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Masel R, Roche ME, Martinez-Outschoorn U. Hodgkin Lymphoma: A disease shaped by the tumor micro- and macroenvironment. Best Pract Res Clin Haematol 2023; 36:101514. [PMID: 38092473 DOI: 10.1016/j.beha.2023.101514] [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: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 12/18/2023]
Abstract
The tumor microenvironment (TMicroE) and tumor macroenvironment (TMacroE) are defining features of classical Hodgkin lymphoma (cHL). They are of critical importance to clinicians since they explain the common signs and symptoms, allow us to classify these neoplasms, develop prognostic and predictive biomarkers, bioimaging and novel treatments. The TMicroE is defined by effects of cancer cells to their immediate surrounding and within the tumor. Effects of cancer cells at a distance or outside of the tumor define the TMacroE. Paraneoplastic syndromes are signs and symptoms due to effects of cancer at a distance or the TMacroE, which are not due to direct cancer cell infiltration. The most common paraneoplastic symptoms are B-symptoms, which manifest as fevers, chills, drenching night sweats, and/or weight loss. Less common paraneoplastic syndromes include those that affect the central nervous system, skin, kidney, and hematological autoimmune phenomena including hemophagocytic lymphohistiocytosis (HLH). Paraneoplastic signs such as leukocytosis, lymphopenia, anemia, and hypoalbuminemia are prognostic biomarkers. The neoplastic cells in cHL are the Hodgkin and Reed Sternberg (HRS) cells, which are preapoptotic germinal center B cells with a high mutational burden and almost universal genetic alterations at the 9p24.1 locus primarily through copy gain and amplification with strong activation of signaling via PD-L1, JAK-STAT, NFkB, and c-MYC. In the majority of cases of cHL over 95% of the tumor cells are non-neoplastic. In the TMicroE, HRS cells recruit and mold non-neoplastic cells vigorously via extracellular vesicles, chemokines, cytokines and growth factors such as CCL5, CCL17, IL6, and TGF-β to promote a feed-forward inflammatory loop, which drives cancer aggressiveness and anti-cancer immune evasion. Novel single cell profiling techniques provide critical information on the role in cHL of monocytes-macrophages, neutrophils, T helper, Tregs, cytotoxic CD8+ T cells, eosinophils, mast cells and fibroblasts. Here, we summarize the effects of EBV on the TMicroE and TMacroE. In addition, how the metabolism of the TMicroE of cHL affects bioimaging and contributes to cancer aggressiveness is reviewed. Finally, we discuss how the TMicroE is being leveraged for risk adapted treatment strategies based on bioimaging results and novel immune therapies. In sum, it is clear that we cannot effectively manage patients with cHL without understanding the TMicroE and TMacroE and its clinical importance is expected to continue to grow rapidly.
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Affiliation(s)
- Rebecca Masel
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University-Philadelphia, USA; Department of Medicine, Cardeza Foundation for Hematological Research, Thomas Jefferson University-Philadelphia, USA
| | - Megan E Roche
- Department of Medicine, Cardeza Foundation for Hematological Research, Thomas Jefferson University-Philadelphia, USA
| | - Ubaldo Martinez-Outschoorn
- Department of Medicine, Cardeza Foundation for Hematological Research, Thomas Jefferson University-Philadelphia, USA.
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2
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Zhang X, Jiang H, Wu S, Wang J, Zhou R, He X, Qian S, Zhao S, Zhang H, Civelek AC, Tian M. Positron Emission Tomography Molecular Imaging for Phenotyping and Management of Lymphoma. PHENOMICS (CHAM, SWITZERLAND) 2022; 2:102-118. [PMID: 36939797 PMCID: PMC9590515 DOI: 10.1007/s43657-021-00042-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
Positron emission tomography (PET) represents molecular imaging for non-invasive phenotyping of physiological and biochemical processes in various oncological diseases. PET imaging with 18F-fluorodeoxyglucose (18F-FDG) for glucose metabolism evaluation is the standard imaging modality for the clinical management of lymphoma. One of the 18F-FDG PET applications is the detection and pre-treatment staging of lymphoma, which is highly sensitive. 18F-FDG PET is also applied during treatment to evaluate the individual chemo-sensitivity and accordingly guide the response-adapted therapy. At the end of the therapy regiment, a negative PET scan is indicative of a good prognosis in patients with advanced Hodgkin's lymphoma and diffuse large B-cell lymphoma. Thus, adjuvant radiotherapy may be alleviated. Future PET studies using non-18F-FDG radiotracers, such as 68Ga-labeled pentixafor (a cyclic pentapeptide that enables sensitive and high-contrast imaging of C-X-C motif chemokine receptor 4), 68Ga-labeled fibroblast activation protein inhibitor (FAPI) that reflects the tumor microenvironment, and 89Zr-labeled atezolizumab that targets the programmed cell death-ligand 1 (PD-L1), may complement 18F-FDG and offer essential tools to decode lymphoma phenotypes further and identify the mechanisms of lymphoma therapy.
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Affiliation(s)
- Xiaohui Zhang
- grid.412465.0Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 Zhejiang China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, 310009 Zhejiang China
- grid.13402.340000 0004 1759 700XInstitute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, 310009 Zhejiang China
| | - Han Jiang
- grid.411176.40000 0004 1758 0478PET-CT Center, Fujian Medical University Union Hospital, Fuzhou, 350001 Fujian China
| | - Shuang Wu
- grid.412465.0Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 Zhejiang China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, 310009 Zhejiang China
- grid.13402.340000 0004 1759 700XInstitute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, 310009 Zhejiang China
| | - Jing Wang
- grid.412465.0Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 Zhejiang China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, 310009 Zhejiang China
- grid.13402.340000 0004 1759 700XInstitute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, 310009 Zhejiang China
| | - Rui Zhou
- grid.412465.0Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 Zhejiang China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, 310009 Zhejiang China
- grid.13402.340000 0004 1759 700XInstitute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, 310009 Zhejiang China
| | - Xuexin He
- grid.412465.0Department of Medical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 Zhejiang China
| | - Shufang Qian
- grid.412465.0Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 Zhejiang China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, 310009 Zhejiang China
- grid.13402.340000 0004 1759 700XInstitute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, 310009 Zhejiang China
| | - Shuilin Zhao
- grid.412465.0Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 Zhejiang China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, 310009 Zhejiang China
- grid.13402.340000 0004 1759 700XInstitute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, 310009 Zhejiang China
| | - Hong Zhang
- grid.412465.0Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 Zhejiang China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, 310009 Zhejiang China
- grid.13402.340000 0004 1759 700XInstitute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, 310009 Zhejiang China
- grid.13402.340000 0004 1759 700XKey Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, 310027 Zhejiang China
- grid.13402.340000 0004 1759 700XCollege of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027 Zhejiang China
| | - Ali Cahid Civelek
- grid.469474.c0000 0000 8617 4175Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, MD 21287 USA
| | - Mei Tian
- grid.8547.e0000 0001 0125 2443Human Phenome Institute, Fudan University, Shanghai, 201203 China
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Naguib MM, Botros SM, Louka AL, Hussein RS. Role of PET/CT in initial evaluation of lymphoma patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021; 52:291. [DOI: https:/doi.org/10.1186/s43055-021-00670-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/22/2021] [Indexed: 08/30/2023] Open
Abstract
Abstract
Background
Accurate radiologic assessment of treatment response in lymphoma patients is important to evaluate the effectiveness of treatment and consequently predict the relapse; the value of PET/CT for post-treatment prognosis prediction has been recently investigated. The aim of this study is to highlight the prognostic value of PET-CT metabolic volumetric parameters in the evaluation of lymphoma patients.
Results
Among the included 40 patients, post-treatment SUV, MTV, and TLG were significantly lower in a responsive group than the non-responsive group. % changes of all quantitative PET/CT parameters were significantly higher in the responsive group than the non-responsive group.
Conclusions
This study suggests that pre-treatment PET/CT quantitative measures (except baseline SUVmax) are not conclusive in the prediction of patient response to treatment; however, the ΔSUVmax, ΔMTV, and ΔTLG% from the baseline to the end of therapy could be used in predicting patient response to treatment, determining patient prognosis, and suggesting the relapse.
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Role of PET/CT in initial evaluation of lymphoma patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00670-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Accurate radiologic assessment of treatment response in lymphoma patients is important to evaluate the effectiveness of treatment and consequently predict the relapse; the value of PET/CT for post-treatment prognosis prediction has been recently investigated. The aim of this study is to highlight the prognostic value of PET-CT metabolic volumetric parameters in the evaluation of lymphoma patients.
Results
Among the included 40 patients, post-treatment SUV, MTV, and TLG were significantly lower in a responsive group than the non-responsive group. % changes of all quantitative PET/CT parameters were significantly higher in the responsive group than the non-responsive group.
Conclusions
This study suggests that pre-treatment PET/CT quantitative measures (except baseline SUVmax) are not conclusive in the prediction of patient response to treatment; however, the ΔSUVmax, ΔMTV, and ΔTLG% from the baseline to the end of therapy could be used in predicting patient response to treatment, determining patient prognosis, and suggesting the relapse.
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In-depth cell-free DNA sequencing reveals genomic landscape of Hodgkin’s lymphoma and facilitates ultrasensitive residual disease detection. MED 2021; 2:1171-1193.e11. [DOI: 10.1016/j.medj.2021.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/12/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022]
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Galvez-Carvajal L, Quero C, Casanova M, Díaz C, Chícharo JR, Espeso M, Medina Á, Ramos I, Alba E, Rueda A. Ability of final PET/CT to predict response to first-line treatment in real patients with classical Hodgkin lymphoma. Int J Hematol 2021; 115:54-60. [PMID: 34546542 DOI: 10.1007/s12185-021-03223-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 01/01/2023]
Abstract
Up to 25% of patients with classical Hodgkin lymphoma (cHL) and a negative interim PET/CT will progress. Unfortunately, there are few published studies on the predictive value of PET/CT performed after finishing treatment. The objective of our study was to assess the role of the final PET/CT (fPET/CT) in predicting progression in a retrospective series of patients treated in the last 10 years with a homogeneous protocol (ABVD + / - radiotherapy). We reviewed a cohort of 227 patients with newly diagnosed cHL. fPET/CT was performed on 212 patients (93%). In patients with a positive fPET, progression-free survival at 60 months was 17% (94% if fPET was negative, p = 0.000). The positive and negative predictive values for the fPET were 76% and 94%, respectively (Fisher's exact test, p = 0.000). In the subgroup of patients with advanced-stage cHL, progression-free survival at 60 months was 91% with negative fPET and 0% with positive fPET (p = 0.000). However, fPET was negative in 19 of the 29 patients with a positive interim PET/CT (only 2 showed progression). In conclusion, fPET is a useful tool to predict treatment failure in patients with newly diagnosed cHL, especially advanced-stage disease.
