Lourdes Baeza
- Medical Department, Takeda Farmacéutica España S.A, Madrid, Spain
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5
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Constantino CS, Leocádio S, Oliveira FPM, Silva M, Oliveira C, Castanheira JC, Silva Â, Vaz S, Teixeira R, Neves M, Lúcio P, João C, Costa DC. Evaluation of Semiautomatic and Deep Learning-Based Fully Automatic Segmentation Methods on [ 18F]FDG PET/CT Images from Patients with Lymphoma: Influence on Tumor Characterization. J Digit Imaging 2023; 36:1864-1876. [PMID: 37059891 PMCID: PMC10407010 DOI: 10.1007/s10278-023-00823-y] [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: 01/03/2023] [Revised: 03/14/2023] [Accepted: 03/27/2023] [Indexed: 04/16/2023] Open
Abstract
The objective is to assess the performance of seven semiautomatic and two fully automatic segmentation methods on [18F]FDG PET/CT lymphoma images and evaluate their influence on tumor quantification. All lymphoma lesions identified in 65 whole-body [18F]FDG PET/CT staging images were segmented by two experienced observers using manual and semiautomatic methods. Semiautomatic segmentation using absolute and relative thresholds, k-means and Bayesian clustering, and a self-adaptive configuration (SAC) of k-means and Bayesian was applied. Three state-of-the-art deep learning-based segmentations methods using a 3D U-Net architecture were also applied. One was semiautomatic and two were fully automatic, of which one is publicly available. Dice coefficient (DC) measured segmentation overlap, considering manual segmentation the ground truth. Lymphoma lesions were characterized by 31 features. Intraclass correlation coefficient (ICC) assessed features agreement between different segmentation methods. Nine hundred twenty [18F]FDG-avid lesions were identified. The SAC Bayesian method achieved the highest median intra-observer DC (0.87). Inter-observers' DC was higher for SAC Bayesian than manual segmentation (0.94 vs 0.84, p < 0.001). Semiautomatic deep learning-based median DC was promising (0.83 (Obs1), 0.79 (Obs2)). Threshold-based methods and publicly available 3D U-Net gave poorer results (0.56 ≤ DC ≤ 0.68). Maximum, mean, and peak standardized uptake values, metabolic tumor volume, and total lesion glycolysis showed excellent agreement (ICC ≥ 0.92) between manual and SAC Bayesian segmentation methods. The SAC Bayesian classifier is more reproducible and produces similar lesion features compared to manual segmentation, giving the best concordant results of all other methods. Deep learning-based segmentation can achieve overall good segmentation results but failed in few patients impacting patients' clinical evaluation.
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Affiliation(s)
- Cláudia S Constantino
- Nuclear Medicine - Radiopharmacology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal.
| | - Sónia Leocádio
- Hematology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Francisco P M Oliveira
- Nuclear Medicine - Radiopharmacology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Mariana Silva
- Nuclear Medicine - Radiopharmacology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Carla Oliveira
- Nuclear Medicine - Radiopharmacology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Joana C Castanheira
- Nuclear Medicine - Radiopharmacology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Ângelo Silva
- Nuclear Medicine - Radiopharmacology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Sofia Vaz
- Nuclear Medicine - Radiopharmacology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Ricardo Teixeira
- Nuclear Medicine - Radiopharmacology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Manuel Neves
- Hematology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Paulo Lúcio
- Hematology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Cristina João
- Hematology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Durval C Costa
- Nuclear Medicine - Radiopharmacology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
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6
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Hu L, Luo N, Li L, Qiu D, Hu X. A preliminary investigation of the relationship between 18F-FDG PET/CT metabolic parameters and prognosis in angioimmunoblastic T-cell lymphoma. Front Oncol 2023; 13:1171048. [PMID: 37397396 PMCID: PMC10311063 DOI: 10.3389/fonc.2023.1171048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Purpose The goal of the study was to determine the prognostic significance of metabolic parameters in baseline 18F-FDG PET/CT images obtained from patients with angioimmunoblastic T-cell lymphoma (AITL). Methods Forty patients with pathologically diagnosed AITL who had baseline 18F-FDG PET/CT between May 2014 and May 2021 were assessed as part of this study. Maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), and total metabolic tumor volume (TMTV) were obtained and analyzed. In addition, many relevant features were evaluated, including sex, age, staging, International Prognostic Index (IPI), prediction index for T-cell lymphoma (PIT), Ki-67, and so on. Estimates of progression-free survival (PFS) and overall survival (OS) were determined using the log-rank test and Kaplan-Meier. Results The median follow-up was 30.2 months (interquartile range 9.82-43.03). Throughout the follow-up period, 29 (72.5%) deaths occurred and 22 (55.0%) patients made progress. The rates for 2- and 3-year PFS were 43.6% and 26.4%, respectively. The 3- and 5-year OS were 42.6% and 21.5%. For TMTV, TLG, and SUVmax, the cut-off values were 87.0 cm3, 711.1, and 15.8, respectively. Poorer PFS and OS were substantially correlated with high SUVmax and TLG. An increased TMTV suggested a shorter OS. TLG performed independently as OS predictors in multivariate analysis. The risk score for predicting the prognosis of AITL includes the TMTV, TLG, SUVmax, and IPI scores, with 4.5 for TMTV, 2 for TLG, 1.5 for IPI scores, and 1 for SUVmax. Three risk categories of patients with AITL had 3-year OS rates of 100.0%, 43.3%, and 25.0%, respectively. Conclusion Baseline TLG was a strong predictor of OS. Here a new prognostic scoring system for AITL based on the clinical indicators and PET/CT metabolic parameters was constructed, which might make stratification of prognosis easy and also help to individualize treatment.
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Affiliation(s)
| | | | | | | | - Xiaoyan Hu
- *Correspondence: Dasheng Qiu, ; Xiaoyan Hu,
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7
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Barrington SF. Advances in positron emission tomography and radiomics. Hematol Oncol 2023; 41 Suppl 1:11-19. [PMID: 37294959 PMCID: PMC10775708 DOI: 10.1002/hon.3137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 06/11/2023]
Abstract
Positron emission tomography is established for staging and response evaluation in lymphoma using visual evaluation and semi-quantitative analysis. Radiomic analysis involving quantitative imaging features at baseline, such as metabolic tumor volume and markers of disease dissemination and changes in the standardized uptake value during treatment are emerging as powerful biomarkers. The combination of radiomic features with clinical risk factors and genomic analysis offers the potential to improve clinical risk prediction. This review discusses the state of current knowledge, progress toward standardization of tumor delineation for radiomic analysis and argues that radiomic features, molecular markers and circulating tumor DNA should be included in clinical trial designs to enable the development of baseline and dynamic risk scores that could further advance the field to facilitate testing of novel treatments and personalized therapy in aggressive lymphomas.
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Affiliation(s)
- Sally F. Barrington
- School of Biomedical Engineering and Imaging SciencesSt Thomas' Campus, Kings College LondonLondonUK
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Milgrom SA, Kim J, Pei Q, Lee I, Hoppe BS, Wu Y, Hodgson D, Kessel S, McCarten KM, Roberts K, Lo AC, Cole PD, Kelly KM, Cho SY. Baseline metabolic tumour burden improves risk stratification in Hodgkin lymphoma: A Children's Oncology Group study. Br J Haematol 2023; 201:1192-1199. [PMID: 36922022 PMCID: PMC10247420 DOI: 10.1111/bjh.18734] [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: 01/05/2023] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 03/17/2023]
Abstract
The Children's Oncology Group AHOD0831 study used a positron emission tomography (PET) response-adapted approach in high-risk Hodgkin lymphoma, whereby slow early responders (SERs) received more intensive therapy than rapid early responders (RERs). We explored if baseline PET-based characteristics would improve risk stratification. Of 166 patients enrolled in the COG AHOD0831 study, 94 (57%) had baseline PET scans evaluable for quantitative analysis. For these patients, total body metabolic tumour volume (MTV), total lesion glycolysis (TLG), maximum standardized uptake value (SUVmax ) and peak SUV (SUVpeak ) were obtained. MTV/TLG thresholds were an SUV of 2.5 (MTV2.5 /TLG2.5 ) and 40% of the tumour SUVmax (MTV40% /TLG40% ). TLG2.5 was associated with event-free survival (EFS) in the complete cohort (p = 0.04) and in RERs (p = 0.01), but not in SERs (p = 0.8). The Youden index cut-off for TLG2.5 was 1841. Four-year EFS was 92% for RER/TLG2.5 up to 1841, 60% for RER/TLG2.5 greater than 1841, 74% for SER/TLG2.5 up to 1841 and 79% for SER/TLG2.5 greater than 1841. Second EFS for RER/TLG2.5 up to 1841 was 100%. Thus, RERs with a low baseline TLG2.5 experienced excellent EFS with less intensive therapy, whereas RERs with a high baseline TLG2.5 experienced poor EFS. These findings suggest that patients with a high upfront tumour burden may benefit from intensified therapy, even if they achieve a RER.
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Affiliation(s)
- Sarah A Milgrom
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado, USA
| | - Jihyun Kim
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Division of Nuclear Medicine, Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Qinglin Pei
- Children's Oncology Group, Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Inki Lee
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Yue Wu
- Children's Oncology Group, Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | | | - Sandy Kessel
- Imaging and Radiation Oncology Core, Lincoln, Rhode Island, USA
| | | | - Kenneth Roberts
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrea C Lo
- BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Peter D Cole
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Kara M Kelly
- Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Steve Y Cho
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
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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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10
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Iterated cross validation method for prediction of survival in diffuse large B-cell lymphoma for small size dataset. Sci Rep 2023; 13:1438. [PMID: 36697456 PMCID: PMC9876907 DOI: 10.1038/s41598-023-28394-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
Efforts have been made to improve the risk stratification model for patients with diffuse large B-cell lymphoma (DLBCL). This study aimed to evaluate the disease prognosis using machine learning models with iterated cross validation (CV) method. A total of 122 patients with pathologically confirmed DLBCL and receiving rituximab-containing chemotherapy were enrolled. Contributions of clinical, laboratory, and metabolic imaging parameters from fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scans to the prognosis were evaluated using five regression models, namely logistic regression, random forest, support vector classifier (SVC), deep neural network (DNN), and fuzzy neural network models. Binary classification predictions for 3-year progression free survival (PFS) and 3-year overall survival (OS) were conducted. The 10-iterated fivefold CV with shuffling process was conducted to predict the capability of learning machines. The median PFS and OS were 41.0 and 43.6 months, respectively. Two indicators were found to be independent predictors for prognosis: international prognostic index and total metabolic tumor volume (MTVsum) from FDG PET/CT. For PFS, SVC and DNN (both with accuracy 71%) have the best predictive results, of which outperformed other algorithms. For OS, the DNN has the best predictive result (accuracy 76%). Using clinical and metabolic parameters as input variables, the machine learning methods with iterated CV method add the predictive values for PFS and OS evaluation in DLBCL patients.
