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Oertel M, Ziepert M, Frontzek F, Nacke N, Altmann B, Nickelsen M, Glass B, Poeschel V, Ruebe C, Lenz G, Schmitz N, Eich HT. Radiotherapy in younger patients with advanced aggressive B-cell lymphoma-long-term results from the phase 3 R-MegaCHOEP trial. Leukemia 2024; 38:1099-1106. [PMID: 38538861 PMCID: PMC11073960 DOI: 10.1038/s41375-024-02231-9] [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: 11/22/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 05/08/2024]
Abstract
The role of consolidative radiotherapy (RT) for patients with aggressive B-cell lymphoma has not been fully elucidated. The R-MegaCHOEP trial investigated the use of high-dose chemotherapy and rituximab with subsequent autologous stem cell transplantations compared to conventional immunochemotherapy (R-CHOEP) for high-risk patients up to 60 years. The study protocol included RT for patients with bulky (maximum diameter ≥7.5 cm) or extranodal disease. Two-hundred sixty-one patients were analyzed, 120 of whom underwent RT. The most frequently irradiated regions were mediastinum (n = 50) and paraaortic (n = 27). Median RT dose was 36 Gray in median fractions of 1.8 Gray. Acute toxicities were mostly mild to moderate, with only 24 and 8 grade 3 and 4 toxicities reported during RT. Patients with bulky disease who received RT showed significantly better 10-year EFS, PFS and OS (EFS: 64% vs. 35%; p < 0.001; PFS 68% vs. 47%; p = 0.003; OS: 72% vs. 59%; p = 0.011). There was no significant increase in secondary malignancies with the use of RT. RT administered for consolidation of bulky disease after immunochemotherapy improved the prognosis of young high-risk patients with aggressive B-cell lymphoma and should be considered part of first-line therapy. The trial was registered with ClinicalTrials.gov, number NCT00129090.
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Affiliation(s)
- Michael Oertel
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Marita Ziepert
- Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Fabian Frontzek
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
- Department of Medicine A for Hematology, Oncology, and Pulmonology, University Hospital Muenster, Muenster, Germany
| | - Nina Nacke
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Bettina Altmann
- Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig, Germany
| | | | - Bertram Glass
- Clinic for Hematology, Oncology, Tumor Immunology, and Palliative Care, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Viola Poeschel
- Department of Hematology, Oncology and Rheumatology, Saarland University Medical School, Homburg, Saar, Germany
| | - Christian Ruebe
- Department of Radiation Oncology, Saarland University Medical School, Homburg, Saar, Germany
| | - Georg Lenz
- Department of Medicine A for Hematology, Oncology, and Pulmonology, University Hospital Muenster, Muenster, Germany
| | - Norbert Schmitz
- Department of Medicine A for Hematology, Oncology, and Pulmonology, University Hospital Muenster, Muenster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany.
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2
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Fox CP, Chaganti S, McIlroy G, Barrington SF, Burton C, Cwynarski K, Eyre TA, Illidge T, Kalakonda N, Kuhnl A, McKay P, Davies AJ. The management of newly diagnosed large B-cell lymphoma: A British Society for Haematology Guideline. Br J Haematol 2024; 204:1178-1192. [PMID: 38247115 DOI: 10.1111/bjh.19273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/20/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024]
Affiliation(s)
| | - Sridhar Chaganti
- Centre for Clinical Haematology, University Hospitals Birmingham, Birmingham, UK
| | - Graham McIlroy
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Sally F Barrington
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Cathy Burton
- Department of Haematology, The Leeds Teaching Hospitals, Leeds, UK
| | - Kate Cwynarski
- Department of Haematology, University College London Hospitals, London, UK
| | - Toby A Eyre
- Oxford Cancer and Haematology Centre, Oxford University Hospitals, Oxford, UK
| | - Timothy Illidge
- Division of Cancer Sciences, Manchester NIHR Biomedical Research Centre, University of Manchester, Manchester, UK
| | - Nagesh Kalakonda
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Andrea Kuhnl
- Department of Haematology, King's College Hospital, London, UK
| | - Pam McKay
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Andrew J Davies
- Cancer Sciences Division, Centre for Cancer Immunology, University of Southampton, Southampton, UK
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3