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Affiliation(s)
- Laura Galvez-Carvajal
- Medical Oncology Intercentre Unit, Regional and Virgen de La Victoria University Hospitals, IBIMA, Teatinos, s/n, C.P., 29010, Málaga, Spain
| | - Cristina Quero
- Medical Oncology Department, Costa del Sol Hospital, Málaga, Spain
| | - María Casanova
- Haematology Department, Costa del Sol Hospital, Málaga, Spain
| | - Carola Díaz
- Haematology Department, Regional University Hospital, Málaga, Spain
| | | | - Manuel Espeso
- Haematology Department, Regional University Hospital, Málaga, Spain
| | - Ángeles Medina
- Haematology Department, Costa del Sol Hospital, Málaga, Spain
| | - Inmaculada Ramos
- Medical Oncology Intercentre Unit, Regional and Virgen de La Victoria University Hospitals, IBIMA, Teatinos, s/n, C.P., 29010, Málaga, Spain
| | - Emilio Alba
- Medical Oncology Intercentre Unit, Regional and Virgen de La Victoria University Hospitals, IBIMA, Teatinos, s/n, C.P., 29010, Málaga, Spain
| | - Antonio Rueda
- Medical Oncology Intercentre Unit, Regional and Virgen de La Victoria University Hospitals, IBIMA, Teatinos, s/n, C.P., 29010, Málaga, Spain.
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Gaur S, Philipovskiy A, Onyedika U, Eiring AM, Dwivedi AK, Orazi A. Discordant PET Findings and a High Relapse Rate Characterize Hispanics With Hodgkin's Lymphoma Treated With ABVD. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:127-133. [PMID: 35399309 PMCID: PMC8962786 DOI: 10.21873/cdp.10017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/25/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Population-based studies on Hodgkin's lymphoma (HL) have shown reduced survival in Hispanics and non-Hispanic Blacks compared with non-Hispanic Whites. To better understand the factors contributing to this outcome discrepancy, we retrospectively reviewed the charts of patients with HL diagnosed and treated at a single institution located along the Texas-Mexico border. PATIENTS AND METHODS We performed a retrospective chart review of all patients with HL treated at our institution over an 8-year period (2011-2018). The International Prognostic Score was calculated for all patients and results of positron-emission tomography (PET) scans (interim and end of treatment) were also recorded. Variables analyzed included tumor-related findings (stage, subtype of HL), treatment history (chemotherapy regimen including number of cycles, dose intensity and radiation treatments) and neutrophil to lymphocyte ratio. Quantitative variables were described using median, interquartile range, minimum and maximum observations. Categorical variables were described using frequency and proportions. Kaplan-Meier curves were used to show relapse-free survival. RESULTS A total of 24 patients were treated in the time frame, of whom 23 were Hispanic. All were treated with doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) or an ABVD-like regimen. Dose intensity for chemotherapy exceeded 90%. After a median follow-up of 43 months, the relapse rate was 45.8%. Positive and negative predictive values for interim PET (0% and 50%) and end of therapy PET (80% and 58%) were suboptimal to allow for a PET-adapted therapeutic approach. CONCLUSION Hispanics have a high relapse rate following ABVD which is not fully explained by universally accepted prognostic factors. Performance of PET scan in predicting outcomes of HL needs to be further studied and optimized before adopting a PET-adapted treatment paradigm for underserved Hispanic populations.
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Affiliation(s)
- Sumit Gaur
- Department of Internal Medicine, Texas Tech University Health ScienceCenter- El Paso, Paul L. Foster School of Medicine, El Paso, TX, U.S.A
| | - Alexander Philipovskiy
- Department of Internal Medicine, Texas Tech University Health ScienceCenter- El Paso, Paul L. Foster School of Medicine, El Paso, TX, U.S.A
| | - Umeanaeto Onyedika
- Department of Internal Medicine, Texas Tech University Health ScienceCenter- El Paso, Paul L. Foster School of Medicine, El Paso, TX, U.S.A
| | - Anna M Eiring
- Center of Emphasis in Cancer, Department of Molecular and Translational Medicine,Texas Tech University Health Science Center, El Paso, TX, U.S.A
| | - Alok K Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular andTranslational Medicine, Texas Tech University Health Science Center, El Paso, TX, U.S.A
| | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Science Center, El Paso, TX, U.S.A
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8
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Drees EEE, Roemer MGM, Groenewegen NJ, Perez‐Boza J, van Eijndhoven MAJ, Prins LI, Verkuijlen SAWM, Tran X, Driessen J, Zwezerijnen GJC, Stathi P, Mol K, Karregat JJJP, Kalantidou A, Vallés‐Martí A, Molenaar TJ, Aparicio‐Puerta E, van Dijk E, Ylstra B, Groothuis‐Oudshoorn CGM, Hackenberg M, de Jong D, Zijlstra JM, Pegtel DM. Extracellular vesicle miRNA predict FDG-PET status in patients with classical Hodgkin Lymphoma. J Extracell Vesicles 2021; 10:e12121. [PMID: 34295456 PMCID: PMC8282992 DOI: 10.1002/jev2.12121] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/13/2022] Open
Abstract
Minimally-invasive tools to assess tumour presence and burden may improve clinical management. FDG-PET (metabolic) imaging is the current gold standard for interim response assessment in patients with classical Hodgkin Lymphoma (cHL), but this technique cannot be repeated frequently. Here we show that microRNAs (miRNA) associated with tumour-secreted extracellular vesicles (EVs) in the circulation of cHL patients may improve response assessment. Small RNA sequencing and qRT-PCR reveal that the relative abundance of cHL-expressed miRNAs, miR-127-3p, miR-155-5p, miR-21-5p, miR-24-3p and let-7a-5p is up to hundred-fold increased in plasma EVs of cHL patients pre-treatment when compared to complete metabolic responders (CMR). Notably, in partial responders (PR) or treatment-refractory cases (n = 10) the EV-miRNA levels remain elevated. In comparison, tumour specific copy number variations (CNV) were detected in cell-free DNA of 8 out of 10 newly diagnosed cHL patients but not in patients with PR. Combining EV-miR-127-3p and/or EV-let-7a-5p levels, with serum TARC (a validated protein cHL biomarker), increases the accuracy for predicting PET-status (n = 129) to an area under the curve of 0.93 (CI: 0.87-0.99), 93.5% sensitivity, 83.8/85.0% specificity and a negative predictive value of 96%. Thus the level of tumour-associated miRNAs in plasma EVs is predictive of metabolic tumour activity in cHL patients. Our findings suggest that plasma EV-miRNA are useful for detection of small residual lesions and may be applied as serial response prediction tool.
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Affiliation(s)
- Esther E. E. Drees
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Margaretha G. M. Roemer
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Nils J. Groenewegen
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
- ExBiome B.V.AmsterdamThe Netherlands
| | - Jennifer Perez‐Boza
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | - Leah I. Prins
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Sandra A. W. M. Verkuijlen
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Xuan‐Mai Tran
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Julia Driessen
- Department of HematologyAmsterdam UMCCancer Center Amsterdam, University of AmsterdamAmsterdamThe Netherlands
| | - G. J. C. Zwezerijnen
- Department of Radiology and Nuclear MedicineCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Phylicia Stathi
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Kevin Mol
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Joey J. J. P. Karregat
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Aikaterini Kalantidou
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Andrea Vallés‐Martí
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - T. J. Molenaar
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ernesto Aparicio‐Puerta
- Department of GeneticsComputational Epigenomics and BioinformaticsUniversity of GranadaGranadaSpain
| | - Erik van Dijk
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Bauke Ylstra
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | - Michael Hackenberg
- ExBiome B.V.AmsterdamThe Netherlands
- Department of GeneticsComputational Epigenomics and BioinformaticsUniversity of GranadaGranadaSpain
| | - Daphne de Jong
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Josée M. Zijlstra
- Department of HematologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - D. Michiel Pegtel
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
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Zanoni L, Mattana F, Calabrò D, Paccagnella A, Broccoli A, Nanni C, Fanti S. Overview and recent advances in PET/CT imaging in lymphoma and multiple myeloma. Eur J Radiol 2021; 141:109793. [PMID: 34148014 DOI: 10.1016/j.ejrad.2021.109793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/18/2021] [Accepted: 05/21/2021] [Indexed: 02/07/2023]
Abstract
Imaging in hematological diseases has evolved extensively over the past several decades. Positron emission tomography/computed tomography (PET/CT) with of 2-[18 F]-fluoro-2-deoxy-d-glucose ([18 F] FDG) is currently essential for accurate staging and for early and late therapy response assessment for all FDG-avid lymphoproliferative histologies. The widely adopted visual Deauville 5-point scale and Lugano Classification recommendations have recently standardized PET scans interpretation and improved lymphoma patient management. In addition [18 F] FDG-PET is routinely recommended for initial evaluation and treatment response assessment of Multiple Myeloma (MM) with significant contribution in risk-stratification and prognostication, although magnetic resonance imaging remains the Gold Standard for the assessment of bone marrow involvement. In this review, an overview of the role of [18 F] FDG-PET, in hematological malignancies is provided, particularly focusing on Hodgkin lymphoma (HL) and Diffuse Large B Cell Lymphoma (DLBCL), both in adult and pediatric populations, and MM, at each point of patient management. Potential alternative molecular imaging applications in this field, such as non-[18 F] FDG-tracers, whole body magnetic resonance imaging (WB-MRI), hybrid PET/MRI and emerging radiomics research are briefly presented.
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Affiliation(s)
- Lucia Zanoni
- IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Nuclear Medicine, via Massarenti 9, 40138, Bologna, Italy.
| | - Francesco Mattana
- Nuclear Medicine, DIMES, Alma Mater studiorum, Università di Bologna, Bologna, Italy.
| | - Diletta Calabrò
- Nuclear Medicine, DIMES, Alma Mater studiorum, Università di Bologna, Bologna, Italy.
| | - Andrea Paccagnella
- Nuclear Medicine, DIMES, Alma Mater studiorum, Università di Bologna, Bologna, Italy.
| | - Alessandro Broccoli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy.
| | - Cristina Nanni
- IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Nuclear Medicine, via Massarenti 9, 40138, Bologna, Italy.
| | - Stefano Fanti
- IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Nuclear Medicine, via Massarenti 9, 40138, Bologna, Italy; Nuclear Medicine, DIMES, Alma Mater studiorum, Università di Bologna, Bologna, Italy.