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11
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Keijzer K, Niezink AG, de Boer JW, van Doesum JA, Noordzij W, van Meerten T, van Dijk LV. Semi-automated 18F-FDG PET segmentation methods for tumor volume determination in Non-Hodgkin lymphoma patients: a literature review, implementation and multi-threshold evaluation. Comput Struct Biotechnol J 2023; 21:1102-1114. [PMID: 36789266 PMCID: PMC9900370 DOI: 10.1016/j.csbj.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/18/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023] Open
Abstract
In the treatment of Non-Hodgkin lymphoma (NHL), multiple therapeutic options are available. Improving outcome predictions are essential to optimize treatment. The metabolic active tumor volume (MATV) has shown to be a prognostic factor in NHL. It is usually retrieved using semi-automated thresholding methods based on standardized uptake values (SUV), calculated from 18F-Fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET) images. However, there is currently no consensus method for NHL. The aim of this study was to review literature on different segmentation methods used, and to evaluate selected methods by using an in house created software tool. A software tool, MUltiple SUV Threshold (MUST)-segmenter was developed where tumor locations are identified by placing seed-points on the PET images, followed by subsequent region growing. Based on a literature review, 9 SUV thresholding methods were selected and MATVs were extracted. The MUST-segmenter was utilized in a cohort of 68 patients with NHL. Differences in MATVs were assessed with paired t-tests, and correlations and distributions figures. High variability and significant differences between the MATVs based on different segmentation methods (p < 0.05) were observed in the NHL patients. Median MATVs ranged from 35 to 211 cc. No consensus for determining MATV is available based on the literature. Using the MUST-segmenter with 9 selected SUV thresholding methods, we demonstrated a large and significant variation in MATVs. Identifying the most optimal segmentation method for patients with NHL is essential to further improve predictions of toxicity, response, and treatment outcomes, which can be facilitated by the MUST-segmenter.
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Key Words
- 18F-FDG PET
- AT, adaptive thresholding methods
- CAR, chimeric antigen receptor
- CT, computed tomography
- DICOM, Digital Imaging and Communications in Medicine
- DLBCL, Diffuse large B-cell lymphoma
- EANM, European Association of Nuclear Medicine
- EARL, EANM Research Ltd.
- FDG, fluorodeoxyglucose
- HL, Hodgkin lymphoma
- IMG, robustness across image reconstruction methods
- IQR, interquartile range
- LBCL, Large B-cell lymphoma
- LDH, lactate dehydrogenase
- MAN, clinician based evaluation using manual segmentations
- MATV, Metabolic active tumor volume
- MIP, Maximum Intensity Projection
- MUST, Multiple SUV Thresholding
- Metabolic tumor volume
- NHL, Non-Hodgkin lymphoma
- Non-Hodgkin lymphoma
- OBS, robustness across observers
- OS, overall survival
- PD-L1, programmed cell death ligand-1
- PET segmentation
- PET, positron emission tomography
- PFS, progression free survival
- PROG, progression vs non-progression
- PTCL, Peripheral T-cell lymphoma
- PTLD, Post-transplant lymphoproliferative disorder
- QS, quality scores
- SOFT, robustness across software
- SUV thresholding
- SUV, standardized uptake value
- Segmentation software
- TCL, T-cell lymphoma
- UMCG, University Medical Center Groningen
- VOI, volume of interest
- cc, cubic centimeter
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Affiliation(s)
- Kylie Keijzer
- Department of Hematology, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, the Netherlands,Department of Radiation Oncology, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, the Netherlands
| | - Anne G.H. Niezink
- Department of Radiation Oncology, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, the Netherlands
| | - Janneke W. de Boer
- Department of Hematology, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, the Netherlands
| | - Jaap A. van Doesum
- Department of Hematology, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, the Netherlands
| | - Walter Noordzij
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, the Netherlands
| | - Tom van Meerten
- Department of Hematology, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, the Netherlands
| | - Lisanne V. van Dijk
- Department of Radiation Oncology, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, the Netherlands,Corresponding author.
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Clinical and Radiographic Predictors of Progression and Survival in Relapsed/Refractory Lymphoma Patients Receiving Anti-CD19 CAR T-cell Therapy. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:49-56. [PMID: 36335021 DOI: 10.1016/j.clml.2022.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/15/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Chimeric antigen receptor (CAR) T-cell therapy has revolutionized treatment of relapsed/refractory (R/R) B-cell lymphomas, though certain patients do not respond to treatment or relapse afterwards. The purpose of this study is to determine patient variables that are predictive of response to CAR-T therapy. METHODS We conducted a retrospective review of 59 R/R B-cell non-Hodgkin lymphoma patients who received anti-CD19 CAR T-cell therapy. Risk factors for progression free survival (PFS) and overall survival (OS) were identified and multivariate logistic regression models for PFS and OS at 1 year were created using stepwise selection. The final multivariate logistic regression models were used to estimate the area under the receiver operating curve (AUROC). RESULTS At median follow up of 25.6 months, median overall survival was not reached, and median progression free survival was 5.7 months. Stage IV disease (odds ratio (OR) 9.335, P = .025) was identified as a predictive variable for progression at day 365 with an AUC of 0.7922 (P < .001). IPI (OR 2.828, P = .014), ALC ≥ 0.50 at collection (OR 0.183, P = .043), CRP ≥ 11 (OR 6.177, P = .019), and tocilizumab administration (OR 0.062, P = .005) as predictors for death at day 365 with an AUC 0.8626 (P < .001). CONCLUSION Clinical variables identify R/R lymphoma patients who are at risk for progression and poor overall survival after CAR T-cell therapy. IPI, CRP, ALC, and tocilizumab administration may be predictors of survival.
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13
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Ricard F, Cheson B, Barrington S, Trotman J, Schmid A, Brueggenwerth G, Salles G, Schwartz L, Goldmacher G, Jarecha R, Narang J, Broussais F, Galette P, Liu M, Bajpai S, Perlman E, Gillis J, Smalberg I, Terve P, Zahlmann G, Korn R. Application of the Lugano Classification for Initial Evaluation, Staging, and Response Assessment of Hodgkin and Non-Hodgkin Lymphoma: The PRoLoG Consensus Initiative (Part 1-Clinical). J Nucl Med 2023; 64:102-108. [PMID: 35835580 PMCID: PMC9841255 DOI: 10.2967/jnumed.122.264106] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 01/28/2023] Open
Abstract
Our objective was to provide consensus recommendations from a consortium of academic and industry experts in the field of lymphoma and imaging for consistent application of the Lugano classification. Methods: Consensus was obtained through a series of meetings from July 2019 until September 2021 sponsored by the Pharma Imaging Network for Therapeutics and Diagnostics (PINTaD) as part of the PINTaD Response Criteria in Lymphoma Working Group (PRoLoG) consensus initiative. Results: Consensus recommendations clarified technical considerations for PET/CT and diagnostic CT from the Lugano classification, including updating the FDG avidity of different lymphoma entities, clarifying the response nomenclature, and refining lesion classification and scoring, especially with regard to scores 4 and 5 and the X category of the 5-point scale. Combination of metabolic and anatomic responses is clarified, as well as response assessment in cases of discordant or missing evaluations. Use of clinical data in the classification, especially the requirement for bone marrow assessment, is further updated on the basis of lymphoma entities. Clarification is provided with regard to spleen and liver measurements and evaluation, as well as nodal response. Conclusion: Consensus recommendations are made to comprehensively address areas of inconsistency and ambiguity in the classification encountered during response evaluation by end users, and such guidance should be used as a companion to the 2014 Lugano classification.
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Affiliation(s)
| | - Bruce Cheson
- Lymphoma Research Foundation, New York, New York
| | - Sally Barrington
- King's College London and Guy's and St. Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom
| | - Judith Trotman
- Concord Repatriation General Hospital, University of Sydney, Concord, New South Wales, Australia
| | - Annette Schmid
- Takeda Pharmaceutical Company Ltd., Cambridge, Massachusetts
| | | | - Gilles Salles
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weil Cornell Medicine, New York, New York
| | - Larry Schwartz
- Department of Radiology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, Columbia, New York
| | | | | | - Jayant Narang
- Takeda Pharmaceutical Company Ltd., Cambridge, Massachusetts
| | | | | | - Min Liu
- Autolus Therapeutics, London, United Kingdom
| | | | - Eric Perlman
- Perlman Advisory Group LLC, Boynton Beach, Florida
| | | | - Ira Smalberg
- Saint John's Cancer Institute and Tower Imaging Medical Group, Sherman Oaks, California
| | | | - Gudrun Zahlmann
- Quantitative Imaging Biomarkers Alliance, Radiological Society of North America, Oak Brook, Illinois; and
| | - Ron Korn
- TGEN/City of Hope and Imaging Endpoints Core Lab, Scottsdale, Arizona
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14
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Clinical and prognostic role of 2-[ 18F]FDG PET/CT and sarcopenia in treatment-naïve patients with T-cell lymphoblastic lymphoma. Ann Hematol 2022; 101:2699-2709. [PMID: 36123452 DOI: 10.1007/s00277-022-04988-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/15/2022] [Indexed: 11/01/2022]
Abstract
T-cell lymphoblastic lymphoma (T-LBL) is a rare and highly aggressive non-Hodgkin lymphoma. This study aimed to explore the role of 2-[18F]FDG PET/CT, sarcopenia, clinical features, and treatment regimens in 49 treatment-naïve patients with T-LBL, and assess their predictive value in the prognosis. Sarcopenia was measured as skeletal muscle index (SMI) at L3 level from the CT component of PET/CT images. All 49 patients (35 males, 14 females; median age, 26 years [range, 3-66 years]) were enrolled in this study, including 36 adult patients and 13 pediatric patients. Lymph nodes, thymus, bone marrow, and pleura were the most common involved sites of T-LBL. The median SUVmax, MTV, and TLG of all lesions in these 49 patients were 12.4 (range, 4.2-40.5), 532.6 (17.4-3518.1), and 2112.2 (53.9-18,699.2), respectively. Eighteen out of 49 patients (36.7%) were diagnosed with sarcopenia. Sarcopenia patients had lower BMI and SUVmax of muscle at L3 level than non-sarcopenia patients (P < 0.05). Univariate Cox regression analysis indicated that higher MTV and TLG and intrathecal therapy (IT) were associated with longer progression-free survival (PFS) and overall survival (OS), while multivariate Cox regression analysis showed that TLG and IT were independent predictors for PFS, and only IT was an independent predictor for OS. In conclusion, low BMI and SUVmax of muscle at L3 level correlated with sarcopenia in T-LBL patients. Higher initial MTV and TLG and receiving IT were associated with better prognosis in T-LBL patients. TLG and IT, but not sarcopenia, were independent prognostic factors.
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15
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Gao F, Zhang T, Liu H, Li W, Liu X, Qiu L, Li L, Zhou S, Qian Z, Dong S, Zhao S, Wang X, Zhang H. Risk factors for POD24 in patients with previously untreated follicular lymphoma: a systematic review and meta-analysis. Ann Hematol 2022; 101:2383-2392. [PMID: 36029326 DOI: 10.1007/s00277-022-04914-8] [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: 03/22/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
Abstract
Progression of disease within 24 months (POD24) is strongly associated with a poor outcome in patients with follicular lymphoma (FL). Our study aimed to identify the potential risk factors for POD24 in patients with FL. Medline, EMBASE and the Cochrane Library were systematically searched from the earliest record to September 2020. Studies investigating the prognostic factors for POD24 in patients with newly diagnosed grade 1-3a FL were included. Among 10,014 pieces of literature, a total of 90 studies investigating 82 risk factors were included for qualitative analysis. Meta-analyses were performed in 31 studies with 11 factors. Results showed that elevated sIL-2R, β2m and LDH, total metabolic tumour volume > 510 cm3, vitamin D < 20 ng/mL, grade 3a and lymphoma-associated macrophages/high-power field ≥ 15 were significantly associated with an increased risk of POD24. No significant association was found between POD24 and the ALC/AMC ratio, sex, T effector signature or EZH2 genetic alteration. Additionally, minimal residual disease, Ki-67, PD-1 and TP53 were analysed narratively. Overall, this is the first study that comprehensively analysed the prognostic factors associated with POD24 in FL patients. We have confirmed the significance value of several common prognostic factors as well as others not commonly included in clinical study, helping to construct an integrated and more efficient model.