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Huang C, Tang TL, Qiu YY, Lin YP, Chen SL, Zhao RZ, Shi GQ, Liao SQ, Chen JH, Fu HY, Liu JZ, Xu BH, Liu TB, Yang Y. Hypofractionated radiotherapy for refractory or relapsed aggressive B-cell lymphoma in the rituximab era. BMC Cancer 2024; 24:72. [PMID: 38218811 PMCID: PMC10788030 DOI: 10.1186/s12885-024-11837-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Radiotherapy (RT) is an effective and available local treatment for patients with refractory or relapsed (R/R) aggressive B-cell lymphomas. However, the value of hypofractionated RT in this setting has not been confirmed. METHODS We retrospectively analyzed patients with R/R aggressive B-cell lymphoma who received hypofractionated RT between January 2020 and August 2022 at a single institution. The objective response rate (ORR), overall survival (OS), progression-free survival (PFS) and acute side effects were analyzed. RESULTS A total of 30 patients were included. The median dose for residual disease was 36 Gy, at a dose per fraction of 2.3-5 Gy. After RT, the ORR and complete response (CR) rates were 90% and 80%, respectively. With a median follow-up of 10 months (range, 2-27 months), 10 patients (33.3%) experienced disease progression and three died. The 1-year OS and PFS rates for all patients were 81.8% and 66.3%, respectively. The majority (8/10) of post-RT progressions involved out-of-field relapses. Patients with relapsed diseases, no response to systemic therapy, multiple lesions at the time of RT, and no response to RT were associated with out-of-field relapses. PFS was associated with response to RT (P = 0.001) and numbers of residual sites (P < 0.001). No serious non-hematological adverse effects (≥ grade 3) associated with RT were reported. CONCLUSION These data suggest that hypofractionated RT was effective and tolerable for patients with R/R aggressive B-cell lymphoma, especially for those that exhibited localized residual disease.
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Affiliation(s)
- Cheng Huang
- Department of Radiation Oncology, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies ), Fujian Medical University Union Hospital, Fuzhou, 350001, P. R. China
| | - Tian-Lan Tang
- Department of Radiation Oncology, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies ), Fujian Medical University Union Hospital, Fuzhou, 350001, P. R. China
| | - Yan-Yan Qiu
- Department of Hematology, Fujian Provincial Key Laboratory On Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, P. R. China
| | - Yu-Ping Lin
- Department of Radiation Oncology, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies ), Fujian Medical University Union Hospital, Fuzhou, 350001, P. R. China
| | - Si-Lin Chen
- Department of Radiation Oncology, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies ), Fujian Medical University Union Hospital, Fuzhou, 350001, P. R. China
| | - Rui-Zhi Zhao
- Department of Radiation Oncology, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies ), Fujian Medical University Union Hospital, Fuzhou, 350001, P. R. China
| | - Gui-Qing Shi
- Department of Radiation Oncology, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies ), Fujian Medical University Union Hospital, Fuzhou, 350001, P. R. China
| | - Si-Qin Liao
- Department of PET/CT, Fujian Medical University Union Hospital, Fuzhou, P. R. China
| | - Jin-Hua Chen
- Follow-Up Center, Fujian Medical University Union Hospital, Fuzhou, P. R. China
| | - Hai-Ying Fu
- Department of Hematology, The Third Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, The Third People's Hospital of Fujian Province, Fuzhou, P. R. China
| | - Jian-Zhi Liu
- Department of Otorhinolaryngology, Fujian Medical University Union Hospital, Fuzhou, P. R. China
| | - Ben-Hua Xu
- Department of Radiation Oncology, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies ), Fujian Medical University Union Hospital, Fuzhou, 350001, P. R. China
| | - Ting-Bo Liu
- Department of Hematology, Fujian Provincial Key Laboratory On Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, P. R. China.
| | - Yong Yang
- Department of Radiation Oncology, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies ), Fujian Medical University Union Hospital, Fuzhou, 350001, P. R. China.
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4
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Oertel M, Eich HT. [Is radiotherapy for diffuse large B-cell lymphoma obsolete? : A radio-oncological view on the UNFOLDER study]. Strahlenther Onkol 2024; 200:103-105. [PMID: 37963995 PMCID: PMC10784371 DOI: 10.1007/s00066-023-02177-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Affiliation(s)
- Michael Oertel
- Klinik für Strahlentherapie - Radioonkologie, Universitätsklinikum Münster (UKM), Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland.
| | - Hans Theodor Eich
- Klinik für Strahlentherapie - Radioonkologie, Universitätsklinikum Münster (UKM), Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
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5
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Lewis KL, Trotman J. Integration of PET in DLBCL. Semin Hematol 2023; 60:291-304. [PMID: 38326144 DOI: 10.1053/j.seminhematol.2023.12.003] [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: 09/09/2023] [Revised: 11/24/2023] [Accepted: 12/04/2023] [Indexed: 02/09/2024]
Abstract
F-fluorodeoxyglucose positron emission tomography-computerized tomography (18FDG-PET/CT) is the gold-standard imaging modality for staging and response assessment for most lymphomas. This review focuses on the utility of 18FDG-PET/CT, and its role in staging, prognostication and response assessment in diffuse large B-cell lymphoma (DLBCL), including emerging possibilities for future use.