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10
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De Paepe KN, Van Keerberghen CA, Agazzi GM, De Keyzer F, Gheysens O, Bechter O, Wolter P, Dierickx D, Janssens A, Verhoef G, Oyen R, Koole M, Vandecaveye V. Quantitative Whole-Body Diffusion-weighted MRI after One Treatment Cycle for Aggressive Non-Hodgkin Lymphoma Is an Independent Prognostic Factor of Outcome. Radiol Imaging Cancer 2021; 3:e200061. [PMID: 33817648 DOI: 10.1148/rycan.2021200061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/12/2020] [Accepted: 01/22/2021] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the prognostic utility of apparent diffusion coefficient (ADC) changes at whole-body diffusion-weighted (WB-DW) MRI after one treatment cycle for aggressive non-Hodgkin lymphoma (NHL) compared with response assessment at interim and end-of-treatment fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT. Materials and Methods This was a secondary analysis of a prospective study (ClinicalTrials.gov identifier: NCT01231269) in which participants with aggressive NHL were recruited between March 2011 and April 2015 and underwent WB-DW MRI before and after one cycle of immunochemotherapy. Volunteers were recruited for test-retest WB-DW MRI (ClinicalTrials.gov identifier: NCT01231282) to assess ADC measurement repeatability. Response assessment was based on ADC change after one treatment cycle at WB-DW MRI and Deauville criteria at 18F-FDG PET/CT. To evaluate prognostic factors of disease-free survival (DFS), Kaplan-Meier survival analysis and univariable and multivariable Cox regression were performed; intraclass correlation coefficient (ICC) and mean difference with limits of agreement were calculated to determine inter- and intraobserver repeatability of ADC measurements. Results Forty-five patients (mean age, 58 years ± 17 [standard deviation]; 31 men) and nine volunteers (mean age, 22 years ± 3; seven men) were enrolled. Median DFS was 48 months (range, 2-48 months). Outcome prediction accuracy was 86.7% (39 of 45), 71.4% (30 of 42), and 73.8% (31 of 42) for WB-DW MRI and interim and end-of-treatment 18F-FDG PET/CT, respectively. WB-DW MRI (hazard ratio [HR], 17.8; P < .001) and interim (HR, 5; P = .008) and end-of-treatment (HR, 4.3; P = .017) 18F-FDG PET/CT were prognostic of DFS. After multivariable analysis, WB-DW MRI remained an independent predictor of outcome (HR, 26.8; P = .002). Intra- and interobserver agreement for ADC measurements were excellent (ICC = 0.85-0.99). Conclusion Quantitative WB-DW MRI after only one cycle of immunochemotherapy predicts DFS in aggressive NHL and is noninferior to routinely performed interim and end-of-treatment 18F-FDG PET/CT.Keywords: MR-Diffusion Weighted Imaging, Lymphoma, Oncology, Tumor Response, Whole-Body ImagingSupplemental material is available for this article.© RSNA, 2021.
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Affiliation(s)
- Katja N De Paepe
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Ciska-Anne Van Keerberghen
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Giorgio M Agazzi
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Frederik De Keyzer
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Olivier Gheysens
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Oliver Bechter
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Pascal Wolter
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Daan Dierickx
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Ann Janssens
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Gregor Verhoef
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Raymond Oyen
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Michel Koole
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
| | - Vincent Vandecaveye
- Departments of Radiology (K.N.D.P., F.D.K., R.O., V.V.), Nuclear Medicine (C.A.V.K., O.G., M.K.), Medical Oncology (O.B., P.W.), and Hematology (D.D., A.J., G.V.), University Hospitals Leuven, Belgium; and Department of Radiology, University Hospital of Brescia, Brescia, Italy (G.M.A.)
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11
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Momotow J, Borchmann S, Eichenauer DA, Engert A, Sasse S. Hodgkin Lymphoma-Review on Pathogenesis, Diagnosis, Current and Future Treatment Approaches for Adult Patients. J Clin Med 2021; 10:jcm10051125. [PMID: 33800409 PMCID: PMC7962816 DOI: 10.3390/jcm10051125] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 01/07/2023] Open
Abstract
Hodgkin lymphoma (HL) is a rare malignancy accounting for roughly 15% of all lymphomas and mostly affecting young patients. A second peak is seen in patients above 60 years of age. The history of HL treatment represents a remarkable success story in which HL has turned from an incurable disease to a neoplasm with an excellent prognosis. First-line treatment with stage-adapted treatment consisting of chemotherapy and/or radiotherapy results in cure rates of approximately 80%. Second-line treatment mostly consists of intensive salvage chemotherapy followed by high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT). Novel approaches such as antibody drug conjugates and immunomodulatory drugs have shown impressive results in clinical trials in refractory and relapsed HL and are now increasingly implemented in earlier treatment lines. This review gives a comprehensive overview on HL addressing epidemiology, pathophysiology and current treatment options as well as recent developments and perspectives.
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Affiliation(s)
- Jesko Momotow
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Medical Faculty and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (S.B.); (D.A.E.); (A.E.)
| | - Sven Borchmann
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Medical Faculty and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (S.B.); (D.A.E.); (A.E.)
| | - Dennis A. Eichenauer
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Medical Faculty and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (S.B.); (D.A.E.); (A.E.)
| | - Andreas Engert
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Medical Faculty and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (S.B.); (D.A.E.); (A.E.)
| | - Stephanie Sasse
- Department IV of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital Aachen, University of Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
- Correspondence:
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12
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Texte E, Lequesne J, Tilly H, Jardin F, Vera P, Stamatoullas A, Becker S. SUV max-based assessment of PET response shows a superior specificity to Deauville criteria for predicting recurrence in Hodgkin's lymphoma. Leuk Lymphoma 2020; 62:1088-1097. [PMID: 33289431 DOI: 10.1080/10428194.2020.1855341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
One of the limitations of 18FDG PET/CT for therapeutic evaluation in Hodgkin's Lymphoma is the relatively high rate of false positive uptake. SUVmax reduction (ΔSUVmax) and tumor/liver ratio (TLr) are promising tools for response assessment in lymphoma. We determined the optimal cutoff values for ΔSUVmax and TLr and compared them to Deauville score (DS) after two and four cycles chemotherapy (PET2 and PET4 respectively) and at the end of treatment PET (PETeot) on a cohort of 362 patients. TLr showed better diagnostic performances than DS for predicting 5-year progression-free survival (PFS), especially on early PET/CT assessments. Positive predictive values at PET2 for TLr, ΔSUVmax and DS were 51%, 34% and 31% respectively. On the multivariable analysis, significant predictive factors of PFS were TLr (at PET2, PET4 and PETeot) and ΔSUVmax (at PET4 and PETeot). DS was not significantly associated with PFS at any PET timing.
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Affiliation(s)
- Edgar Texte
- Nuclear Medicine Department, Henri Becquerel Cancer Center, Rouen, France.,QuantiF-LITIS (EA 4108-FR CNRS 3638), Faculty of Medicine, University of Rouen, Rouen, France
| | - Justine Lequesne
- Department of Biostatistics, Henri Becquerel Cancer Center, Rouen, France
| | - Hervé Tilly
- Hematology Department, Henri Becquerel Cancer Center, Rouen, France.,INSERM U1245, Henri Becquerel Cancer Center, Rouen, France
| | - Fabrice Jardin
- Hematology Department, Henri Becquerel Cancer Center, Rouen, France.,INSERM U1245, Henri Becquerel Cancer Center, Rouen, France
| | - Pierre Vera
- Nuclear Medicine Department, Henri Becquerel Cancer Center, Rouen, France.,QuantiF-LITIS (EA 4108-FR CNRS 3638), Faculty of Medicine, University of Rouen, Rouen, France
| | - Aspasia Stamatoullas
- Hematology Department, Henri Becquerel Cancer Center, Rouen, France.,INSERM U1245, Henri Becquerel Cancer Center, Rouen, France
| | - Stéphanie Becker
- Nuclear Medicine Department, Henri Becquerel Cancer Center, Rouen, France.,QuantiF-LITIS (EA 4108-FR CNRS 3638), Faculty of Medicine, University of Rouen, Rouen, France
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13
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Lang N, Crump M. PET-adapted approaches to primary therapy for advanced Hodgkin lymphoma. Ther Adv Hematol 2020; 11:2040620720914490. [PMID: 32537115 PMCID: PMC7268111 DOI: 10.1177/2040620720914490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/18/2020] [Indexed: 12/12/2022] Open
Abstract
Recent results of randomized phase III studies of FDG-PET-adapted therapy for advanced Hodgkin lymphoma (HL) have clearly demonstrated benefit to alteration of treatment according to interim response, in particular regarding reducing toxicity while maintaining efficacy. However, these studies have differences in design including initial chemotherapy regimen, PET response criteria, patient populations enrolled, and inclusion of radiation, and report different results regarding efficacy and toxicities, which makes cross-trial comparisons difficult. Practitioners are presented with deciding which of these approaches will provide the optimum outcome, balancing toxicity and efficacy, and for which patient with advanced-stage HL. This review summarizes the observations reported from these trials and provides context to help guide physicians and patients in treatment decisions for advanced HL.