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Affiliation(s)
- Fenghua Gao
- Department of Lymphoma, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Tingting Zhang
- Department of Lymphoma, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Hengqi Liu
- Department of Lymphoma, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Wei Li
- Department of Lymphoma, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Xianming Liu
- Department of Lymphoma, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Lihua Qiu
- Department of Lymphoma, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Lanfang Li
- Department of Lymphoma, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Shiyong Zhou
- Department of Lymphoma, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Zhengzi Qian
- Department of Lymphoma, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Sitong Dong
- Systematic Review Solutions Ltd, The Ingenuity Centre, Nottingham, UK
| | - Sai Zhao
- Systematic Review Solutions Ltd, The Ingenuity Centre, Nottingham, UK
| | - Xianhuo Wang
- Department of Lymphoma, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China.
| | - Huilai Zhang
- Department of Lymphoma, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China.
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Mikhaeel NG, Heymans MW, Eertink JJ, de Vet HC, Boellaard R, Dührsen U, Ceriani L, Schmitz C, Wiegers SE, Hüttmann A, Lugtenburg PJ, Zucca E, Zwezerijnen GJ, Hoekstra OS, Zijlstra JM, Barrington SF. Proposed New Dynamic Prognostic Index for Diffuse Large B-Cell Lymphoma: International Metabolic Prognostic Index. J Clin Oncol 2022; 40:2352-2360. [PMID: 35357901 PMCID: PMC9287279 DOI: 10.1200/jco.21.02063] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/23/2022] [Accepted: 02/09/2022] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Baseline metabolic tumor volume (MTV) is a promising biomarker in diffuse large B-cell lymphoma (DLBCL). Our aims were to determine the best statistical relationship between MTV and survival and to compare MTV with the International Prognostic Index (IPI) and its individual components to derive the best prognostic model. METHODS PET scans and clinical data were included from five published studies in newly diagnosed diffuse large B-cell lymphoma. Transformations of MTV were compared with the primary end points of 3-year progression-free survival (PFS) and overall survival (OS) to derive the best relationship for further analyses. MTV was compared with IPI categories and individual components to derive the best model. Patients were grouped into three groups for survival analysis using Kaplan-Meier analysis; 10% at highest risk, 30% intermediate risk, and 60% lowest risk, corresponding with expected clinical outcome. Validation of the best model was performed using four studies as a test set and the fifth study for validation and repeated five times. RESULTS The best relationship for MTV and survival was a linear spline model with one knot located at the median MTV value of 307.9 cm3. MTV was a better predictor than IPI for PFS and OS. The best model combined MTV with age as continuous variables and individual stage as I-IV. The MTV-age-stage model performed better than IPI and was also better at defining a high-risk group (3-year PFS 46.3% v 58.0% and 3-year OS 51.5% v 66.4% for the new model and IPI, respectively). A regression formula was derived to estimate individual patient survival probabilities. CONCLUSION A new prognostic index is proposed using MTV, age, and stage, which outperforms IPI and enables individualized estimates of patient outcome.
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Affiliation(s)
- N. George Mikhaeel
- Department of Clinical Oncology, Guy's Cancer Centre and School of Cancer and Pharmaceutical Sciences, King's College London University, London, United Kingdom
| | - Martijn W. Heymans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Jakoba J. Eertink
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Henrica C.W. de Vet
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Ronald Boellaard
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Ulrich Dührsen
- Department of Hematology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Luca Ceriani
- Department of Oncology, IOSI—Oncology Institute of Southern Switzerland, Bellinzona; Università della Svizzera Italiana, Bellinzona, Switzerland
- SAKK—Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Christine Schmitz
- Department of Hematology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sanne E. Wiegers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Andreas Hüttmann
- Department of Hematology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Pieternella J. Lugtenburg
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Emanuele Zucca
- Department of Oncology, IOSI—Oncology Institute of Southern Switzerland, Bellinzona; Università della Svizzera Italiana, Bellinzona, Switzerland
- SAKK—Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Gerben J.C. Zwezerijnen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Otto S. Hoekstra
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Josée M. Zijlstra
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Sally F. Barrington
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's Health Partners, Kings College London, London, United Kingdom
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High baseline total lesion glycolysis predicts early progression of disease within 24 months in patients with high-tumor-burden follicular lymphoma. Int J Hematol 2022; 116:712-722. [PMID: 35857194 DOI: 10.1007/s12185-022-03418-5] [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: 03/02/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
Despite the introduction of rituximab-containing regimens, approximately 20% of patients with follicular lymphoma (FL) still experience progression of disease within 24 months (POD24) and have poor overall survival. Therefore, a more accurate risk assessment tool is required. We investigated the predictive value of two new volume-based parameters determined from baseline 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT), baseline total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG), in 45 patients with high-tumor-burden FL who underwent baseline PET/CT. We observed that high TMTV, high TLG, and poor initial treatment response (less than complete [metabolic] response [non-CR/CMR] at the end of induction therapy) independently predicted poor PFS. Notably, POD24-positive patients were more common in the high-TLG group than in the high-TMTV group, which suggests that TLG is a stronger predictor of outcomes than TMTV. Combining baseline TLG and initial treatment response showed that patients with both high TLG and non-CR/CMR experienced significantly poorer outcomes, with a 2 year PFS of 0% (hazard ratio 60.39, P = 0.000002). This combination had 56% sensitivity and 100% specificity for detecting patients who would experience POD24. Baseline TLG and initial treatment response can precisely identify patients at high risk of POD24.
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18F-Fluorodeoxyglucose PET/CT for Early Prediction of Outcomes in Patients with Advanced Lung Adenocarcinomas and EGFR Mutations Treated with First-Line EGFR-TKIs. Cancers (Basel) 2022; 14:cancers14061507. [PMID: 35326662 PMCID: PMC8945925 DOI: 10.3390/cancers14061507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Epithelial growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are the first-line therapy for patients with advanced-stage lung adenocarcinoma with EGFR mutations. However, 17–31% of these patients do not respond to therapy, making early evaluation of treatment response crucial. This prospective study investigates the value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for timely prediction of response and survival of these patients. We evaluated 30 patients with stage IIIB/IV lung adenocarcinomas and EGFR mutations, receiving first-line EGFR-TKI therapy. 18F-FDG PET/CT was performed before and two weeks after initiation of treatment. Positron Emission Tomography Response Criteria in Solid Tumors served as an independent predictor of non-progressive disease; baseline and change of metabolic tumor volume represented independent predictors of progression-free survival and overall survival, respectively. Therefore, 18F-FDG PET/CT is an early predictor of outcomes and individual prognosis of patients with stage IIIB/IV lung adenocarcinomas and EGFR mutations receiving first-line EGFR-TKI therapy. Abstract This study aims to investigate the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in early prediction of response and survival following epithelial growth factor receptor (EGFR)–tyrosine kinase inhibitor (TKI) therapy in patients with advanced lung adenocarcinomas and EGFR mutations. Thirty patients with stage IIIB/IV lung adenocarcinomas and EGFR mutations receiving first-line EGFR-TKIs were prospectively evaluated between November 2012 and May 2015. EGFR mutations were quantified by delta cycle threshold (dCt). 18F-FDG PET/CT was performed before and 2 weeks after treatment initiation. PET response was assessed based on PET Response Criteria in Solid Tumors (PERCIST). Baseline and percentage changes in the summed standardized uptake value, metabolic tumor volume (bsumMTV and ΔsumMTV, respectively), and total lesion glycolysis of ≤5 target lesions/patient were calculated. The association between parameters (clinical and PET) and non-progression disease after 3 months of treatment in CT based on the Response Evaluation Criteria in Solid Tumors Version 1.1 (nPD3mo), progression-free survival (PFS), and overall survival (OS) were tested. The median follow-up time was 19.6 months. The median PFS and OS were 12.0 and 25.3 months, respectively. The PERCIST criteria was an independent predictor of nPD3mo (p = 0.009), dCt (p = 0.014) and bsumMTV (p = 0.014) were independent predictors of PFS, and dCt (p = 0.014) and ΔsumMTV (p = 0.005) were independent predictors of OS. 18F-FDG PET/CT achieved early prediction of outcomes in patients with advanced lung adenocarcinomas and EGFR mutations receiving EGFR-TKIs.
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Zhang JH, Zhao J, Fan Y, Fu ZL, Zhang XC, Liu M, Zhao GY, Cen XN, Chen XQ, Ning J, Li X, Wang RF. Prognostic significance of pretreatment 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in patients with primary T cell lymphomas. Nucl Med Commun 2022; 43:186-192. [PMID: 34783717 DOI: 10.1097/mnm.0000000000001504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE T cell lymphomas are associated with an aggressive worse prognosis. This study is designed to assess T cell lymphomas using 18F-FDG PET/CT. METHODS Sixty-four patients with newly diagnosed T cell lymphomas underwent PET/computed tomography (PET/CT) scans, 47 cases who were fully followed up were retrospectively reviewed and analyzed. Overall survival (OS) and progression-free survival (PFS) were recorded for prognosis. We measured the maximum standardized uptake value (SUVmax) in all cases, analyzed the correlation between SUVmax and survival and other clinicopathologic parameters. Kaplan-Meier log-rank tests were then used to compare the survival of high and low PET/CT parameter groups, and multivariate Cox proportional hazards regression analysis was carried out to identify predictors of OS and PFS. RESULTS With a median follow-up of 26.5 (range 0.7-117.5) months, the 1-, 2- and 3-year OS were 75.6, 61.7 and 49.2%, and PFS were 49.3, 39.9 and 29.9%, respectively in 47 patients. Among them, 33 cases progressed with a median time of 9.5 (0.7-115.0) months, and 26 patients died with a median survival time of 26.5 (0.7-117.5) months. Multivariate analysis showed the following independent prognostic factors for OS: age >60 years (P = 0.002), SUVmax >9.7 (P = 0.009) and extranodal involvement of more than one site (P = 0.018). In addition, lactate dehydrogenase level (P = 0.003) and B symptoms (P = 0.018) were independent risk factors for PFS. CONCLUSION Pretherapy SUVmax may serve as an independent predictor of outcome in patients with newly diagnosed T cell lymphomas.
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Affiliation(s)
- Jian-Hua Zhang
- Department of Nuclear Medicine, Peking University First Hospital
| | - Jing Zhao
- Department of Nuclear Medicine, Peking University First Hospital
- Department of Nuclear Medicine, Peking University International Hospital
| | - Yan Fan
- Department of Nuclear Medicine, Peking University First Hospital
| | - Zhan-Li Fu
- Department of Nuclear Medicine, Peking University First Hospital
| | - Xu-Chu Zhang
- Department of Nuclear Medicine, Peking University First Hospital
| | - Meng Liu
- Department of Nuclear Medicine, Peking University First Hospital
| | - Guang-Yu Zhao
- Department of Nuclear Medicine, Peking University First Hospital
| | - Xi-Nan Cen
- Department of Hematology, Peking University First Hospital, Beijing, China
| | - Xue-Qi Chen
- Department of Nuclear Medicine, Peking University First Hospital
| | - Jing Ning
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Xiang Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Rong-Fu Wang
- Department of Nuclear Medicine, Peking University First Hospital
- Department of Nuclear Medicine, Peking University International Hospital
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El-Galaly TC, Villa D, Cheah CY, Gormsen LC. Pre-treatment total metabolic tumour volumes in lymphoma: Does quantity matter? Br J Haematol 2022; 197:139-155. [PMID: 35037240 DOI: 10.1111/bjh.18016] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/23/2021] [Accepted: 12/10/2021] [Indexed: 11/28/2022]
Abstract
Positron emission tomography/computed tomography (PET/CT) is used for the staging of lymphomas. Clinical information, such as Ann Arbor stage and number of involved sites, is derived from baseline staging and correlates with tumour volume. With modern imaging software, exact measures of total metabolic tumour volumes (tMTV) can be determined, in a semi- or fully-automated manner. Several technical factors, such as tumour segmentation and PET/CT technology influence tMTV and there is no consensus on a standardized uptake value (SUV) thresholding method, or how to include the volumes in the bone marrow and spleen. In diffuse large B-cell lymphoma, follicular lymphoma, peripheral T-cell lymphoma, and Hodgkin lymphoma, tMTV has been shown to predict progression-free survival and/or overall survival, after adjustments for clinical risk scores. However, most studies have used receiver operating curves to determine the optimal cut-off for tMTV and many studies did not include a training-validation approach, which led to the risk of overestimation of the independent prognostic value of tMTV. The identified cut-off values are heterogeneous, even when the same SUV thresholding method is used. Future studies should focus on testing tMTV in homogeneously-treated cohorts and seek to validate identified cut-off values externally so that a prognostic value can be documented, over and above currently used clinical surrogates for tumour volume.