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Affiliation(s)
| | - Judith Trotman
- Concord Repatriation General Hospital, Concord, NSW, Australia
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6
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Xue M, Gao Z, Yan M, Bao Y. Profiling risk factors for separation of infection complications in patients with gastrointestinal and nodal diffuse large B-cell lymphoma. BMC Infect Dis 2023; 23:711. [PMID: 37864133 PMCID: PMC10589955 DOI: 10.1186/s12879-023-08671-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/05/2023] [Indexed: 10/22/2023] Open
Abstract
OBJECTIVE To identify risk factors for infection complications in patients with gastrointestinal diffuse large B-cell lymphoma (GI-DLBCL) and nodal DLBCL (N-DLBCL) during treatment, respectively. METHODS Total 51 GI-DLBCL patients and 80 N-DLBCL patients were included after retrieving clinical data from a single medical center in the past ten years. Logistic regression analysis was utilized to analyze patients' data, including baseline demographics, treatments and laboratory values, to determine independent risk factors of infection in these patients. RESULTS Total 28 of 51 patients (54.9%) in the GI-DLBCL group and 52 of 80 patients (65%) in the N-DLBCL group were observed infection events during treatment. A multivariate logistic regression model revealed that Ann-arbor stage IV (P = 0.034; odds ratio [OR]: 10.635; 95% confidence interval [CI]: 1.152-142.712), extra-nodal lesions ≥ 2 (P = 0.041; OR: 23.116; 95%CI: 1.144-466.949) and high serum lactate dehydrogenase (LDH) at the time of diagnosis (LDH > 252U/L; P = 0.033; OR: 6.058; 95%CI: 1.159-31.659) were independent risk factors for the development of infection in patients with GI-DLBCL after systemic treatment. In the N-DLBCL group, high serum C-reactive protein (CRP) (P = 0.027; OR: 1.104; 95%CI: 1.011-1.204) and a low platelet count (P = 0.041; OR: 0.991; 95%CI: 0.982-1.000) at routine blood tests just before infection occurred were identified as significant risk factors related to infection events during treatment. CONCLUSIONS Discordant independent risk factors induced infection may be present during the treatment in patients with GI-DLBCL and N-DLBCL. Close monitoring these risk factors is likely an effective strategy to prevent microbial infections in these patients.
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Affiliation(s)
- Min Xue
- Graduate School, Bengbu Medical College, 2600 Donghai Road, Bengbu, 233000, Anhui, China
- The Key Laboratory, The Second Affiliated Hospital of Jiaxing University, 1518 North Huancheng Road, Jiaxing, 314000, Zhejiang, China
| | - Zhenzhen Gao
- The Department of Oncology, The Second Affiliated Hospital of Jiaxing University, 1518 North Huancheng Road, Jiaxing, 314000, Zhejiang, China
| | - Miaolong Yan
- The Key Laboratory, The Second Affiliated Hospital of Jiaxing University, 1518 North Huancheng Road, Jiaxing, 314000, Zhejiang, China
| | - Yi Bao
- The Key Laboratory, The Second Affiliated Hospital of Jiaxing University, 1518 North Huancheng Road, Jiaxing, 314000, Zhejiang, China.
- The Department of Oncology, The Second Affiliated Hospital of Jiaxing University, 1518 North Huancheng Road, Jiaxing, 314000, Zhejiang, China.
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7
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Kaanders JHAM, Bussink J, Aarntzen EHJG, Braam P, Rütten H, van der Maazen RWM, Verheij M, van den Bosch S. [18F]FDG-PET-Based Personalized Radiotherapy Dose Prescription. Semin Radiat Oncol 2023; 33:287-297. [PMID: 37331783 DOI: 10.1016/j.semradonc.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
PET imaging with 2'-deoxy-2'-[18F]fluoro-D-glucose ([18F]FDG) has become one of the pillars in the management of malignant diseases. It has proven value in diagnostic workup, treatment policy, follow-up, and as prognosticator for outcome. [18F]FDG is widely available and standards have been developed for PET acquisition protocols and quantitative analyses. More recently, [18F]FDG-PET is also starting to be appreciated as a decision aid for treatment personalization. This review focuses on the potential of [18F]FDG-PET for individualized radiotherapy dose prescription. This includes dose painting, gradient dose prescription, and [18F]FDG-PET guided response-adapted dose prescription. The current status, progress, and future expectations of these developments for various tumor types are discussed.