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Affiliation(s)
- Noemie Lang
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Michael Crump
- Princess Margaret Cancer Centre, University of Toronto, 610 University Avenue, OPG 6-426, Toronto, ON, M5G 2M9, Canada
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14
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Aldin A, Umlauff L, Estcourt LJ, Collins G, Moons KG, Engert A, Kobe C, von Tresckow B, Haque M, Foroutan F, Kreuzberger N, Trivella M, Skoetz N. Interim PET-results for prognosis in adults with Hodgkin lymphoma: a systematic review and meta-analysis of prognostic factor studies. Cochrane Database Syst Rev 2020; 1:CD012643. [PMID: 31930780 PMCID: PMC6984446 DOI: 10.1002/14651858.cd012643.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Hodgkin lymphoma (HL) is one of the most common haematological malignancies in young adults and, with cure rates of 90%, has become curable for the majority of individuals. Positron emission tomography (PET) is an imaging tool used to monitor a tumour's metabolic activity, stage and progression. Interim PET during chemotherapy has been posited as a prognostic factor in individuals with HL to distinguish between those with a poor prognosis and those with a better prognosis. This distinction is important to inform decision-making on the clinical pathway of individuals with HL. OBJECTIVES To determine whether in previously untreated adults with HL receiving first-line therapy, interim PET scan results can distinguish between those with a poor prognosis and those with a better prognosis, and thereby predict survival outcomes in each group. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL and conference proceedings up until April 2019. We also searched one trial registry (ClinicalTrials.gov). SELECTION CRITERIA We included retrospective and prospective studies evaluating interim PET scans in a minimum of 10 individuals with HL (all stages) undergoing first-line therapy. Interim PET was defined as conducted during therapy (after one, two, three or four treatment cycles). The minimum follow-up period was at least 12 months. We excluded studies if the trial design allowed treatment modification based on the interim PET scan results. DATA COLLECTION AND ANALYSIS We developed a data extraction form according to the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). Two teams of two review authors independently screened the studies, extracted data on overall survival (OS), progression-free survival (PFS) and PET-associated adverse events (AEs), assessed risk of bias (per outcome) according to the Quality in Prognosis Studies (QUIPS) tool, and assessed the certainty of the evidence (GRADE). We contacted investigators to obtain missing information and data. MAIN RESULTS Our literature search yielded 11,277 results. In total, we included 23 studies (99 references) with 7335 newly-diagnosed individuals with classic HL (all stages). Participants in 16 studies underwent (interim) PET combined with computed tomography (PET-CT), compared to PET only in the remaining seven studies. The standard chemotherapy regimen included ABVD (16) studies, compared to BEACOPP or other regimens (seven studies). Most studies (N = 21) conducted interim PET scans after two cycles (PET2) of chemotherapy, although PET1, PET3 and PET4 were also reported in some studies. In the meta-analyses, we used PET2 data if available as we wanted to ensure homogeneity between studies. In most studies interim PET scan results were evaluated according to the Deauville 5-point scale (N = 12). Eight studies were not included in meta-analyses due to missing information and/or data; results were reported narratively. For the remaining studies, we pooled the unadjusted hazard ratio (HR). The timing of the outcome measurement was after two or three years (the median follow-up time ranged from 22 to 65 months) in the pooled studies. Eight studies explored the independent prognostic ability of interim PET by adjusting for other established prognostic factors (e.g. disease stage, B symptoms). We did not pool the results because the multivariable analyses adjusted for a different set of factors in each study. Overall survival Twelve (out of 23) studies reported OS. Six of these were assessed as low risk of bias in all of the first four domains of QUIPS (study participation, study attrition, prognostic factor measurement and outcome measurement). The other six studies were assessed as unclear, moderate or high risk of bias in at least one of these four domains. Four studies were assessed as low risk, and eight studies as high risk of bias for the domain other prognostic factors (covariates). Nine studies were assessed as low risk, and three studies as high risk of bias for the domain 'statistical analysis and reporting'. We pooled nine studies with 1802 participants. Participants with HL who have a negative interim PET scan result probably have a large advantage in OS compared to those with a positive interim PET scan result (unadjusted HR 5.09, 95% confidence interval (CI) 2.64 to 9.81, I² = 44%, moderate-certainty evidence). In absolute values, this means that 900 out of 1000 participants with a negative interim PET scan result will probably survive longer than three years compared to 585 (95% CI 356 to 757) out of 1000 participants with a positive result. Adjusted results from two studies also indicate an independent prognostic value of interim PET scan results (moderate-certainty evidence). Progression-free survival Twenty-one studies reported PFS. Eleven out of 21 were assessed as low risk of bias in the first four domains. The remaining were assessed as unclear, moderate or high risk of bias in at least one of the four domains. Eleven studies were assessed as low risk, and ten studies as high risk of bias for the domain other prognostic factors (covariates). Eight studies were assessed as high risk, thirteen as low risk of bias for statistical analysis and reporting. We pooled 14 studies with 2079 participants. Participants who have a negative interim PET scan result may have an advantage in PFS compared to those with a positive interim PET scan result, but the evidence is very uncertain (unadjusted HR 4.90, 95% CI 3.47 to 6.90, I² = 45%, very low-certainty evidence). This means that 850 out of 1000 participants with a negative interim PET scan result may be progression-free longer than three years compared to 451 (95% CI 326 to 569) out of 1000 participants with a positive result. Adjusted results (not pooled) from eight studies also indicate that there may be an independent prognostic value of interim PET scan results (low-certainty evidence). PET-associated adverse events No study measured PET-associated AEs. AUTHORS' CONCLUSIONS This review provides moderate-certainty evidence that interim PET scan results predict OS, and very low-certainty evidence that interim PET scan results predict progression-free survival in treated individuals with HL. This evidence is primarily based on unadjusted data. More studies are needed to test the adjusted prognostic ability of interim PET against established prognostic factors.
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Affiliation(s)
- Angela Aldin
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Kerpener Str. 62, Cologne, Germany, 50937
| | - Lisa Umlauff
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Kerpener Str. 62, Cologne, Germany, 50937
| | - Lise J Estcourt
- NHS Blood and Transplant, Haematology/Transfusion Medicine, Level 2, John Radcliffe Hospital, Headington, Oxford, UK, OX3 9BQ
| | - Gary Collins
- University of Oxford, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Windmill Road, Oxford, UK, OX3 7LD
| | - Karel Gm Moons
- University Medical Center Utrecht, Utrecht University, Julius Center for Health Sciences and Primary Care, PO Box 85500, Utrecht, Netherlands, 3508 GA
| | - Andreas Engert
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Kerpener Str. 62, Cologne, Germany, 50924
| | - Carsten Kobe
- Faculty of Medicine and University Hospital Cologne, Department for Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Bastian von Tresckow
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Kerpener Str. 62, Cologne, Germany, 50924
| | - Madhuri Haque
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Kerpener Str. 62, Cologne, Germany, 50937
| | - Farid Foroutan
- McMaster University, Department of Health Research Methods, Evidence, and Impact, 1280 Main St W, Hamilton, Ontario, Canada, L8S 4L8
| | - Nina Kreuzberger
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Kerpener Str. 62, Cologne, Germany, 50937
| | - Marialena Trivella
- University of Oxford, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Windmill Road, Oxford, UK, OX3 7LD
| | - Nicole Skoetz
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Cochrane Cancer, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Kerpener Str. 62, Cologne, Germany, 50937
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15
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Aldin A, Umlauff L, Estcourt LJ, Collins G, Moons KGM, Engert A, Kobe C, von Tresckow B, Haque M, Foroutan F, Kreuzberger N, Trivella M, Skoetz N. Interim PET-results for prognosis in adults with Hodgkin lymphoma: a systematic review and meta-analysis of prognostic factor studies. Cochrane Database Syst Rev 2019; 9:CD012643. [PMID: 31525824 PMCID: PMC6746624 DOI: 10.1002/14651858.cd012643.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hodgkin lymphoma (HL) is one of the most common haematological malignancies in young adults and, with cure rates of 90%, has become curable for the majority of individuals. Positron emission tomography (PET) is an imaging tool used to monitor a tumour's metabolic activity, stage and progression. Interim PET during chemotherapy has been posited as a prognostic factor in individuals with HL to distinguish between those with a poor prognosis and those with a better prognosis. This distinction is important to inform decision-making on the clinical pathway of individuals with HL. OBJECTIVES To determine whether in previously untreated adults with HL receiving first-line therapy, interim PET scan results can distinguish between those with a poor prognosis and those with a better prognosis, and thereby predict survival outcomes in each group. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL and conference proceedings up until April 2019. We also searched one trial registry (ClinicalTrials.gov). SELECTION CRITERIA We included retrospective and prospective studies evaluating interim PET scans in a minimum of 10 individuals with HL (all stages) undergoing first-line therapy. Interim PET was defined as conducted during therapy (after one, two, three or four treatment cycles). The minimum follow-up period was at least 12 months. We excluded studies if the trial design allowed treatment modification based on the interim PET scan results. DATA COLLECTION AND ANALYSIS We developed a data extraction form according to the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). Two teams of two review authors independently screened the studies, extracted data on overall survival (OS), progression-free survival (PFS) and PET-associated adverse events (AEs), assessed risk of bias (per outcome) according to the Quality in Prognosis Studies (QUIPS) tool, and assessed the certainty of the evidence (GRADE). We contacted investigators to obtain missing information and data. MAIN RESULTS Our literature search yielded 11,277 results. In total, we included 23 studies (99 references) with 7335 newly-diagnosed individuals with classic HL (all stages).Participants in 16 studies underwent (interim) PET combined with computed tomography (PET-CT), compared to PET only in the remaining seven studies. The standard chemotherapy regimen included ABVD (16) studies, compared to BEACOPP or other regimens (seven studies). Most studies (N = 21) conducted interim PET scans after two cycles (PET2) of chemotherapy, although PET1, PET3 and PET4 were also reported in some studies. In the meta-analyses, we used PET2 data if available as we wanted to ensure homogeneity between studies. In most studies interim PET scan results were evaluated according to the Deauville 5-point scale (N = 12).Eight studies were not included in meta-analyses due to missing information and/or data; results were reported narratively. For the remaining studies, we pooled the unadjusted hazard ratio (HR). The timing of the outcome measurement was after two or three years (the median follow-up time ranged from 22 to 65 months) in the pooled studies.Eight studies explored the independent prognostic ability of interim PET by adjusting for other established prognostic factors (e.g. disease stage, B symptoms). We did not pool the results because the multivariable analyses adjusted for a different set of factors in each study.Overall survivalTwelve (out of 23) studies reported OS. Six of these were assessed as low risk of bias in all of the first four domains of QUIPS (study participation, study attrition, prognostic factor measurement and outcome measurement). The other six studies were assessed as unclear, moderate or high risk of bias in at least one of these four domains. Nine studies were assessed as high risk, and three studies as moderate risk of bias for the domain study confounding. Eight studies were assessed as low risk, and four studies as high risk of bias for the domain statistical analysis and reporting.We pooled nine studies with 1802 participants. Participants with HL who have a negative interim PET scan result probably have a large advantage in OS compared to those with a positive interim PET scan result (unadjusted HR 5.09, 95% confidence interval (CI) 2.64 to 9.81, I² = 44%, moderate-certainty evidence). In absolute values, this means that 900 out of 1000 participants with a negative interim PET scan result will probably survive longer than three years compared to 585 (95% CI 356 to 757) out of 1000 participants with a positive result.Adjusted results from two studies also indicate an independent prognostic value of interim PET scan results (moderate-certainty evidence).Progression-free survival Twenty-one studies reported PFS. Eleven out of 21 were assessed as low risk of bias in the first four domains. The remaining were assessed as unclear, moderate or high risk of bias in at least one of the four domains. Eleven studies were assessed as high risk, nine studies as moderate risk and one study as low risk of bias for study confounding. Eight studies were assessed as high risk, three as moderate risk and nine as low risk of bias for statistical analysis and reporting.We pooled 14 studies with 2079 participants. Participants who have a negative interim PET scan result may have an advantage in PFS compared to those with a positive interim PET scan result, but the evidence is very uncertain (unadjusted HR 4.90, 95% CI 3.47 to 6.90, I² = 45%, very low-certainty evidence). This means that 850 out of 1000 participants with a negative interim PET scan result may be progression-free longer than three years compared to 451 (95% CI 326 to 569) out of 1000 participants with a positive result.Adjusted results (not pooled) from eight studies also indicate that there may be an independent prognostic value of interim PET scan results (low-certainty evidence).PET-associated adverse eventsNo study measured PET-associated AEs. AUTHORS' CONCLUSIONS This review provides moderate-certainty evidence that interim PET scan results predict OS, and very low-certainty evidence that interim PET scan results predict progression-free survival in treated individuals with HL. This evidence is primarily based on unadjusted data. More studies are needed to test the adjusted prognostic ability of interim PET against established prognostic factors.