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Affiliation(s)
- Tarec Christoffer El-Galaly
- Department of Haematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Diego Villa
- BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, British Columbia, Canada
| | - Chan Yoon Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Lars C Gormsen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
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21
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PET imaging of lymphomas. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00047-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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22
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Prognostic value of baseline metabolic tumour volume in advanced-stage Hodgkin's lymphoma. Sci Rep 2021; 11:23195. [PMID: 34853386 PMCID: PMC8636481 DOI: 10.1038/s41598-021-02734-w] [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: 08/11/2021] [Accepted: 11/17/2021] [Indexed: 12/22/2022] Open
Abstract
Our aim was to evaluate the prognostic value of initial total metabolic tumour volume (TMTV) in a population of patients with advanced-stage Hodgkin's lymphoma (HL). We retrospectively included 179 patients with stage IIb-III-IV Hodgkin's disease who received BEACOPP or ABVD as the first-line treatment. The initial TMTV was determined using a semi-automatic method for each patient. We analysed its prognostic value in terms of 5-year progression-free survival (PFS), overall survival, and positron emission tomography (PET) response after two courses of chemotherapy. Considering all the treatments and using a threshold of 217 cm3, TMTV was predictive of 5-year PFS and PET response after two courses of chemotherapy. In multivariable analysis involving TMTV, IPI score, and the first treatment received, TMTV remained a baseline prognostic factor for 5-year PFS. In the subgroup of patients treated with BEACOPP with a threshold of 331 cm3, TMTV was predictive of PET response, but not 5-year PFS (p = 0.087). The combined analysis of TMTV and PET response enabled the individualisation of a subgroup of patients (low TMTV and complete response on PET) with a very low risk of recurrence. Baseline TMTV appears to be a useful independent prognostic factor for predicting relapse in advanced-stage HL in ABVD subgroup, with a tendency of survival curves separation in BEACOPP subgroup.
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Total Lesion Glycolysis Improves Tumor Burden Evaluation and Risk Assessment at Diagnosis in Hodgkin Lymphoma. J Clin Med 2021; 10:jcm10194396. [PMID: 34640418 PMCID: PMC8509690 DOI: 10.3390/jcm10194396] [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: 08/19/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 11/20/2022] Open
Abstract
Hodgkin lymphoma (HL) is a hematological malignancy with an excellent prognosis. However, we still need to identify those patients that could experience failed standard frontline chemotherapy. Tumor burden evaluation and standard decisions are based on Ann Arbor (AA) staging, but this approach may be insufficient in predicting outcomes. We aim to study new ways to assess tumor burden through volume-based PET parameters to improve the risk assessment of HL patients. We retrospectively analyzed 101 patients with HL from two hospitals in the Balearic Islands between 2011 and 2018. Higher metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were significantly associated with a higher incidence of III-IV AA stages, B-symptoms, hypoalbuminemia, lymphopenia, and higher IPS. Standardized uptake value (SUVmax) was significantly related to AA stage and hypoalbuminemia. We found that TLG or the combination of SUVmax, TLG, and MTV significantly improved the risk assessment when compared to AA staging. We conclude that TLG is the best single PET/CT-related tumor-load parameter that significantly improves HL risk assessment when compared to AA staging. If confirmed in a larger and validated sample, this information could be used to modify standard frontline therapy and justifies the inclusion of TLG inside an HL prognostic score.
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Tari G, Lemonnier F, Morschhauser F. Epigenetic focus on angioimmunoblastic T-cell lymphoma: pathogenesis and treatment. Curr Opin Oncol 2021; 33:400-405. [PMID: 34230442 DOI: 10.1097/cco.0000000000000773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Angioimmunoblastic T-cell lymphoma (AITL) is a frequent peripheral T-cell lymphoma affecting elderly patients with a poor outcome when treated with conventional chemotherapy. Molecular studies revealed a homogenous mutational landscape gathering anomalies in genes regulating the DNA methylation and hydroxymethylation and anomalies in T-cell signalling. RECENT FINDINGS Recent studies indicate that AITL emerges from a TET2 and/or DNMT3A mutated clonal haematopoiesis. This clonal haematopoiesis bearing mutations altering DNA hydroxymethylation can explain the observed coexistence of AITL with myeloid neoplasms. In addition, AITL development requires AITL-specific mutations, such as the RHOAG17V mutations. Combination of TET2 and RHOAG17V alterations results in the development of AITL-like disease in mouse models. The impact of the presence of these mutations on patient outcome seems limited and new biological factor predicting treatment response and survival remains to be determined. At the therapeutic level, therapies targeting epigenetic changes, such as histone deacetylase inhibitors and the hypomethylating 5-azacytidine agent, could have efficacy in this disease and gave promising results. Recent progress in mouse model development should allow development of new treatments. SUMMARY Epigenetic changes are frequent in AITL and could be a promising target.
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Affiliation(s)
| | - François Lemonnier
- Univ Paris Est Créteil, INSERM, IMRB
- AP-HP, Groupe hospitalo-universitaire Chenevier Mondor, Service Unité Hémopathies Lymphoides, Créteil
| | - Franck Morschhauser
- University Lille, CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
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Meignan M, Cottereau AS, Specht L, Mikhaeel NG. Total tumor burden in lymphoma - an evolving strong prognostic parameter. Br J Radiol 2021; 94:20210448. [PMID: 34379496 DOI: 10.1259/bjr.20210448] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Total metabolic tumor volume (TMTV), a new parameter extracted from baseline FDG-PET/CT, has been recently proposed by several groups as a prognosticator in lymphomas before first-line treatment. TMTV, the sum of the metabolic volume of each lesion, is an index of the metabolically most active part of the tumor and highly correlates with the total tumor burden. TMTV measurement is obtained from PET images processed with different software and techniques, many being now freely available. In the various lymphoma subtypes where it has been measured, such as diffuse large B-cell lymphoma, Hodgkin lymphoma, Follicular Lymphoma, and Peripheral T-cell lymphoma, TMTV has been reported as a strong predictor of outcome (progression-free survival and overall survival) often outperforming the clinical scores, molecular predictors, and results of interim PET. Combined with these scores, TMTV improves the stratification of the populations into risk groups with different outcomes. TMTV cut-off separating the high-risk from the low-risk population impacts the outcome whatever the technique used for its measurement and an international harmonization is ongoing. TMTV is a unique and easy tool that could replace the surrogate of tumor burden included in the prognostic indexes used in lymphoma and help tailor therapy. Other parameters extracted from the baseline PET may give an information on the dissemination of this total tumor volume such as the maximum distance between the lesions. Trials based on TMTV would probably demonstrate its predictive value.
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Affiliation(s)
- Michel Meignan
- LYSA Imaging, Henri Mondor University Hospitals, University Paris Est, Créteil, France
| | | | - Lena Specht
- Dept. of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - N George Mikhaeel
- Department of Clinical Oncology, Guy's & St Thomas' NHS Trust and School of Cancer and Pharmaceutical Sciences, King's College London University, London, United Kingdom
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26
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Juweid ME, Mueller M, Alhouri A, A-Risheq MZ, Mottaghy FM. Positron emission tomography/computed tomography in the management of Hodgkin and B-cell non-Hodgkin lymphoma: An update. Cancer 2021; 127:3727-3741. [PMID: 34286864 DOI: 10.1002/cncr.33772] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 01/20/2023]
Abstract
18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is now an integral part of lymphoma staging and management. Because of its greater accuracy compared with CT alone, PET/CT is currently routinely performed for staging and for response assessment at the end of treatment in the vast majority of FDG-avid lymphomas and is the cornerstone of response classification for these lymphomas according to the Lugano classification. Interim PET/CT, typically performed after 2 to 4 of 6 to 8 chemotherapy/chemoimmunotherapy cycles with or without radiation, is commonly performed for prognostication and potential treatment escalation or de-escalation early in the course of therapy, a concept known as response-adapted or risk-adapted treatment. Quantitative PET is an area of growing interest. Metrics, such as the standardized uptake value, changes (Δ) in the standardized uptake value, metabolic tumor volume, and total lesion glycolysis, are being investigated as more reproducible and potentially more accurate predictors of response and prognosis. Despite the progress made in standardizing the use of PET/CT in lymphoma, challenges remain, particularly with respect to its limited positive predictive value, emphasizing the need for more specific molecular probes. This review highlights the most relevant applications of PET/CT in Hodgkin and B-cell non-Hodgkin lymphoma, its strengths and limitations, as well as recent efforts at implementing PET/CT-based metrics as promising tools for precision medicine.
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Affiliation(s)
- Malik E Juweid
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Marguerite Mueller
- Department of Nuclear Medicine, University Hospital Rheinish-Westphalian Technical University, Aachen University, Aachen, Germany
| | - Abdullah Alhouri
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - M Ziad A-Risheq
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital Rheinish-Westphalian Technical University, Aachen University, Aachen, Germany.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
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Prognostic value of baseline total metabolic tumour volume of 18F-FDG PET/CT imaging in patients with angioimmunoblastic T-cell lymphoma. EJNMMI Res 2021; 11:64. [PMID: 34264417 PMCID: PMC8282837 DOI: 10.1186/s13550-021-00807-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/24/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose The aim of this study was to explore the prognostic value of baseline metabolic parameters of 18F-FDG PET/CT imaging in patients with angioimmunoblastic T-cell lymphoma (AITL). Materials and methods Fifty-six AITL patients (average age 64.0 ± 1.3 years) diagnosed pathologically from August 2009 to August 2019 were enrolled in this retrospective study. The total metabolic tumour volume (TMTV), total lesion glycolysis (TLG), maximum standardized uptake value (SUVmax), and correlated clinical characteristics were collected and analysed. TMTV was computed with the 41% SUVmax threshold method. The chi-square test or Fisher’s exact probability method was used to compare clinical characteristics. Kaplan–Meier curves were used to describe progression-free survival (PFS) and overall survival (OS). The log-rank test was used to analyse the difference within groups. The statistically significant factors in the univariate regression analysis were incorporated into the Cox risk proportional regression model for multivariate survival analysis. Results The TMTV cut-off value was 514.6 cm3 from the ROC curve analysis. Forty (71.4%) patients progressed and 31 (55.4%) patients died within a median follow-up time of 19.1 (interquartile range 7.8–34.6) months. The 1-year and 3-year PFS rates were 42.9% and 30.1%, and the 3-year and 5-year OS rates were 45.9% and 34.4%, respectively. Univariate survival analysis showed that high TMTV and TLG may be the factors contributing to poor PFS and OS. Multivariate analysis showed that TMTV and prognostic index for T-cell lymphoma (PIT) were independent parameters for PFS and OS in AITL patients. TMTV, combined with PIT, may have better risk stratification performance than TMTV alone. Conclusions Baseline TMTV and PIT were independent prognostic predictors in AITL patients. The combination of TMTV and PIT can facilitate prognostic stratification and contribute to personalized therapy.