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Affiliation(s)
- Johannes H A M Kaanders
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands..
| | - Johan Bussink
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Erik H J G Aarntzen
- Department of Medical Imaging, Radboud university medical center, Nijmegen, The Netherlands
| | - Pètra Braam
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Heidi Rütten
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Marcel Verheij
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Sven van den Bosch
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands
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8
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Oertel M, Eich HT. In Regard to Campbell et al. Int J Radiat Oncol Biol Phys 2023; 116:468-469. [PMID: 37179099 DOI: 10.1016/j.ijrobp.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/15/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Michael Oertel
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany.
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
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9
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Zanoni L, Bezzi D, Nanni C, Paccagnella A, Farina A, Broccoli A, Casadei B, Zinzani PL, Fanti S. PET/CT in Non-Hodgkin Lymphoma: An Update. Semin Nucl Med 2023; 53:320-351. [PMID: 36522191 DOI: 10.1053/j.semnuclmed.2022.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 12/15/2022]
Abstract
Non-Hodgkin lymphomas represents a heterogeneous group of lymphoproliferative disorders characterized by different clinical courses, varying from indolent to highly aggressive. 18F-FDG-PET/CT is the current state-of-the-art diagnostic imaging, for the staging, restaging and evaluation of response to treatment in lymphomas with avidity for 18F-FDG, despite it is not routinely recommended for surveillance. PET-based response criteria (using five-point Deauville Score) are nowadays uniformly applied in FDG-avid lymphomas. In this review, a comprehensive overview of the role of 18F-FDG-PET in Non-Hodgkin lymphomas is provided, at each relevant point of patient management, particularly focusing on recent advances on diffuse large B-cell lymphoma and follicular lymphoma, with brief updates also on other histotypes (such as marginal zone, mantle cell, primary mediastinal- B cell lymphoma and T cell lymphoma). PET-derived semiquantitative factors useful for patient stratification and prognostication and emerging radiomics research are also presented.
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Affiliation(s)
- Lucia Zanoni
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Davide Bezzi
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Paccagnella
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy; Nuclear Medicine Unit, AUSL Romagna, Cesena, Italy
| | - Arianna Farina
- Nuclear Medicine, Alma Mater Studiorum University of 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
| | - Beatrice Casadei
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
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10
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Pepper NB, Oertel M, Rehn S, Kobe C, Eich HT. Modern PET-Guided Radiotherapy Planning and Treatment for Malignant Lymphoma. Semin Nucl Med 2023; 53:389-399. [PMID: 36241473 DOI: 10.1053/j.semnuclmed.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 12/24/2022]
Abstract
Malignant lymphoma comprises a broad spectrum of diverse entities originating from different types of lymphocytes. In the last century, successive improvements of treatment possibilities have led to an continuous amelioration of patient prognosis from lethal outcome to high rates of disease control and long-term survivors. PET/CT-based imaging plays a key role in stratification of stage and treatment response. Especially for radiotherapy, an essential treatment modality for lymphoma patients, functional imaging and the reevaluation of disease activity after frontline chemotherapy has led to major improvements regarding size of treatment fields and toxicity. International expert groups like the International Lymphoma Radiation Oncology Group (ILROG) develop guidelines for the optimal use of imaging for treatment planning. The shift from uniform large-field treatment volumes to complex individual setups taking into account biological response-assessments based on functional imaging resulted in a further de-escalation of side effects and modernization of lymphoma treatment. This paper aims to summarize the use of FDG-PET-imaging for radiation therapy planning in malignant lymphoma in the context of historic and future developments, as well as associated limitations and challenges ahead. We will discuss the contemporary standard of care as recommended by international expert guidelines like the ILROG, the national comprehensive cancer network (NCCN), as well as the newly updated German S3-guidelines.
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Affiliation(s)
| | - Michael Oertel
- University Hospital Muenster, Department of Radiation Oncology, Muenster, Germany
| | - Stephan Rehn
- University Hospital Muenster, Department of Radiation Oncology, Muenster, Germany
| | - Carsten Kobe
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Hans Theodor Eich
- University Hospital Muenster, Department of Radiation Oncology, Muenster, Germany.