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Affiliation(s)
- Angela Aldin
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Haematological MalignanciesUniversity of CologneKerpener Str. 62CologneGermany50937
| | - Lisa Umlauff
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Haematological MalignanciesUniversity of CologneKerpener Str. 62CologneGermany50937
| | - Lise J Estcourt
- NHS Blood and TransplantHaematology/Transfusion MedicineLevel 2, John Radcliffe HospitalHeadingtonOxfordUKOX3 9BQ
| | - Gary Collins
- University of OxfordCentre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill RoadOxfordUKOX3 7LD
| | - Karel GM Moons
- University Medical Center Utrecht, Utrecht UniversityJulius Center for Health Sciences and Primary CarePO Box 85500UtrechtNetherlands3508 GA
| | - Andreas Engert
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne DuesseldorfUniversity of CologneKerpener Str. 62CologneGermany50924
| | - Carsten Kobe
- Faculty of Medicine and University Hospital Cologne, Department for Nuclear MedicineUniversity of CologneCologneGermany
| | - Bastian von Tresckow
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne DuesseldorfUniversity of CologneKerpener Str. 62CologneGermany50924
| | - Madhuri Haque
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Haematological MalignanciesUniversity of CologneKerpener Str. 62CologneGermany50937
| | - Farid Foroutan
- McMaster UniversityDepartment of Health Research Methods, Evidence, and Impact1280 Main St WHamiltonCanadaL8S 4L8
| | - Nina Kreuzberger
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Haematological MalignanciesUniversity of CologneKerpener Str. 62CologneGermany50937
| | - Marialena Trivella
- University of OxfordCentre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill RoadOxfordUKOX3 7LD
| | - Nicole Skoetz
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane CancerUniversity of CologneKerpener Str. 62CologneGermany50937
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Guo B, Tan X, Ke Q, Cen H. Prognostic value of baseline metabolic tumor volume and total lesion glycolysis in patients with lymphoma: A meta-analysis. PLoS One 2019; 14:e0210224. [PMID: 30625203 PMCID: PMC6326501 DOI: 10.1371/journal.pone.0210224] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/17/2018] [Indexed: 01/11/2023] Open
Abstract
Whether baseline metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) measured by FDG-PET/CT affected prognosis of patients with lymphoma was controversial. We searched PubMed, EMBASE and Cochrane to identify studies assessing the effect of baseline TMTV and TLG on the survival of lymphoma patients. Pooled hazard ratios (HR) for overall survival (OS) and progression-free survival (PFS) were calculated, along with 95% confidence intervals (CI). Twenty-seven eligible studies including 2,729 patients were analysed. Patients with high baseline TMTV showed a worse prognosis with an HR of 3.05 (95% CI 2.55–3.64, p<0.00001) for PFS and an HR of 3.07 (95% CI 2.47–3.82, p<0.00001) for OS. Patients with high baseline TLG also showed a worse prognosis with an HR of 3.44 (95% CI 2.37–5.01, p<0.00001) for PFS and an HR of 3.08 (95% CI 1.84–5.16, p<0.00001) for OS. A high baseline TMTV was significantly associated with worse survival in DLBCL patients treated with R-CHOP (OS, pooled HR = 3.52; PFS, pooled HR = 2.93). A high baseline TLG was significantly associated with worse survival in DLBCL patients treated with R-CHOP (OS, pooled HR = 3.06; PFS, pooled HR = 2.93). The negative effect of high baseline TMTV on PFS was demonstrated in HL (pooled HR = 3.89). A high baseline TMTV was significantly associated with worse survival in ENKL patients (OS, pooled HR = 2.24; PFS, pooled HR = 3.25). A high baseline TLG was significantly associated with worse survival in ENKL patients (OS, pooled HR = 2.58; PFS, pooled HR = 2.99). High baseline TMTV or TLG predict significantly worse PFS and OS in patients with lymphoma. Future studies are warranted to explore whether TMTV or TLG could be integrated into various prognostic models for clinical decision making.
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Affiliation(s)
- Baoping Guo
- Department of Chemotherapy, Guangxi Cancer Hospital and of Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, People’s Republic of China
| | - Xiaohong Tan
- Department of Chemotherapy, Guangxi Cancer Hospital and of Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, People’s Republic of China
| | - Qing Ke
- Department of Chemotherapy, Guangxi Cancer Hospital and of Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, People’s Republic of China
| | - Hong Cen
- Department of Chemotherapy, Guangxi Cancer Hospital and of Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, People’s Republic of China
- * E-mail:
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Amitai I, Gurion R, Vidal L, Dann EJ, Raanani P, Gafter-Gvili A. PET-adapted therapy for advanced Hodgkin lymphoma - systematic review. Acta Oncol 2018; 57:765-772. [PMID: 29345517 DOI: 10.1080/0284186x.2018.1426877] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Positron emission tomography-computed tomography (PET-CT) performed after two chemotherapy cycles (PET-2) has become an accepted prognostic tool in Hodgkin lymphoma (HL). We evaluated the effect of PET-adapted strategy on outcome in advanced stage HL. METHODS In August 2017, we searched electronic databases, conference proceedings and ongoing trials. We included all studies in which treatment modification for advanced HL was performed based on the results of the interim PET scan. The primary analysis included randomized controlled trials (RCTs). Outcomes were progression-free survival (PFS) and overall survival (OS). RESULTS We identified 13 studies (4 RCTs, 7 phase II and 2 retrospective studies), conducted between 1999 and 2014, including 6856 patients. Of the four RCTS: one used therapy escalation, one did de-escalation and two trials performed both. Outcomes were assessed at different time point between 2 and 5 years. Three RCTs for de-escalating therapy, obtained similar outcomes despite reducing therapy, with a 2-year PFS of 88-92% (6 escalated BEACOPP (EB) vs. 4 ABVD cycles), a 5-year PFS of 91-92% (6/8 EB vs. 4 EB cycles) and a 5-year PFS of 80-82% (6 ABVD vs. omitting bleomycin after two successful ABVD cycles). Two RCTs implemented escalation. The randomization was between adding rituximab or not. In both trials, it did not affect outcome, with a 4-year PFS of 68-69% (addition of rituximab to BEACOPP after 2 ABVD cycles) and 5-year PFS of 88-90% (addition of rituximab to EB after 2 EB cycles). Performing true randomization between PET-adapted and a standard ABVD control arm was not feasible, given historical data. CONCLUSIONS This systematic review of PET-adapted therapy, mainly based on RCTs, suggests that a change to the treatment paradigm is appropriate in advanced HL.
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Affiliation(s)
- Irina Amitai
- Institute of Hematology, Davidoff Cancer Center, Petah-Tikva, Israel
- Sackler School of Medicine, Tel-Aviv, Israel
| | - Ronit Gurion
- Institute of Hematology, Davidoff Cancer Center, Petah-Tikva, Israel
- Sackler School of Medicine, Tel-Aviv, Israel
| | - Liat Vidal
- Institute of Hematology, Davidoff Cancer Center, Petah-Tikva, Israel
- Sackler School of Medicine, Tel-Aviv, Israel
| | - Eldad J. Dann
- Department of Hematology, Rambam Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine Technion, Israel Technical Institute, Haifa, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Petah-Tikva, Israel
- Sackler School of Medicine, Tel-Aviv, Israel
| | - Anat Gafter-Gvili
- Institute of Hematology, Davidoff Cancer Center, Petah-Tikva, Israel
- Sackler School of Medicine, Tel-Aviv, Israel
- Internal Medicine A, Rabin Medical Center, Petah-Tikva, Israel
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18
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Delgado-Bolton R, Esposito G, Colletti PM, Jadvar H. Reply: Staging, Restaging, and Treatment Response Assessment in Lymphomas: What We Should Know. J Nucl Med 2018; 59:715-716. [DOI: 10.2967/jnumed.117.206946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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19
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Circulating tumor DNA reveals genetics, clonal evolution, and residual disease in classical Hodgkin lymphoma. Blood 2018; 131:2413-2425. [PMID: 29449275 DOI: 10.1182/blood-2017-11-812073] [Citation(s) in RCA: 192] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/11/2018] [Indexed: 01/15/2023] Open
Abstract
The rarity of neoplastic cells in the biopsy imposes major technical hurdles that have so far limited genomic studies in classical Hodgkin lymphoma (cHL). By using a highly sensitive and robust deep next-generation sequencing approach for circulating tumor DNA (ctDNA), we aimed to identify the genetics of cHL in different clinical phases, as well as its modifications on treatment. The analysis was based on specimens collected from 80 newly diagnosed and 32 refractory patients with cHL, including longitudinal samples collected under ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) chemotherapy and longitudinal samples from relapsing patients treated with chemotherapy and immunotherapy. ctDNA mirrored Hodgkin and Reed-Sternberg cell genetics, thus establishing ctDNA as an easily accessible source of tumor DNA for cHL genotyping. By identifying STAT6 as the most frequently mutated gene in ∼40% of cases, we refined the current knowledge of cHL genetics. Longitudinal ctDNA profiling identified treatment-dependent patterns of clonal evolution in patients relapsing after chemotherapy and patients maintained in partial remission under immunotherapy. By measuring ctDNA changes during therapy, we propose ctDNA as a radiation-free tool to track residual disease that may integrate positron emission tomography imaging for the early identification of chemorefractory patients with cHL. Collectively, our results provide the proof of concept that ctDNA may serve as a novel precision medicine biomarker in cHL.