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28
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Feng X, Wen X, Li L, Sun Z, Li X, Zhang L, Wu J, Fu X, Wang X, Yu H, Ma X, Zhang X, Xie X, Han X, Zhang M. Baseline Total Metabolic Tumor Volume and Total Lesion Glycolysis Measured on 18F-FDG PET-CT Predict Outcomes in T-Cell Lymphoblastic Lymphoma. Cancer Res Treat 2021; 53:837-846. [PMID: 33285054 PMCID: PMC8291183 DOI: 10.4143/crt.2020.123] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE There is no optimal prognostic model for T-cell lymphoblastic lymphoma (T-LBL). Here, we discussed the predictive value of total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) measured on 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) in T-LBL. MATERIALS AND METHODS Thirty-seven treatment naïve T-LBL patients with PET-CT scans were enrolled. TMTV was obtained using the 41% maximum standardized uptake value (SUVmax) threshold method, and TLG was measured as metabolic tumor volume multiplied by the mean SUV. Progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan-Meier curves and compared by the log-rank test. RESULTS The optimal cutoff values for SUVmax, TMTV, and TLG were 12.7, 302 cm3, and 890, respectively. A high SUVmax, TMTV, and TLG indicated a shorten PFS and OS. On multivariable analysis, TMTV ≥ 302 cm3, and central nervous system (CNS) involvement predicted inferior PFS, while high SUVmax, TLG and CNS involvement were associated with worse OS. Subsequently, we generated a risk model comprising high SUVmax, TMTV or TLG and CNS involvement, which stratified the population into three risk groups, which had significantly different median PFS of not reached, 14 months, and 7 months for low-risk group, mediate-risk group, and high-risk group, respectively (p < 0.001). Median OS were not reached, 27 months, and 13 months, respectively (p < 0.001). CONCLUSION Baseline SUVmax, TMTV, and TLG measured on PET-CT are strong predictors of worse outcome in T-LBL. A risk model integrating these three parameters with CNS involvement identifies patients at high risk of disease progression.
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Affiliation(s)
- Xiaoyan Feng
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou,
China
| | - Xin Wen
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou,
China
| | - Ling Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou,
China
| | - Zhenchang Sun
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou,
China
| | - Xin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou,
China
| | - Lei Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou,
China
| | - Jingjing Wu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou,
China
| | - Xiaorui Fu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou,
China
| | - Xinhua Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou,
China
| | - Hui Yu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou,
China
| | - Xinran Ma
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou,
China
| | - Xudong Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou,
China
| | - Xinli Xie
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou,
China
| | - Xingmin Han
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou,
China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou,
China
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Cottereau AS, Meignan M, Nioche C, Capobianco N, Clerc J, Chartier L, Vercellino L, Casasnovas O, Thieblemont C, Buvat I. Risk stratification in diffuse large B-cell lymphoma using lesion dissemination and metabolic tumor burden calculated from baseline PET/CT†. Ann Oncol 2021; 32:404-411. [DOI: 10.1016/j.annonc.2020.11.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/05/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022] Open
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30
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Malecek MK, Mehta-Shah N. Prognosis and risk stratification of peripheral T-cell lymphomas. Semin Hematol 2021; 58:70-77. [PMID: 33906724 DOI: 10.1053/j.seminhematol.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/22/2021] [Accepted: 02/01/2021] [Indexed: 12/31/2022]
Abstract
Peripheral T-cell lymphomas represent a rare heterogeneous group of non-Hodgkin lymphomas with generally worse outcomes with standard chemotherapy compared to B-cell lymphomas. Clinical risk prediction tools at baseline have been shown to be prognostic but generally do not impact clinical decision making. However, improving understanding of the prognostic implications of histology and its molecular underpinnings as well as strategies surrounding the use of CD30 as a predictive biomarker for brentuximab vedotin have led to better understanding of how to risk stratify patients. Baseline, interim, and end of treatment PET/CT as evaluated by the Lugano criteria as well as by baseline metabolic tumor volume have also been shown to be prognostic. The role of minimal residual disease tools such as cell free DNA and T-cell gene receptor sequencing remain active areas of investigation in hopes to develop predictive biomarkers in these rare diseases. This review focuses on strategies used to prognosticate in more common forms of peripheral T-cell lymphoma as well as in extranodal NK/T-cell lymphoma.
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Lemonnier F, Safar V, Beldi-Ferchiou A, Cottereau AS, Bachy E, Cartron G, Fataccioli V, Pelletier L, Robe C, Letourneau A, Missiaglia E, Fourati S, Moles-Moreau MP, Delmer A, Bouabdallah R, Voillat L, Becker S, Bossard C, Parrens M, Casasnovas O, Cacheux V, Régny C, Camus V, Delfau-Larue MH, Meignan M, de Leval L, Gaulard P, Haioun C. Integrative analysis of a phase 2 trial combining lenalidomide with CHOP in angioimmunoblastic T-cell lymphoma. Blood Adv 2021; 5:539-548. [PMID: 33496747 PMCID: PMC7839364 DOI: 10.1182/bloodadvances.2020003081] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023] Open
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a frequent T-cell lymphoma in the elderly population that has a poor prognosis when treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) therapy. Lenalidomide, which has been safely combined with CHOP to treat B-cell lymphoma, has shown efficacy as a single agent in AITL treatment. We performed a multicentric phase 2 trial combining 25 mg lenalidomide daily for 14 days per cycle with 8 cycles of CHOP21 in previously untreated AITL patients aged 60 to 80 years. The primary objective was the complete metabolic response (CMR) rate at the end of treatment. Seventy-eight of the 80 patients enrolled were included in the efficacy and safety analysis. CMR was achieved in 32 (41%; 95% confidence interval [CI], 30%-52.7%) patients, which was below the prespecified CMR rate of 55% defined as success in the study. The 2-year progression-free survival (PFS) was 42.1% (95% CI, 30.9%-52.8%), and the 2-year overall survival was 59.2% (95% CI, 47.3%-69.3%). The most common toxicities were hematologic and led to treatment discontinuation in 15% of patients. This large prospective and uniform series of AITL treatment data was used to perform an integrative analysis of clinical, pathologic, biologic, and molecular data. TET2, RHOA, DNMT3A, and IDH2 mutations were present in 78%, 54%, 32%, and 22% of patients, respectively. IDH2 mutations were associated with distinct pathologic and clinical features and DNMT3A was associated with shorter PFS. In conclusion, the combination of lenalidomide and CHOP did not improve the CMR in AITL patients. This trial clarified the clinical impact of recurrent mutations in AITL. This trial was registered at www.clincialtrials.gov as #NCT01553786.
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Affiliation(s)
- François Lemonnier
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Unité Hémopathies Lymphoïdes, Créteil, France
- Université Paris Est Créteil, INSERM, Institut Médical de Recherche Biomédicale, Créteil, France
| | - Violaine Safar
- Service d'Hématologie Clinique, Hospices Civils de Lyon, Pierre-Bénite, and Université Lyon 1, Lyon, France
| | - Asma Beldi-Ferchiou
- Université Paris Est Créteil, INSERM, Institut Médical de Recherche Biomédicale, Créteil, France
- Département d'Hématologie et d'Immunologie Biologique, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France
| | - Anne-Ségolène Cottereau
- Département de Médecine Nucléaire, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris, France
| | - Emmanuel Bachy
- Service d'Hématologie Clinique, Hospices Civils de Lyon, Pierre-Bénite, and Université Lyon 1, Lyon, France
| | - Guillaume Cartron
- Département d'Hématologie Clinique, Centre Hospitalo-Universitaire de Montpellier, Unité Mixte de Recherche-Centre National de Recherche Scientifique 5535, Université de Montpellier, Montpellier, France
| | - Virginie Fataccioli
- Université Paris Est Créteil, INSERM, Institut Médical de Recherche Biomédicale, Créteil, France
- Département de Pathologie, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Laura Pelletier
- Université Paris Est Créteil, INSERM, Institut Médical de Recherche Biomédicale, Créteil, France
| | - Cyrielle Robe
- Université Paris Est Créteil, INSERM, Institut Médical de Recherche Biomédicale, Créteil, France
- Département de Pathologie, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Audrey Letourneau
- Institut de Pathologie, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland
| | - Edoardo Missiaglia
- Institut de Pathologie, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland
| | - Slim Fourati
- Université Paris Est Créteil, INSERM, Institut Médical de Recherche Biomédicale, Créteil, France
- Service de Virologie, Département Prévention, Diagnostic et Traitement des Infections, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France
| | | | - Alain Delmer
- Service d'Hématologie, Centre Hospitalier Universitaire, Reims, France
| | - Reda Bouabdallah
- Service d'Hématologie, Institut Paoli-Calmette, Marseille, France
| | | | - Stéphanie Becker
- Service de Médecine Nucléaire, Centre de Lutte Contre le Cancer Becquerel, Rouen, France
| | - Céline Bossard
- Université de Nantes, Center Hospitalier Universitaire Nantes, Département de Pathologie, INSERM Centre de Recherche en Cancérologie et Immunologie Nantes Angers, Nantes, France
| | - Marie Parrens
- Département de Pathologie, Hôpital Haut-Lévêque, Pessac, INSERM U1053, Université de Bordeaux, Bordeaux, France
| | | | - Victoria Cacheux
- Service d'Hématologie, Centre Hospitalier Universitaire, Clermont Ferrand, France
| | - Caroline Régny
- Service d'Hématologie, Centre Hospitalier Universitaire, Grenoble, France
| | - Vincent Camus
- Département d'Hématologie, Centre Henri Becquerel, Rouen, France; and
| | - Marie-Hélène Delfau-Larue
- Université Paris Est Créteil, INSERM, Institut Médical de Recherche Biomédicale, Créteil, France
- Département d'Hématologie et d'Immunologie Biologique, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France
| | - Michel Meignan
- LYSA Image, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Laurence de Leval
- Institut de Pathologie, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland
| | - Philippe Gaulard
- Université Paris Est Créteil, INSERM, Institut Médical de Recherche Biomédicale, Créteil, France
- Département de Pathologie, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Corinne Haioun
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Unité Hémopathies Lymphoïdes, Créteil, France
- Université Paris Est Créteil, INSERM, Institut Médical de Recherche Biomédicale, Créteil, France
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Yamanaka S, Miyagawa M, Sugawara Y, Hasebe S, Fujii T, Takeuchi K, Tanaka K, Yakushijin Y. The prognostic significance of whole-body and spleen MTV (metabolic tumor volume) scanning for patients with diffuse large B cell lymphoma. Int J Clin Oncol 2020; 26:225-232. [PMID: 33097970 DOI: 10.1007/s10147-020-01807-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/28/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Positron Emission Tomography-Computed Tomography (PET-CT) has been changing diagnostic and therapeutic strategies for patients with cancers, and several PET-CT-related prognostic factors have been reported. We have focused on metabolic tumor volumes (MTVs) over the whole body and in specific organs using 18F-PET-CT imaging, and have compared clinical data to know the prognosis of patients with diffuse large B cell lymphoma (DLBCL). PATIENTS AND METHODS From January 2006 to December 2016, patients who were newly diagnosed for de novo DLBCL and who received 18F-FDG PET-CT scans for disease staging at Ehime University Hospital were reviewed. RESULTS A total of forty out of 108 patients with DLBCL were analyzed. The median and the average follow-up were 3.9 years and 3.6 years. Both MTV50 and MTV60 whole-body searching indicated effective prognostic values for patients with DLBCL statistically (P = 0.027). However, analysis of MTVs in the spleen and in bone marrow did not provide any prognostic value. Receiver operating characteristic (ROC) analysis indicated that the cutoff level 25.8 in MTV60 is the most effective prognostic value (P = 0.022) which predicts patient survival after treatment with R-CHOP chemotherapy. CONCLUSION MTV60 using whole-body scanning appears to be an effective indicator in DLBCL and indicates the patient prognosis.