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20
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Adams HJA, Kwee TC. Prevention of large-scale implementation of unnecessary and expensive predictive tests in Hodgkin's lymphoma. LANCET HAEMATOLOGY 2017; 4:e63-e64. [PMID: 28159190 DOI: 10.1016/s2352-3026(16)30190-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 11/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht 3584, The Netherlands.
| | - Thomas C Kwee
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht 3584, The Netherlands
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21
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Thanarajasingam G, Bennani-Baiti N, Thompson CA. PET-CT in Staging, Response Evaluation, and Surveillance of Lymphoma. Curr Treat Options Oncol 2017; 17:24. [PMID: 27032646 DOI: 10.1007/s11864-016-0399-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OPINION STATEMENT Lymphoma represents a broad spectrum of diseases with diverse biology, clinical behavior, and imaging features. Functional imaging with 18-F-fluorodeoxyglucose (FDG)-positron emission tomography combined with computed tomography (PET-CT) is widely recognized as the most sensitive and specific imaging modality for patients with lymphoma and is used as part of staging, response evaluation, and surveillance in patients with Hodgkin (HL) and non-Hodgkin lymphoma (NHL). Recent efforts at standardizing the conduct and consensus interpretation of PET-CT have facilitated its use in patients on clinical studies and beyond. The role of PET-CT has been affirmed in some clinical situations, such as staging and end-of-treatment evaluation in Hodgkin lymphoma and diffuse large B cell lymphoma (DLBCL), and in the evaluation of aggressive transformation of an indolent lymphoma. However, the role of functional imaging in other histologies and clinical settings is not as clear given the higher rate of false positive results and the costs inherent to PET-CT. There is little evidence to suggest its utility or impact on outcome in most indolent lymphomas, or in the setting of post-treatment surveillance. In addition, there remains controversy about the value of PET-CT in early response assessment during active therapy, particularly in DLBCL. This review will evaluate the evidence surrounding the role of PET-CT in staging, response evaluation and surveillance of Hodgkin and non-Hodgkin lymphoma.
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Affiliation(s)
- Gita Thanarajasingam
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Nabila Bennani-Baiti
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Carrie A Thompson
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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22
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Abstract
18-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) is currently the most valuable imaging technique in Hodgkin lymphoma. Since its first use in lymphomas in the 1990s, it has become the gold standard in the staging and end-of-treatment remission assessment in patients with Hodgkin lymphoma. The possibility of using early (interim) PET during first-line therapy to evaluate chemosensitivity and thus personalize treatment at this stage holds great promise, and much attention is now being directed toward this goal. With high probability, it is believed that in the near future, the result of interim PET-CT would serve as a compass to optimize treatment. Also the role of PET in pre-transplant assessment is currently evolving. Much controversy surrounds the possibility of detecting relapse after completed treatment with the use of PET in surveillance in the absence of symptoms suggestive of recurrence and the results of published studies are rather discouraging because of low positive predictive value. This review presents current knowledge about the role of 18-FDG-PET/CT imaging at each point of management of patients with Hodgkin lymphoma.
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23
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Skoetz N, Collins G, Moons K, Estcourt LJ, Engert A, Kobe C, von Tresckow B, Trivella M. Interim PET for prognosis in adults with Hodgkin lymphoma: a prognostic factor exemplar review. Hippokratia 2017. [DOI: 10.1002/14651858.cd012643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Nicole Skoetz
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Kerpener Str. 62 Cologne Germany 50937
| | - Gary Collins
- University of Oxford; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; Windmill Road Oxford UK OX3 7LD
| | - Karel Moons
- University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care; PO Box 85500 Utrecht Netherlands 3508 GA
| | - Lise J Estcourt
- NHS Blood and Transplant; Haematology/Transfusion Medicine; Level 2, John Radcliffe Hospital Headington Oxford UK OX3 9BQ
| | - Andreas Engert
- University Hospital of Cologne; Department I of Internal Medicine; Kerpener Str. 62 Cologne Germany 50924
| | - Carsten Kobe
- University Hospital of Cologne; Department for Nuclear Medicine; Cologne Germany
| | - Bastian von Tresckow
- University Hospital of Cologne; Department I of Internal Medicine; Kerpener Str. 62 Cologne Germany 50924
| | - Marialena Trivella
- University of Oxford; Centre for Statistics in Medicine; Botnar Research Centre Windmill Road Oxford UK OX3 7LD
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Adams HJA, Kwee TC. Reply: Interim PET in Hodgkin Lymphoma: Is It So Useless? J Nucl Med 2017; 58:1180-1182. [PMID: 28280222 DOI: 10.2967/jnumed.117.192294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Hugo J A Adams
- Deventer Ziekenhuis Nico Bolkesteinlaan 75 7416 SE Deventer, The Netherlands E-mail:
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25
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Does interim 18F-FDG-PET response-adapted therapy really benefit advanced-stage Hodgkin lymphoma patients? Nucl Med Commun 2017; 37:1333-1334. [PMID: 27501435 DOI: 10.1097/mnm.0000000000000584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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26
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Zwarthoed C, El-Galaly TC, Canepari M, Ouvrier MJ, Viotti J, Ettaiche M, Viviani S, Rigacci L, Trentin L, Rusconi C, Luminari S, Cantonetti M, Bolis S, Borra A, Darcourt J, Salvi F, Subocz E, Tajer J, Kulikowski W, Malkowski B, Zaucha JM, Gallamini A. Prognostic Value of Bone Marrow Tracer Uptake Pattern in Baseline PET Scans in Hodgkin Lymphoma: Results from an International Collaborative Study. J Nucl Med 2017; 58:1249-1254. [PMID: 28126883 DOI: 10.2967/jnumed.116.184218] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/21/2016] [Indexed: 12/28/2022] Open
Abstract
PET/CT-ascertained bone marrow involvement (BMI) constitutes the single most important reason for upstaging by PET/CT in Hodgkin lymphoma (HL). However, BMI assessment in PET/CT can be challenging. This study analyzed the clinicopathologic correlations and prognostic meaning of different patterns of bone marrow (BM) 18F-FDG uptake in HL. Methods: One hundred eighty newly diagnosed early unfavorable and advanced-stage HL patients, all scanned at baseline and after 2 adriamycin-bleomycin-vinblastine-dacarbazine (ABVD) courses with 18F-FDG PET, enrolled in 2 international studies aimed at assessing the role of interim PET scanning in HL, were retrospectively included. Patients were treated with ABVD × 4-6 cycles and involved-field radiation when needed, and no treatment adaptation on interim PET scanning was allowed. Two masked reviewers independently reported the scans. Results: Thirty-eight patients (21.1%) had focal lesions (fPET+), 10 of them with a single (unifocal) and 28 with multiple (multifocal) BM lesions. Fifty-three patients (29.4%) had pure strong (>liver) diffuse uptake (dPET+) and 89 (48.4%) showed no or faint (≤liver) BM uptake (nPET+). BM biopsy was positive in 6 of 38 patients (15.7%) for fPET+, in 1 of 53 (1.9%) for dPET+, and in 5 of 89 (5.6%) for nPET+ dPET+ was correlated with younger age, higher frequency of bulky disease, lower hemoglobin levels, higher leukocyte counts, and similar diffuse uptake in the spleen. Patients with pure dPET+ had a 3-y progression-free survival identical to patients without any 18F-FDG uptake (82.9% and 82.2%, respectively, P = 0.918). However, patients with fPET+ (either unifocal or multifocal) had a 3-y progression-free survival significantly inferior to patients with dPET+ and nPET+ (66.7% and 82.5%, respectively, P = 0.03). The κ values for interobserver agreement were 0.84 for focal uptake and 0.78 for diffuse uptake. Conclusion: We confirmed that 18F-FDG PET scanning is a reliable tool for BMI assessment in HL, and BM biopsy is no longer needed for routine staging. Moreover, the interobserver agreement for BMI in this study proved excellent and only focal 18F-FDG BM uptake should be considered as a harbinger of HL.
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Affiliation(s)
- Colette Zwarthoed
- Nuclear Medicine Department, A. Lacassagne Cancer Center, Nice, France
| | | | | | | | - Julien Viotti
- Research, Innovation and Statistics Department, A. Lacassagne Cancer Center, Nice, France
| | - Marc Ettaiche
- Research, Innovation and Statistics Department, A. Lacassagne Cancer Center, Nice, France
| | - Simonetta Viviani
- Hematology Department and Paediatric Onco-Haematology, National Tumour Institute, Milan, Italy
| | - Luigi Rigacci
- Hematology Chair University of Florence, Policlinico Careggi, Florence, Italy
| | - Livio Trentin
- Hematology Section, Department of Medicine, Padua University, Padua, Italy
| | - Chiara Rusconi
- Hematology Department, Ca-Granda Niguarda Hospital, Milan, Italy
| | - Stefano Luminari
- Hematology Department, Modena and Reggio Emilia University, Reggio Emilia, Italy
| | | | - Silvia Bolis
- Hematology Department, San Gerardo Hospital, Monza, Italy
| | - Anna Borra
- Hematology Department, S. Croce Hospital, Cuneo, Italy
| | - Jacques Darcourt
- Nuclear Medicine Department, A. Lacassagne Cancer Center, Nice, France
| | - Flavia Salvi
- Hematology Department, S. Antonio and Biagio Hospital, Alessandria, Italy
| | - Edyta Subocz
- Hematology Department, Military Institute of Medicine, Warszawa, Poland
| | - Joanna Tajer
- Lymphoproliferative Disease Department, Maria Sklodowska-Curie Memorial Institute, Warszawa, Poland
| | - Waldemar Kulikowski
- Hematology Department, Interior Ministry Hospital, Warmia and Mazury Medical University, Olsztyn, Poland
| | - Bogdan Malkowski
- Nuclear Medicine Department, Oncology Center, Bydgoszcz, Poland; and
| | - Jan Maciej Zaucha
- Gdynia Oncology Center and Department of Oncological Propaedeutic, Medical University of Gdańsk, Gdańsk, Poland
| | - Andrea Gallamini
- Research, Innovation and Statistics Department, A. Lacassagne Cancer Center, Nice, France
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Press OW, Friedberg JW. Reply to H.J.A. Adams et al and E.A. Hawkes et al. J Clin Oncol 2017; 35:373. [PMID: 28095266 DOI: 10.1200/jco.2016.69.7979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Oliver W Press
- Oliver W. Press, Fred Hutchinson Cancer Research Center, Seattle, WA, and Jonathan W. Friedberg, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | - Jonathan W Friedberg
- Oliver W. Press, Fred Hutchinson Cancer Research Center, Seattle, WA, and Jonathan W. Friedberg, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY
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28
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Adams HJA, Kwee TC. Fact Sheet About Interim and End-of-Treatment 18F-FDG PET/CT in Lymphoma. J Nucl Med 2017; 58:1178-1179. [PMID: 28062598 DOI: 10.2967/jnumed.116.187815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Hugo J A Adams
- Deventer Ziekenhuis Nico Bolkesteinlaan 75 7416 SE Deventer, The Netherlands E-mail:
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29
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Moghbel MC, Mittra E, Gallamini A, Niederkohr R, Chen DL, Zukotynski K, Nadel H, Kostakoglu L. Response Assessment Criteria and Their Applications in Lymphoma: Part 2. J Nucl Med 2016; 58:13-22. [DOI: 10.2967/jnumed.116.184242] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/19/2016] [Indexed: 01/10/2023] Open
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30
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Borchmann P, Engert A. Reply to H.J.A. Adams et al, E.A. Hawkes et al, and C.F. Hess et al. J Clin Oncol 2016; 35:375-376. [PMID: 28095272 DOI: 10.1200/jco.2016.69.7987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Peter Borchmann
- Peter Borchmann and Andreas Engert, University Hospital of Cologne and University of Cologne, Cologne, Germany
| | - Andreas Engert
- Peter Borchmann and Andreas Engert, University Hospital of Cologne and University of Cologne, Cologne, Germany
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Adams HJA, Kwee TC. Predictive Value of Interim [ 18F]Fluorodeoxyglucose-Positron Emission Tomography in Advanced-Stage Hodgkin Lymphoma Is Not Well Established. J Clin Oncol 2016; 35:370-371. [PMID: 28095276 DOI: 10.1200/jco.2016.68.1494] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Hugo J A Adams
- Hugo J.A. Adams, University Medical Center Utrecht, Utrecht, the Netherlands; and Thomas C. Kwee, University Medical Center Groningen, Groningen, the Netherlands
| | - Thomas C Kwee
- Hugo J.A. Adams, University Medical Center Utrecht, Utrecht, the Netherlands; and Thomas C. Kwee, University Medical Center Groningen, Groningen, the Netherlands
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The application of positron emission tomography (PET/CT) in diagnosis of breast cancer. Part II. Diagnosis after treatment initiation, future perspectives. Contemp Oncol (Pozn) 2016; 20:205-9. [PMID: 27647983 PMCID: PMC5013681 DOI: 10.5114/wo.2016.61560] [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: 12/22/2014] [Accepted: 07/20/2015] [Indexed: 11/17/2022] Open
Abstract
Similarly to the applications described in the first part of this publication, positron emission tomography with computed tomography (PET/CT) is also gaining importance in monitoring a tumour's response to therapy and diagnosing breast cancer recurrences. This is additionally caused by the fact that many new techniques (dual-time point imaging, positron emission tomography with magnetic resonance PET/MR, PET/CT mammography) and radiotracers (16α-18F-fluoro-17β-estradiol, 18F-fluorothymidine) are under investigation. The highest sensitivity and specificity when monitoring response to treatment is achieved when the PET/CT scan is made after one or two chemotherapy courses. Response to anti-hormonal treatment can also be monitored, also when new radiotracers, such as FES, are used. When monitoring breast cancer recurrences during follow-up, PET/CT has higher sensitivity than conventional imaging modalities, making it possible to monitor the whole body simultaneously. New techniques and radiotracers enhance the sensitivity and specificity of PET and this is why, despite relatively high costs, it might become more widespread in monitoring response to treatment and breast cancer recurrences.
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Adams HJA, Kwee TC. Controversies on the prognostic value of interim FDG-PET in advanced-stage Hodgkin lymphoma. Eur J Haematol 2016; 97:491-498. [PMID: 27528557 DOI: 10.1111/ejh.12791] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2016] [Indexed: 12/01/2022]
Abstract
Hodgkin lymphoma, even in advanced-stage, is a highly curable malignancy, but treatment is associated with short-term toxicity and long-term side effects. Early predictive markers are required to identify those patients who do not require the full-length standard therapy (and thus qualify for therapy de-escalation) and those patients who will not be cured by standard therapy (and thus qualify for therapy escalation). Multiple trials have assessed the value of 18 F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) after a few cycles of chemotherapy (also known as 'interim FDG-PET') in predicting outcome in advanced-stage Hodgkin lymphoma. Furthermore, multiple interim FDG-PET-adapted trials, in which patients with positive interim FDG-PET scans are assigned to escalated therapies, and patients with negative interim FDG-PET scans are assigned to de-escalated therapies, have recently been published or are currently ongoing, with generally heterogeneous results. The present article reports the currently available evidence (and controversies) on the prognostic value of interim FDG-PET in advanced-stage Hodgkin lymphoma in patients with positive and negative interim FDG-PET findings following continuation of standard chemotherapy or escalated/de-escalated therapy.
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Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thomas C Kwee
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
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Mesguich C, Cazeau AL, Bouabdallah K, Soubeyran P, Guyot M, Milpied N, Bordenave L, Hindié E. Hodgkin lymphoma: a negative interim-PET cannot circumvent the need for end-of-treatment-PET evaluation. Br J Haematol 2016; 175:652-660. [PMID: 27539369 DOI: 10.1111/bjh.14292] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/22/2016] [Indexed: 02/02/2023]
Abstract
We examined the outcome of a cohort of patients with Hodgkin lymphoma (HL) in order to assess if fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) at the end of treatment (end-PET) can be omitted when the interim PET (int-PET) is negative. Seventy-six ABVD(adriamycin, bleomycin, vinblastine, dacarbazine)-treated patients were retrospectively included. No change in treatment was made on the basis of int-PET results. Suspicious foci on end-PET received biopsy confirmation whenever possible. Median follow-up was 58·9 months. Uptake on int-PET higher than liver (scores 4-5) was rated positive according to the Lugano classification, while a positive end-PET corresponded to scores 3, 4 and 5. Fifteen patients had treatment failure. Sensitivity, specificity, positive predictive value (PPV), negative predictive value and accuracy of int-PET were 46·7%, 85·2%, 43·8%, 86·7% and 77·6%, respectively. For end-PET the figures were: 80%, 93·4%, 75%, 95% and 90·8%. Eight patients with negative int-PET had treatment failure; six of them were identified as non-responders with end-PET. The 5-year progression-free survival (PFS) was 87% for patients with negative int-PET versus 56% with positive int-PET. The 5-year PFS was 96% with negative end-PET versus 23% with positive end-PET. The prognostic information from int-PET as regards PFS (log-rank test P = 0·0048) was lower than that provided by end-PET (P < 0·0001). Int-PET predicted only half of the failures. When used in clinical routine, a negative int-PET study cannot obviate the need for end-PET examination.
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Affiliation(s)
- Charles Mesguich
- Department of Nuclear Medicine, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France
| | - Anne-Laure Cazeau
- Department of Nuclear Medicine, Institut Bergonié Cancer Centre, Bordeaux, France
| | - Krimo Bouabdallah
- Department of Haematology, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France
| | - Pierre Soubeyran
- Department of Haematology, Institut Bergonié Cancer Centre, Bordeaux, France
| | - Martine Guyot
- Department of Nuclear Medicine, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France
| | - Noël Milpied
- Department of Haematology, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France
| | - Laurence Bordenave
- Department of Nuclear Medicine, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France
| | - Elif Hindié
- Department of Nuclear Medicine, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France
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Adams HJA, Kwee TC. Proportion of false-positive lesions at interim and end-of-treatment FDG-PET in lymphoma as determined by histology: Systematic review and meta-analysis. Eur J Radiol 2016; 85:1963-1970. [PMID: 27776647 DOI: 10.1016/j.ejrad.2016.08.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 08/12/2016] [Accepted: 08/16/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To systematically review and meta-analyze the proportion of false-positive lesions at interim and end-of-treatment 18F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) in lymphoma using biopsy as reference standard. MATERIALS AND METHODS Medline was searched for original studies. Methodological quality of included studies was evaluated, and results were meta-analytically summarized using random effects (in case of interstudy heterogeneity [I2≤50%]) or fixed effects (in case of no interstudy heterogeneity [I2>50%]). RESULTS Eleven studies, comprising 139 patients who underwent biopsy of an FDG-avid lesion during or after completion of antilymphoma treatment, were included. Overall methodological quality was moderate. The proportion of false-positive results among all biopsied FDG-avid lesions at PET performed during of after completion of treatment ranged between 7.7% and 90.5% (the vast majority was due to inflammatory changes), with a weighted summary proportion (random effects, I2=75.7%) of 55.7% (95% confidence interval [CI]: 32.6-76.6%). There were no available studies on interim FDG-PET in Hodgkin lymphoma. The pooled summary false-positive proportions were 83.0% (95% CI: 72.0%-90.2%) for interim FDG-PET in non-Hodgkin lymphoma (fixed effects, I2=27.7%), 23.1% (95% CI: 4.7%-64.5%) for end-of-treatment FDG-PET in Hodgkin lymphoma (random effects; I2=67.1%), and 31.5% (95% CI: 3.9%-83.9%) for end-of-treatment FDG-PET in non-Hodgkin lymphoma (random effects, I2=68.3%). CONCLUSION Both interim and end-of-treatment FDG-PET scans in patients with lymphoma suffer from a very high number of false-positive FDG-avid lesions. This finding, in combination with the previously reported high number of false-negative FGD-PET scans for residual disease detection, suggests that the role of interim and end-of-treatment FDG-PET should be reconsidered.
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Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Thomas C Kwee
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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Procházka V, Klugar M, Bachanova V, Klugarová J, Tučková D, Papajík T. Comparing the accuracy of quantitative versus qualitative analyses of interim PET to prognosticate Hodgkin lymphoma: a systematic review protocol of diagnostic test accuracy. BMJ Open 2016; 6:e011729. [PMID: 27496236 PMCID: PMC4986203 DOI: 10.1136/bmjopen-2016-011729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Hodgkin lymphoma is an effectively treated malignancy, yet 20% of patients relapse or are refractory to front-line treatments with potentially fatal outcomes. Early detection of poor treatment responders is crucial for appropriate application of tailored treatment strategies. Tumour metabolic imaging of Hodgkin lymphoma using visual (qualitative) 18-fluorodeoxyglucose positron emission tomography (FDG-PET) is a gold standard for staging and final outcome assessment, but results gathered during the interim period are less accurate. Analysis of continuous metabolic-morphological data (quantitative) FDG-PET may enhance the robustness of interim disease monitoring, and help to improve treatment decision-making processes. The objective of this review is to compare diagnostic test accuracy of quantitative versus qualitative interim FDG-PET in the prognostication of patients with Hodgkin lymphoma. METHODS The literature on this topic will be reviewed in a 3-step strategy that follows methods described by the Joanna Briggs Institute (JBI). First, MEDLINE and EMBASE databases will be searched. Second, listed databases for published literature (MEDLINE, Tripdatabase, Pedro, EMBASE, the Cochrane Central Register of Controlled Trials and WoS) and unpublished literature (Open Grey, Current Controlled Trials, MedNar, ClinicalTrials.gov, Cos Conference Papers Index and International Clinical Trials Registry Platform of the WHO) will be queried. Third, 2 independent reviewers will analyse titles, abstracts and full texts, and perform hand search of relevant studies, and then perform critical appraisal and data extraction from selected studies using the DATARI tool (JBI). If possible, a statistical meta-analysis will be performed on pooled sensitivity and specificity data gathered from the selected studies. Statistical heterogeneity will be assessed. Funnel plots, Begg's rank correlations and Egger's regression tests will be used to detect and/or correct publication bias. ETHICS AND DISSEMINATION The results will be disseminated by publishing in a peer-reviewed journal. Ethical assessment will not be needed; only existing sources of literature will be searched. TRIAL REGISTRATION NUMBER CRD42016027953.