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Affiliation(s)
| | - Masao Miyagawa
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Yoshifumi Sugawara
- Department of Diagnostic Radiology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, Japan
| | - Shinji Hasebe
- Cancer Center, Ehime University Hospital, Toon, Ehime, Japan
| | - Tomomi Fujii
- Cancer Center, Ehime University Hospital, Toon, Ehime, Japan.,Department of Clinical Oncology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kazuto Takeuchi
- Cancer Center, Ehime University Hospital, Toon, Ehime, Japan
| | - Keiko Tanaka
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.,Research Promotion Unit, Translation Research Center, Ehime University Hospital, Toon, Ehime, Japan
| | - Yoshihiro Yakushijin
- Cancer Center, Ehime University Hospital, Toon, Ehime, Japan. .,Department of Clinical Oncology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
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Terao T, Machida Y, Tsushima T, Miura D, Narita K, Kitadate A, Takeuchi M, Matsue K. Pre-treatment metabolic tumour volume and total lesion glycolysis are superior to conventional positron-emission tomography/computed tomography variables for outcome prediction in patients with newly diagnosed multiple myeloma in clinical practice. Br J Haematol 2020; 191:223-230. [PMID: 32253760 DOI: 10.1111/bjh.16633] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/10/2020] [Indexed: 12/31/2022]
Abstract
Metabolic tumour volume (MTV) and total lesion glycolysis (TLG) are positron-emission tomography/computed tomography (PET/CT) variables for predicting multiple myeloma's (MM) outcome. We retrospectively investigated and compared the predictive value of MTV, TLG and high-risk PET/CT variables in clinical practice in 185 patients with newly diagnosed symptomatic MM. High-risk PET/CT findings were defined as the presence of at least one of the following: more than three focal lesions, maximum standardised uptake value (SUVmax ) >4·2 and extramedullary disease. MTV was defined as the volume of myeloma lesions visualised on PET/CT with SUV ≥ 2·5. TLG was calculated as the sum of the product of the average SUV and MTV of all lesions. The mortality prediction optimal cut-off values for MTV and TLG were 56·4 cm3 and 166·4 g, respectively. High-burden MTV (≥56·4 cm3 ), TLG (≥166·4 g) and high-risk PET/CT findings differed significantly in progression-free survival (PFS) and overall survival (OS). High-burden MTV and TLG findings also predicted survival outcomes in young patients (age <75 years) and patients with high-risk chromosomal abnormalities. High-burden MTV and TLG independently predicted both worse PFS and OS. Pre-treatment MTV and TLG independently predicted survival outcomes in clinical practice and may be more useful than high-risk PET/CT variables.
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Affiliation(s)
- Toshiki Terao
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Kamogawa, Japan
| | - Youichi Machida
- Department of Radiology, Kameda Medical Centre, Kamogawa, Japan
| | - Takafumi Tsushima
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Kamogawa, Japan
| | - Daisuke Miura
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Kamogawa, Japan
| | - Kentaro Narita
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Kamogawa, Japan
| | - Akihiro Kitadate
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Kamogawa, Japan
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Masami Takeuchi
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Kamogawa, Japan
| | - Kosei Matsue
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Kamogawa, Japan
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Jiang C, Teng Y, Chen J, Wang Z, Zhou Z, Ding C, Xu J. Baseline total metabolic tumor volume combined with international peripheral T-cell lymphoma project may improve prognostic stratification for patients with peripheral T-cell lymphoma (PTCL). EJNMMI Res 2020; 10:110. [PMID: 32965554 PMCID: PMC7511502 DOI: 10.1186/s13550-020-00698-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/11/2020] [Indexed: 02/05/2023] Open
Abstract
Purpose The aim of this study was to explore the prognostic value of total metabolic tumor volume (TMTV) at baseline 18F-FDG PET/CT in patients diagnosed with peripheral T-cell lymphoma (PTCL). Materials and methods Eighty-four newly diagnosed PTCL patients who underwent baseline 18F-FDG PET/CT prior to treatment between March 2009 and January 2019 were enrolled in this retrospective study. The FDG-avid lesions in each patient were segmented using semiautomated software to calculate the maximum standardized uptake value (SUVmax), total metabolic tumor volume (TMTV), and total lesion glycolysis (TLG) values using the boundaries of voxels presenting with the 41% SUVmax threshold method. Progression-free survival (PFS) and overall survival (OS) were used as end points to evaluate patient prognosis. The log-rank test and Cox regression analyses were used to evaluate PFS and OS. Results ROC curve analysis indicated an ideal TMTV cut-off value of 228.8 cm3. During the 4–131 months (29.2 ± 28.5 months) follow-up period, high TMTV was significantly associated with worse PFS and OS. TMTV and the international peripheral T-cell lymphoma project score (IPTCLP) were independent predictors of PFS and OS with multivariate analysis. The combination of TMTV and the IPTCLP may provide significantly better risk substratification in PFS and OS of PTCL patients. Conclusions Both TMTV and IPTCLP are independent predictors of PTCL patient survival outcomes. Moreover, the combination of TMTV and IPTCLP improved patient risk stratification and may contribute to personalized therapeutic regimens.
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Affiliation(s)
- Chong Jiang
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yue Teng
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jieyu Chen
- Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhen Wang
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Zhengyang Zhou
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
| | - Chongyang Ding
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.
| | - Jingyan Xu
- Department of Hematology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
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35
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Schmitz C, Rekowski J, Müller SP, Farsijani N, Hertenstein B, Franzius C, von Verschuer U, La Rosée P, Freesmeyer M, Wilop S, Krohn T, Raghavachar A, Ganser A, Bengel FM, Prange-Krex G, Kroschinsky F, Kotzerke J, Giagounidis A, Dührsen U, Hüttmann A. Impact of complete surgical resection on outcome in aggressive non-Hodgkin lymphoma treated with immunochemotherapy. Cancer Med 2020; 9:8386-8396. [PMID: 32926763 PMCID: PMC7666729 DOI: 10.1002/cam4.3448] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022] Open
Abstract
Background Surgical resection is considered to be of purely diagnostic value in aggressive lymphoma. Evidence for an impact on outcome is scant and restricted to retrospective observations. Methods In the “Positron Emission Tomography‐guided Therapy of Aggressive non‐Hodgkin Lymphomas” (PETAL) trial, patients with a negative baseline positron emission tomography (PET) scan were documented in a prospective observational substudy. Baseline PET‐negative patients with the absence of lymph node enlargement on computed tomography and a negative bone marrow biopsy were considered to have undergone complete lymphoma resection. Results Eighty‐two of 1,041 patients (7.9%) had a negative baseline PET scan, and 67 were included in this analysis. All were treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), plus rituximab for CD20‐positive lymphomas. Among 52 patients with diffuse large B‐cell lymphoma (DLBCL), 48 had completely resected disease. Their outcome tended to be better than that of 115 baseline PET‐positive stage I DLBCL patients treated in the main part of the PETAL trial (2‐year progression‐free survival 92.7% [95% confidence interval 84.7‐100] versus 88.4% [82.5‐94.3], P = .056; 2‐year overall survival 92.7% [84.7‐100] versus 93.7% [89.2‐98.2], P = .176), but this was restricted to patients below the age of 60 years (2‐year progression‐free survival 100% versus 92.2% [84.8‐99.6], P = .031; 2‐year overall survival 100% versus 95.9% [90.2‐100], P = .075). In peripheral T‐cell lymphoma, eight of 11 patients had completely resected disease. In contrast to DLBCL, complete resection was not associated with improved outcome compared to the control. Conclusion Young patients with early stage DLBCL may benefit from complete lymphoma resection prior to immunochemotherapy.
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Affiliation(s)
- Christine Schmitz
- Klinik für Hämatologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Jan Rekowski
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Stefan P Müller
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Navid Farsijani
- Klinik für Hämatologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | | | - Christiane Franzius
- Zentrum für moderne Diagnostik (Zemodi), Zentrum für Nuklearmedizin und PET/CT, Bremen, Germany
| | | | - Paul La Rosée
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | | | - Stefan Wilop
- Klinik für Hämatologie, Onkologie, Hämostaseologie und Stammzelltransplantation, Universitätsklinikum Aachen, Aachen, Germany
| | - Thomas Krohn
- Klinik für Nuklearmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Aruna Raghavachar
- Medizinische Klinik 1, Helios Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Arnold Ganser
- Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany
| | - Frank M Bengel
- Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Frank Kroschinsky
- Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Jörg Kotzerke
- Klinik für Nuklearmedizin, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | | | - Ulrich Dührsen
- Klinik für Hämatologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Andreas Hüttmann
- Klinik für Hämatologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
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Kitadate A, Narita K, Fukumoto K, Terao T, Tsushima T, Kobayashi H, Abe Y, Miura D, Takeuchi M, Machida Y, Matsue K. Baseline total lesion glycolysis combined with interim positron emission tomography-computed tomography is a robust predictor of outcome in patients with peripheral T-cell lymphoma. Cancer Med 2020; 9:5509-5518. [PMID: 32558387 PMCID: PMC7402824 DOI: 10.1002/cam4.3226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Peripheral T-cell lymphoma (PTCL) represents a heterogeneous and rare subgroup of aggressive lymphomas that generally demonstrate poor clinical outcomes with conventional treatment. Since the prognosis of PTCL is heterogeneous, more accurate risk assessment, and risk-adapted treatment strategies are required. In this study, we examined whether interim positron emission tomography (iPET)-computed tomography (PET/CT) results can be combined with baseline volume-based metabolic assessments including total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) for risk stratification in PTCL. METHODS The data of 63 patients with nodal PTCL, who had analyzable baseline PET/CT and iPET, were retrospectively reviewed. We calculated the baseline TMTV and TLG values. All iPET responses were analyzed using the Deauville 5-point scale. RESULTS On univariate analysis, a prognostic index for PTCL (PIT) higher than 2 (hazard ratio [HR], 2.03; P = .026), high TMTV (>389 cm3 ; HR, 2.24; P = .01), high TLG (>875; HR, 3.77; P = .0005), and positive iPET (HR, 2.18; P = .009) were significantly associated with poorer progression-free survival (PFS). On multivariate analysis, only high TLG and positive iPET independently predicted both poorer overall survival (OS) and PFS. A model combining TLG and iPET showed that patients with low TLG and negative iPET had superior outcomes, with a 5-year PFS and OS of 72% and 90%, respectively. Conversely, both 5-year PFS and OS for those with high TLG and positive iPET were 0%. CONCLUSIONS In summary, TLG combined with iPET predicted survival in PTCL more accurately. This information may help in the development of risk-adapted treatment strategies for PTCL.