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Affiliation(s)
- Vít Procházka
- Faculty of Medicine and Dentistry, Department of Hemato-Oncology, Palacký University in Olomouc, Olomouc, Czech Republic
| | - Miloslav Klugar
- Faculty of Medicine and Dentistry, Department of Social Medicine and Public Health, Palacký University in Olomouc, Olomouc, Czech Republic
- Faculty of Medicine and Dentistry, The Czech Republic (Middle European) Centre for Evidence-Based Health Care: An Affiliated Centre of the Joanna Briggs Institute, Palacký University in Olomouc,Olomouc, Czech Republic
| | - Veronika Bachanova
- Division of Hematology, Oncology and Transplantation University of Minnesota, Minneapolis, Minnesota, USA
| | - Jitka Klugarová
- Faculty of Medicine and Dentistry, Department of Hemato-Oncology, Palacký University in Olomouc, Olomouc, Czech Republic
- Faculty of Medicine and Dentistry, The Czech Republic (Middle European) Centre for Evidence-Based Health Care: An Affiliated Centre of the Joanna Briggs Institute, Palacký University in Olomouc,Olomouc, Czech Republic
| | - Dagmar Tučková
- Faculty of Medicine and Dentistry, Department of Social Medicine and Public Health, Palacký University in Olomouc, Olomouc, Czech Republic
- Faculty of Medicine and Dentistry, The Czech Republic (Middle European) Centre for Evidence-Based Health Care: An Affiliated Centre of the Joanna Briggs Institute, Palacký University in Olomouc,Olomouc, Czech Republic
| | - Tomáš Papajík
- Faculty of Medicine and Dentistry, Department of Hemato-Oncology, Palacký University in Olomouc, Olomouc, Czech Republic
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Annunziata S, Cuccaro A, Calcagni ML, Hohaus S, Giordano A, Rufini V. Interim FDG-PET/CT in Hodgkin lymphoma: the prognostic role of the ratio between target lesion and liver SUVmax (rPET). Ann Nucl Med 2016; 30:588-92. [PMID: 27246952 DOI: 10.1007/s12149-016-1092-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/18/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the prognostic role of the ratio between target lesion and liver SUVmax (rPET) in patients with Hodgkin lymphoma (HL) undergoing interim FDG-PET/CT and to compare rPET with the 5-point Deauville Score (5p-DS). METHODS Sixty-eight patients with HL undergoing interim FDG-PET/CT after first courses of chemotherapy were evaluated. The receiver operating characteristic (ROC) approach was applied to identify the optimal cutpoint of rPET with respect to progression free survival (PFS). The prognostic significance of rPET was compared with 5p-DS (scores 4 and 5 considered as positive). Positive predictive value (PPV) and negative predictive value (NPV) were calculated using the presence of an adverse event as the gold standard. RESULTS The ROC analysis for rPET as a predictor of progression showed an optimal rPET cutpoint of 1.14. Both 5p-DS and rPET were strong outcome predictors (p < 0.001). Patients with negative 5p-DS and patients with rPET <1.14 had a similar two-year PFS (86 and 87 %, respectively). Patients with a positive 5p-DS had a 2-year PFS of 27 %, while patients with rPET >1.14 had a 2-year PFS of 15 %. 5p-DS and rPET cutoff of 1.14 showed a PPV of 58 versus 70 %, and a NPV of 85 versus 86 %, respectively. CONCLUSIONS rPET could be considered an accurate prognostic factor in patients with HL undergoing interim FDG-PET/CT. Larger prospective studies are needed to confirm these data.
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Affiliation(s)
- Salvatore Annunziata
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Annarosa Cuccaro
- Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Lucia Calcagni
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Stefan Hohaus
- Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Giordano
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Vittoria Rufini
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
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Adams HJA, Kwee TC. Prognostic value of pretransplant FDG-PET in refractory/relapsed Hodgkin lymphoma treated with autologous stem cell transplantation: systematic review and meta-analysis. Ann Hematol 2016; 95:695-706. [PMID: 26931115 PMCID: PMC4819743 DOI: 10.1007/s00277-016-2619-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/14/2016] [Indexed: 11/29/2022]
Abstract
This study aimed to systematically review the prognostic value of pretransplant 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in refractory/relapsed Hodgkin lymphoma treated with autologous stem cell transplantation (SCT). MEDLINE was systematically searched for appropriate studies. Included studies were methodologically appraised. Results of individual studies were meta-analyzed, if possible. Eleven studies, comprising a total of 745 refractory/relapsed Hodgkin lymphoma patients who underwent FDG-PET before autologous SCT, were included. The overall methodological quality of these studies was moderate. The proportion of pretransplant FDG-PET positive patients ranged between 25 and 65.2 %. Progression-free survival ranged between 0 and 52 % in pretransplant FDG-PET positive patients, and between 55 and 85 % in pretransplant FDG-PET negative patients. Overall survival ranged between 17 and 77 % in pretransplant FDG-PET positive patients, and between 78 and 100 % in FDG-PET negative patients. Based on five studies that provided sufficient data for meta-analysis, pooled sensitivity and specificity of pretransplant FDG-PET in predicting treatment failure (i.e., either progressive, residual, or relapsed disease) were 67.2 % (95 % confidence interval [CI] 58.2–75.3 %) and 70.7 % (95 % CI 64.2–76.5 %), respectively. Based on two studies that provided sufficient data for meta-analysis, pooled sensitivity and specificity of pretransplant FDG-PET in predicting death during follow-up were 74.4 % (95 % CI 58.8–86.5 %) and 58.0 % (95 % CI 49.3–66.3 %), respectively. In conclusion, the moderate quality evidence suggests pretransplant FDG-PET to have value in predicting outcome in refractory/relapsed Hodgkin lymphoma patients treated with autologous SCT. Nevertheless, a considerable proportion of pretransplant FDG-PET positive patients remains disease free and a considerable proportion of pretransplant FDG-PET negative patients develops disease relapse after autologous SCT.
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Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Thomas C Kwee
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Adams HJA, Kwee TC. Will treatment intensification in early-stage Hodgkin lymphoma patients with a positive interim FDG-PET improve outcome? Pediatr Hematol Oncol 2016; 33:1-4. [PMID: 26900636 DOI: 10.3109/08880018.2015.1104567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hugo J A Adams
- a Department of Radiology and Nuclear Medicine , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Thomas C Kwee
- a Department of Radiology and Nuclear Medicine , University Medical Center Utrecht , Utrecht , The Netherlands
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Cavalli F, Ceriani L, Zucca E. Functional Imaging Using 18-Fluorodeoxyglucose PET in the Management of Primary Mediastinal Large B-Cell Lymphoma: The Contributions of the International Extranodal Lymphoma Study Group. Am Soc Clin Oncol Educ Book 2016; 35:e368-75. [PMID: 27249743 DOI: 10.1200/edbk_159037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Primary mediastinal large B-cell lymphoma (PMLBCL) is recognized as a distinct disease entity. Treatment outcomes appear better than in other diffuse large B-cell lymphoma (DLBCL) types, partly because of their earlier stage at presentation and the younger age of most patients. If initial treatment fails, however, the results of salvage chemotherapy and myeloablative treatment are poor. The need to avoid relapses after initial therapy has led to controversy over the extent of front-line therapy, particularly whether consolidation radiotherapy to the mediastinum is always required and whether the 18-fluorodeoxyglucose ((18)F-FDG) uptake detected by PET-CT scan can be used to determine its requirements. Functional imaging using PET-CT generally allows distinguishing of residual mediastinal masses containing active lymphoma from those with only sclerotic material remaining. The International Extranodal Lymphoma Study Group (IELSG) conducted the prospective IELSG-26 study, which showed that a five-point visual scale can be used to define metabolic response after immunochemotherapy and that a cut point based on liver uptake discriminates effectively between high or low risk of failure, with 5-year progression-free survival (PFS) of 99% versus 68% and 5-year overall survival (OS) of 100% versus 83%. This study also showed that a baseline quantitative PET parameter, namely the total lesion glycolysis describing the metabolic tumor burden, can be a powerful predictor of PMLBCL outcomes and warrants further validation as a biomarker. The ongoing IELSG-37 randomized study addresses the need for consolidation mediastinal radiotherapy in patients in whom a complete metabolic response (CMR) can be seen on PET scans after standard immunochemotherapy.
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Affiliation(s)
- Franco Cavalli
- From the Oncology Institute of Southern Switzerland, Lymphoma Unit-Ospedale San Giovanni, Bellinzona, Switzerland
| | - Luca Ceriani
- From the Oncology Institute of Southern Switzerland, Lymphoma Unit-Ospedale San Giovanni, Bellinzona, Switzerland
| | - Emanuele Zucca
- From the Oncology Institute of Southern Switzerland, Lymphoma Unit-Ospedale San Giovanni, Bellinzona, Switzerland
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Nievelstein RAJ, Littooij AS. Whole-body MRI in paediatric oncology. Radiol Med 2015; 121:442-53. [PMID: 26631075 PMCID: PMC4837204 DOI: 10.1007/s11547-015-0600-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 10/27/2015] [Indexed: 12/12/2022]
Abstract
Imaging plays a crucial role in the diagnosis and follow-up of paediatric malignancies. Until recently, computed tomography (CT) has been the imaging technique of choice in children with cancer, but nowadays there is an increasing interest in the use of functional imaging techniques like positron emission tomography and single-photon emission tomography. These later techniques are often combined with CT allowing for simultaneous acquisition of image data on the biological behaviour of tumour, as well as the anatomical localisation and extent of tumour spread. Because of the small but not negligible risk of radiation induced secondary cancers and the significantly improved overall survival rates of children with cancer, there is an increasing interest in the use of alternative imaging techniques that do not use ionising radiation. Magnetic resonance imaging (MRI) is a radiation-free imaging tool that allows for acquiring images with a high spatial resolution and excellent soft tissue contrast throughout the body. Moreover, recent technological advances have resulted in fast diagnostic sequences for whole-body MR imaging (WB-MRI), including functional techniques such as diffusion weighted imaging. In this review, the current status of the technique and major clinical applications of WB-MRI in children with cancer will be discussed.
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Affiliation(s)
- Rutger A J Nievelstein
- Department of Paediatric Radiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. .,Imaging Division, Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Annemieke S Littooij
- Department of Paediatric Radiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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