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Affiliation(s)
- Akihiro Kitadate
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Japan.,Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Kentaro Narita
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Kouta Fukumoto
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Japan.,Department of Hematology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Toshiki Terao
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Takafumi Tsushima
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Hiroki Kobayashi
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Yoshiaki Abe
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Japan.,Department of Hematology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Daisuke Miura
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Masami Takeuchi
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Youichi Machida
- Department of Radiology, Kameda Medical Center, Kamogawa, Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Japan
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Capobianco N, Meignan M, Cottereau AS, Vercellino L, Sibille L, Spottiswoode B, Zuehlsdorff S, Casasnovas O, Thieblemont C, Buvat I. Deep-Learning 18F-FDG Uptake Classification Enables Total Metabolic Tumor Volume Estimation in Diffuse Large B-Cell Lymphoma. J Nucl Med 2020; 62:30-36. [PMID: 32532925 PMCID: PMC8679589 DOI: 10.2967/jnumed.120.242412] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/09/2020] [Indexed: 11/23/2022] Open
Abstract
Total metabolic tumor volume (TMTV), calculated from 18F-FDG PET/CT baseline studies, is a prognostic factor in diffuse large B-cell lymphoma (DLBCL) whose measurement requires the segmentation of all malignant foci throughout the body. No consensus currently exists regarding the most accurate approach for such segmentation. Further, all methods still require extensive manual input from an experienced reader. We examined whether an artificial intelligence–based method could estimate TMTV with a comparable prognostic value to TMTV measured by experts. Methods: Baseline 18F-FDG PET/CT scans of 301 DLBCL patients from the REMARC trial (NCT01122472) were retrospectively analyzed using a prototype software (PET Assisted Reporting System [PARS]). An automated whole-body high-uptake segmentation algorithm identified all 3-dimensional regions of interest (ROIs) with increased tracer uptake. The resulting ROIs were processed using a convolutional neural network trained on an independent cohort and classified as nonsuspicious or suspicious uptake. The PARS-based TMTV (TMTVPARS) was estimated as the sum of the volumes of ROIs classified as suspicious uptake. The reference TMTV (TMTVREF) was measured by 2 experienced readers using independent semiautomatic software. The TMTVPARS was compared with the TMTVREF in terms of prognostic value for progression-free survival (PFS) and overall survival (OS). Results: TMTVPARS was significantly correlated with the TMTVREF (ρ = 0.76; P < 0.001). Using PARS, an average of 24 regions per subject with increased tracer uptake was identified, and an average of 20 regions per subject was correctly identified as nonsuspicious or suspicious, yielding 85% classification accuracy, 80% sensitivity, and 88% specificity, compared with the TMTVREF region. Both TMTV results were predictive of PFS (hazard ratio, 2.3 and 2.6 for TMTVPARS and TMTVREF, respectively; P < 0.001) and OS (hazard ratio, 2.8 and 3.7 for TMTVPARS and TMTVREF, respectively; P < 0.001). Conclusion: TMTVPARS was consistent with that obtained by experts and displayed a significant prognostic value for PFS and OS in DLBCL patients. Classification of high-uptake regions using deep learning for rapidly discarding physiologic uptake may considerably simplify TMTV estimation, reduce observer variability, and facilitate the use of TMTV as a predictive factor in DLBCL patients.
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Affiliation(s)
- Nicolò Capobianco
- Siemens Healthcare GmbH, Erlangen, Germany .,Technical University of Munich, Munich, Germany
| | - Michel Meignan
- Lysa Imaging, Henri Mondor University Hospitals, APHP, University Paris East, Créteil, France
| | | | | | | | | | | | | | | | - Irène Buvat
- Laboratoire d'Imagerie Translationnelle en Oncologie, INSERM, Institut Curie, Université Paris-Saclay, Orsay, France
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Effects of stem cell transplantation in patients with peripheral T-cell lymphoma not otherwise specified and angioimmunoblastic T-cell lymphoma. Int J Hematol 2020; 112:74-83. [PMID: 32297159 DOI: 10.1007/s12185-020-02879-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 12/24/2022]
Abstract
The effects of stem cell transplantation (SCT) in patients with peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) and angioimmunoblastic T-cell lymphoma (AITL) remain controversial. We analyzed the feasibility of SCT and risk factors associated with outcomes of PTCL-NOS and AITL patients to identify the potential clinical efficacy of SCT. We retrospectively analyzed the data of PTCL-NOS (n = 83) and AITL (n = 112) patients who received autologous (n = 10 and 16, respectively) or allogeneic (n = 12 and 4, respectively) SCT, or no SCT (n = 61 and 92, respectively) between 2008 and 2018. All PTCL-NOS and AITL diagnoses were reconfirmed by an experienced hematopathologist. Median age at PTCL-NOS and AITL diagnoses in the SCT group was younger than that in the no SCT group. Significant risk factors for lower overall survival were intermediate-high and high-risk international prognostic indexes in PTCL-NOS patients (P = 0.0052), and a > 2 modified prognostic index for T-cell lymphoma (P = 0.0079) and no SCT (P = 0.028) in AITL patients. Autologous or allogeneic SCT compared with no SCT in AITL patients resulted in 3-year overall survival of 68.6% and 100% vs. 57.2% (P = 0.018). Strategies should be developed to improve selection of PTCL-NOS and AITL patients suitable for SCT and/or additional novel therapies.
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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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Schmitz C, Rekowski J, Müller SP, Hertenstein B, Franzius C, Ganser A, Bengel FM, Kroschinsky F, Kotzerke J, La Rosée P, Freesmeyer M, Hoeffkes HG, Hertel A, Behringer D, Mesters R, Weckesser M, Mahlmann S, Haberkorn U, Martens U, Prange-Krex G, Brenner W, Giagounidis A, Moeller R, Runde V, Sandmann M, Hautzel H, Wilop S, Krohn T, Dürk H, Heike M, Alashkar F, Brinkmann M, Trenn G, Wacker D, Kreisel-Büstgens C, Bernhard H, Heil G, Larisch R, Kurch L, Jöckel KH, Hoelzer D, Klapper W, Boellaard R, Dührsen U, Hüttmann A. Baseline and interim PET-based outcome prediction in peripheral T-cell lymphoma: A subgroup analysis of the PETAL trial. Hematol Oncol 2020; 38:244-256. [PMID: 32067259 DOI: 10.1002/hon.2697] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 12/14/2022]
Abstract
The prospective randomized Positron Emission Tomography (PET)-Guided Therapy of Aggressive Non-Hodgkin Lymphomas (PETAL) trial was designed to test the ability of interim PET (iPET) to direct therapy. As reported previously, outcome remained unaffected by iPET-based treatment changes. In this subgroup analysis, we studied the prognostic value of baseline total metabolic tumor volume (TMTV) and iPET response in 76 patients with T-cell lymphoma. TMTV was measured using the 41% maximum standardized uptake value (SUV41max ) and SUV4 thresholding methods. Interim PET was performed after two treatment cycles and evaluated using the ΔSUVmax approach and the Deauville scale. Because of significant differences in outcome, patients with anaplastic lymphoma kinase (ALK)-positive lymphoma were analyzed separately from patients with ALK-negative lymphoma. In the latter, TMTV was statistically significantly correlated with progression-free survival, with thresholds best dichotomizing the population, of 232 cm3 using SUV41max and 460 cm3 using SUV4 . For iPET response, the respective thresholds were 46.9% SUVmax reduction and Deauville score 1-4 vs 5. The proportion of poor prognosis patients was 46% and 29% for TMTV by SUV41max and SUV4 , and 29% and 25% for iPET response by ΔSUVmax and Deauville, respectively. At diagnosis, the hazard ratio (95% confidence interval) for poor prognosis vs good prognosis patients according to TMTV was 2.291 (1.135-4.624) for SUV41max and 3.206 (1.524-6.743) for SUV4 . At iPET, it was 3.910 (1.891-8.087) for ΔSUVmax and 4.371 (2.079-9.187) for Deauville. On multivariable analysis, only TMTV and iPET response independently predicted survival. Patients with high baseline TMTV and poor iPET response (22% of the population) invariably progressed or died within the first year (hazard ratio, 9.031 [3.651-22.336]). Due to small numbers and events, PET did not predict survival in ALK-positive lymphoma. Baseline TMTV and iPET response are promising tools to select patients with ALK-negative T-cell lymphoma for early allogeneic transplantation or innovative therapies.
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Affiliation(s)
| | - Jan Rekowski
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universität Duisburg-Essen, Essen, Germany
| | - Stefan P Müller
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Essen, Germany
| | | | - Christiane Franzius
- Zentrum für moderne Diagnostik (Zemodi), Zentrum für Nuklearmedizin und PET/CT, Bremen, Germany
| | - Arnold Ganser
- Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany
| | - Frank M Bengel
- Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | - Frank Kroschinsky
- Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Jörg Kotzerke
- Klinik für Nuklearmedizin, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Paul La Rosée
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | | | | | - Andreas Hertel
- Klinik für Diagnostische und Therapeutische Nuklearmedizin, Klinikum Fulda, Fulda, Germany
| | - Dirk Behringer
- Klinik für Hämatologie, Onkologie und Palliativmedizin, Augusta-Kranken-Anstalt, Bochum, Germany
| | - Rolf Mesters
- Medizinische Klinik A, Universitätsklinikum Münster, Münster, Germany
| | - Matthias Weckesser
- Klinik für Nuklearmedizin, Universitätsklinikum Münster, Münster, Germany
| | - Stefan Mahlmann
- Klinik für Innere Medizin 1, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - Uwe Haberkorn
- Radiologische Klinik und Poliklinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Uwe Martens
- Klinik für Innere Medizin III: Hämatologie, Onkologie, Palliativmedizin, Klinikum am Gesundbrunnen, Heilbronn, Germany
| | | | - Winfried Brenner
- Klinik für Nuklearmedizin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Aristoteles Giagounidis
- Klinik für Onkologie, Hämatologie und Palliativmedizin, Marien Hospital, Düsseldorf, Germany
| | - Regina Moeller
- Hämatologisch-onkologische Gemeinschaftspraxis, Halle, Germany
| | - Volker Runde
- Klinik für Innere Medizin mit den Schwerpunkten Hämatologie, Onkologie und Palliativmedizin, Wilhelm-Anton-Hospital, Goch, Germany
| | - Matthias Sandmann
- Klinik für Innere Medizin III - Hämatologie und Onkologie, Palliativmedizin, Petrus-Krankenhaus, Wuppertal, Germany
| | - Hubertus Hautzel
- Klinik für Nuklearmedizin, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Stefan Wilop
- Klinik für Hämatologie, Onkologie, Hämostaseologie und Stammzelltransplantation, Universitätsklinikum Aachen, Aachen, Germany
| | - Thomas Krohn
- Klinik für Nuklearmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Heinz Dürk
- Klinik für Hämatologie, Onkologie und Palliativmedizin, Evangelisches Krankenhaus, Hamm, Germany
| | - Michael Heike
- Klinik für Gastroenterologie, Hämatologie und internistische Onkologie und Endokrinologie, Klinikum Dortmund, Germany
| | - Ferras Alashkar
- Klinik für Hämatologie, Universitätsklinikum Essen, Essen, Germany
| | - Marcus Brinkmann
- Zentrum für Klinische Studien Essen (ZKSE), Universität Duisburg-Essen, Essen, Germany
| | - Guido Trenn
- Klinik für Innere Medizin I, Knappschaftskrankenhaus, Bottrop, Germany
| | - Dietmar Wacker
- Medizinische Klinik III, Hämatologie, Onkologie und Palliativmedizin, Klinikum Vest, Recklinghausen, Germany
| | | | - Helga Bernhard
- Medizinische Klinik V, Klinikum Darmstadt, Darmstadt, Germany
| | - Gerhard Heil
- Klinik für Hämatologie und Onkologie, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - Rolf Larisch
- Klinik für Nuklearmedizin, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - Lars Kurch
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Karl-Heinz Jöckel
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universität Duisburg-Essen, Essen, Germany
| | | | - Wolfram Klapper
- Institut für Pathologie, Sektion für Hämatopathologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location VUMC, Amsterdam, the Netherlands
| | - Ulrich Dührsen
- Klinik für Hämatologie, Universitätsklinikum Essen, Essen, Germany
| | - Andreas Hüttmann
- Klinik für Hämatologie, Universitätsklinikum Essen, Essen, Germany
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Timmins MA, Wagner SD, Ahearne MJ. The new biology of PTCL-NOS and AITL: current status and future clinical impact. Br J Haematol 2020; 189:54-66. [PMID: 32064593 DOI: 10.1111/bjh.16428] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Peripheral T-cell lymphomas (PTCL) comprise a heterogeneous group of aggressive lymphoproliferative disorders almost all of which are associated with poor clinical outcomes. Angioimmunoblastic T-cell lymphoma (AITL) and some peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) have similarities to normal CD4+ T-cell subsets in their gene expression profiles. A cell of origin model is, therefore, emerging and is likely to be refined in the future. Follicular helper (Tfh) T cells are now established as the cell of origin of AITL and about 20% of PTCL-NOS. Sequencing studies have identified recurrent genetic alterations in epigenetic modifiers, T-cell receptor signalling pathway intermediates or RHOA, most commonly a specific mutation leading to RHOA G17V. While PTCL-NOS remains a diagnosis of exclusion, advances in genomics have identified subgroups expressing transcription factors TBX 21 (Th1-like origin) and GATA3 (Th2-like origin). These findings suggest new biomarkers and new therapeutic avenues including the hypomethylating agent azacytidine, or inhibitors of proximal T-cell receptor (TCR) signalling and potentially certain monoclonal antibodies. The advances over the past few years, therefore, prompt stratified medicine approaches to test biologically based treatments and determine the clinical utility of the new disease classifications.
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Affiliation(s)
- Matthew A Timmins
- Leicester Cancer Research Centre, Ernest and Helen Scott Haematology Research Institute, University of Leicester, Leicester, UK
| | - Simon D Wagner
- Leicester Cancer Research Centre, Ernest and Helen Scott Haematology Research Institute, University of Leicester, Leicester, UK
| | - Matthew J Ahearne
- Leicester Cancer Research Centre, Ernest and Helen Scott Haematology Research Institute, University of Leicester, Leicester, UK
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Baseline and interim functional imaging with PET effectively risk stratifies patients with peripheral T-cell lymphoma. Blood Adv 2020; 3:187-197. [PMID: 30670535 DOI: 10.1182/bloodadvances.2018024075] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 12/12/2018] [Indexed: 12/16/2022] Open
Abstract
The prognosis of peripheral T-cell lymphoma (PTCL) is heterogenous. Baseline or interim imaging characteristics may inform risk-adapted treatment paradigms. We identified 112 patients with PTCL who were consecutively treated with cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP)/CHOP-like regimens with the intent to consolidate with an autologous transplant. Baseline (n = 93) and interim (after 4 cycles, n = 99) positron emission tomography (PET) images were reevaluated, and we calculated baseline total metabolic tumor volume (TMTV). Interim PET (iPET) responses were graded visually by 5-point score (i5PS) and by percentage change of standardized uptake value. By univariate analysis, predictors of event-free survival (EFS) included Prognostic Index for Peripheral TCL (PIT) higher than 1 (hazard ratio [HR], 1.83; P = .021), International Prognostic Index (IPI) higher than 3 (HR, 2.01; P = .021), high TMTV (>125 cm3; HR, 3.92; P = .003), and positive iPET (HR, 3.57; P < .001). By multivariate analysis, high baseline TMTV predicted worse overall survival (OS; HR, 6.025; P = .022) and EFS (HR, 3.861; P = .005). Patients with i5PS of 1 to 3 had a longer median OS and EFS (104 months, 64 months) than those with i5PS of 4 to 5 (19 months, 11 months; P < .001). Four-year OS and EFS for patients with i5PS of 1 to 3 and PIT of 1 or less were 85% and 62%, respectively. However, 4-year OS and EFS for those with i5PS of 4 to 5 and PIT higher than 1 were both 0% (P < .001). In multivariate analysis, after controlling for IPI and PIT, i5PS was independently prognostic for EFS (HR, 3.400 95% confidence interval, 1.750-6.750; P < .001) and OS (HR, 10.243; 95% confidence interval, 4.052-25.891; P < .001). In conjunction with clinical parameters, iPET helps risk stratify patients with PTCL and could inform risk-adapted treatment strategies. Prospective studies are needed to confirm these findings.
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Dynamic risk assessment based on positron emission tomography scanning in diffuse large B-cell lymphoma: Post-hoc analysis from the PETAL trial. Eur J Cancer 2020; 124:25-36. [DOI: 10.1016/j.ejca.2019.09.027] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 01/07/2023]
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Xia J, Zhu HY, Liang JH, Ding CY, Wang L, Wu W, Cao L, Li TL, Li JY, Xu W. The prognostic role of 18F-FDG PET/CT baseline quantitative metabolic parameters in peripheral T-cell lymphoma. J Cancer 2019; 10:5805-5811. [PMID: 31737117 PMCID: PMC6843878 DOI: 10.7150/jca.30415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 08/20/2019] [Indexed: 12/22/2022] Open
Abstract
Objectives: The aim of this study is to investigate the prognostic significance of baseline maximum standard uptake value (SUVmax), whole body SUVmax (WBSUVmax), whole body metabolic tumor volume (WBMTV) and whole body total lesion glycolysis (WBTLG) in patients with peripheral T-cell lymphoma (PTCL). Methods: Eighty patients with PTCL who underwent pretreatment 18F-PET/CT were enrolled in this study. WBMTV and WBTLG were computed by using the margin threshold of SUV>3.0. WBSUVmax was obtained by summing of SUVmax of the whole-body SUVmax of 11 nodal and 10 extra-nodal lesions. Results: Median SUVmax was 13.8 (range, 4.6-35.5), median WBSUVmax was 24.6 (range, 4.6-153.4), median WBMTV was 149 cm3 (range, 4-4545 cm3) and median WBTLG was 1017 (range, 16.5-23739). Six patients with anaplastic large cell lymphoma, ALK positive were excluded in the following statistical analysis for their unique pathological types and good prognosis. The receiver operating curve (ROC) analysis showed that the optimal cut-off values of WBSUVmax, WBMTV and WBTLG with overall survival (OS) were 22.2, 169.5 cm3 and 746.1, respectively. Patients with high WBSUVmax, WBMTV and WBTLG had a poor prognosis. WBSUVmax, WBMTV and WBTLG were associated with international prognostic index (IPI) and prognostic index for T-cell lymphoma (PIT). In multivariate analysis, WBTLG and PIT were independent prognostic factors of both progression free survival (PFS) and OS. Conclusions: Our study shows that high WBTLG, WBMTV and WBSUVmax could predict a relatively poor prognosis, and has a highly significant association with PIT and IPI.WBTLG could be an independent predictive factor for survival outcomes in patients with PTCL.
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Affiliation(s)
- Jun Xia
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China.,Department of Hematology, Affiliated Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Hua-Yuan Zhu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China
| | - Jin-Hua Liang
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China
| | - Chong-Yang Ding
- Department of Nuclear Medicine, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Li Wang
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China
| | - Wei Wu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China
| | - Lei Cao
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China
| | - Tian-Lv Li
- Department of Nuclear Medicine, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Jian-Yong Li
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China
| | - Wei Xu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China
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Song J, Li Z, Chen P, Yu J, Wang F, Yang Z, Wang X. A 18FDG PET/CT-based volume parameter is a predictor of overall survival in patients with local advanced gastric cancer. Chin J Cancer Res 2019; 31:632-640. [PMID: 31564806 PMCID: PMC6736658 DOI: 10.21147/j.issn.1000-9604.2019.04.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective The present study investigated the prognosis value of preoperative fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with local advanced gastric cancer (LAGC). Methods In total, 144 patients [median age 63 (range: 48−80) years old] with LAGC underwent18F-FDG PET/CT prior to any treatment. The maximum standardized uptake values (SUVmax), mean standardized uptake values (SUVmean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of the primary lesion were measured on PET/CT and correlated with clinicopathological features and survival.
Results Significant differences in SUVmean, SUVmax, MTV and TLG were found according to Lauren’s classification, histologic grade and T category (P<0.05). During the 26.5-month follow-up, 51 (35.4%) patients died and 70 (48.6%) exhibited disease progression. The optimal thresholds of MTV and TLG were 15.1 cm3 and 47.3 cm3, respectively. The 3-year progression-free survival (PFS) and overall survival (OS) for patients with high TLG values were 30% and 38% compared to 38% and 47% for low TLG values, respectively (P<0.05). Univariate and multifactor analyses demonstrated that lymph node metastasis and T stage were independent prognostic factors for PFS; T stage, histologic grade and TLG were independent prognostic factors for OS (P<0.05). Molecular markers had no relationship with patient’s outcomes.
Conclusions Metabolic activity of primary gastric tumors from 18F-FDG PET/CT is a prognostic factor in patients with LAGC.
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Affiliation(s)
| | - Zhongwu Li
- Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China
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46
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The Optimal Use of Imaging in Radiation Therapy for Lymphoma: Guidelines from the International Lymphoma Radiation Oncology Group (ILROG). Int J Radiat Oncol Biol Phys 2019; 104:501-512. [DOI: 10.1016/j.ijrobp.2019.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 01/28/2019] [Accepted: 02/03/2019] [Indexed: 12/21/2022]
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47
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Metabolic tumor burden on baseline 18F-FDG PET/CT improves risk stratification in pediatric patients with mature B-cell lymphoma. Eur J Nucl Med Mol Imaging 2019; 46:1830-1839. [DOI: 10.1007/s00259-019-04363-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/25/2019] [Indexed: 01/21/2023]
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48
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Boughan KM, Caimi PF. Follicular Lymphoma: Diagnostic and Prognostic Considerations in Initial Treatment Approach. Curr Oncol Rep 2019; 21:63. [DOI: 10.1007/s11912-019-0808-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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49
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Barrington SF, Meignan M. Time to Prepare for Risk Adaptation in Lymphoma by Standardizing Measurement of Metabolic Tumor Burden. J Nucl Med 2019; 60:1096-1102. [PMID: 30954945 DOI: 10.2967/jnumed.119.227249] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 03/28/2019] [Indexed: 12/26/2022] Open
Abstract
Increased tumor burden is associated with inferior outcomes in many lymphoma subtypes. Surrogates of tumor burden that are easy to measure, such as the maximum tumor dimension of the bulkiest lesion on CT, have been used as prognostic indices for many years. Recently, total metabolic tumor volume (MTV) and tumor lesion glycolysis have emerged as promising and robust biomarkers of outcome in various lymphomas. The median MTV and the optimal cutoffs to separate patients into risk groups in a study population are, however, highly dependent on the population characteristics and the delineation method used to outline tumor on the PET image. This issue has precluded the use of MTV for risk stratification in trials and clinical practice. Standardization of the methodology is timely to allow the potential for risk adaptation to be explored in addition to response adaptation using PET. Meetings between representatives from research groups active in the field were held under the auspices of the PET International Lymphoma and Myeloma Workshop. A summary of those discussions, which included a review of the literature and a practical assessment of methods used for outlining, including various software options, is presented. Finally, a proposal is made to perform a technical validation of MTV measurement enabling benchmark reference ranges to be derived for published delineation approaches used for outlining with various software. This process would require collation of representative imaging data sets of the most common lymphoma subtypes; agreement on pragmatic criteria for the selection of lesions; generation of a range of MTVs, with consensus to be reached on final contours in a training set; and development of automated software solutions with a set of minimum functionalities to reduce measurement variability. Methods developed in the above training exercise could then be applied to another data set, with a final set of contours and values generated. This final data set would provide a benchmark against which end-users could test their ability to measure MTVs that are consistent with expected values. The data set and automated software solutions could be shared with manufacturers with the aim of including these in standard workflows to allow standardization of MTV measurement across the world.
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Affiliation(s)
- Sally F Barrington
- Guy's and St. Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom; and
| | - Michel Meignan
- Lymphoma Study Association-Imaging (LYSA-IM), Functional Imaging and Therapeutics Department, Henri Mondor University Hospitals, University Paris Est Créteil, Créteil, France
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Baseline PET features to predict prognosis in primary mediastinal B cell lymphoma: a comparative analysis of different methods for measuring baseline metabolic tumour volume. Eur J Nucl Med Mol Imaging 2019; 46:1334-1344. [DOI: 10.1007/s00259-019-04286-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/06/2019] [Indexed: 12/28/2022]
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