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11
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Nanni C, Kobe C, Baeßler B, Baues C, Boellaard R, Borchmann P, Buck A, Buvat I, Chapuy B, Cheson BD, Chrzan R, Cottereau AS, Dührsen U, Eikenes L, Hutchings M, Jurczak W, Kraeber-Bodéré F, Lopci E, Luminari S, MacLennan S, Mikhaeel NG, Nijland M, Rodríguez-Otero P, Treglia G, Withofs N, Zamagni E, Zinzani PL, Zijlstra JM, Herrmann K, Kunikowska J. European Association of Nuclear Medicine (EANM) Focus 4 consensus recommendations: molecular imaging and therapy in haematological tumours. Lancet Haematol 2023; 10:e367-e381. [PMID: 37142345 DOI: 10.1016/s2352-3026(23)00030-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/23/2022] [Accepted: 01/18/2023] [Indexed: 05/06/2023]
Abstract
Given the paucity of high-certainty evidence, and differences in opinion on the use of nuclear medicine for hematological malignancies, we embarked on a consensus process involving key experts in this area. We aimed to assess consensus within a panel of experts on issues related to patient eligibility, imaging techniques, staging and response assessment, follow-up, and treatment decision-making, and to provide interim guidance by our expert consensus. We used a three-stage consensus process. First, we systematically reviewed and appraised the quality of existing evidence. Second, we generated a list of 153 statements based on the literature review to be agreed or disagreed with, with an additional statement added after the first round. Third, the 154 statements were scored by a panel of 26 experts purposively sampled from authors of published research on haematological tumours on a 1 (strongly disagree) to 9 (strongly agree) Likert scale in a two-round electronic Delphi review. The RAND and University of California Los Angeles appropriateness method was used for analysis. Between one and 14 systematic reviews were identified on each topic. All were rated as low to moderate quality. After two rounds of voting, there was consensus on 139 (90%) of 154 of the statements. There was consensus on most statements concerning the use of PET in non-Hodgkin and Hodgkin lymphoma. In multiple myeloma, more studies are required to define the optimal sequence for treatment assessment. Furthermore, nuclear medicine physicians and haematologists are awaiting consistent literature to introduce volumetric parameters, artificial intelligence, machine learning, and radiomics into routine practice.
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Affiliation(s)
- Cristina Nanni
- Medicina Nucleare, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Carsten Kobe
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Bettina Baeßler
- Institute of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Christian Baues
- Department of Radiooncology, Radiotherapy and CyberKnife Center, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Ronald Boellaard
- Radiology & Nuclear Medicine, Amsterdam UMC, VUMC Cancer Center Amsterdam, Amsterdam, Netherlands; Nuclear Medicine & Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Peter Borchmann
- Department of Haematology and Oncology, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Andreas Buck
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Irène Buvat
- Laboratory of Translational Imaging in Oncology, Institut Curie, Inserm, PSL University, Orsay, France
| | - Björn Chapuy
- Department of Hematology, Oncology and Tumorimmunology, Charité University Medical Center Berlin, Benjamin Franklin Campus, Berlin, Germany
| | | | - Robert Chrzan
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Ulrich Dührsen
- Klinik für Hämatologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Live Eikenes
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Martin Hutchings
- Department of Haematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Wojciech Jurczak
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Françoise Kraeber-Bodéré
- Service de Médecine Nucléaire, University Hospital Hôtel-Dieu, Nantes, France; CRCI2NA, INSERM, CNRS, Université d'Angers, Nantes Université, Nantes, France
| | - Egesta Lopci
- Nuclear Medicine, IRCCS-Humanitas Research Hospital, Milan, Italy
| | - Stefano Luminari
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine Department, University of Modena and Reggio Emilia, Reggio Emilia, Italy; Hematology Unit, Azienda USL IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Steven MacLennan
- Academic Urology Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - N George Mikhaeel
- Department of Clinical Oncology, Guy's Cancer Centre, Guy's and St Thomas' NHS Trust, London, UK; School of Cancer & Pharmaceutical Sciences, King's College, University of London, London, UK
| | - Marcel Nijland
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Giorgio Treglia
- Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Faculty of Biomedical sciences, Università della Svizzera italiana, Lugano, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nadia Withofs
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liege, Liege, Belgium; GIGA-CRC In Vivo Imaging, University of Liege, Liege, Belgium
| | - Elena Zamagni
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Pier Luigi Zinzani
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Josée M Zijlstra
- Department of Hematology, Amsterdam UMC, VUMC Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Jolanta Kunikowska
- Department of Nuclear Medicine, Medical University of Warsaw, Warsaw, Poland
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12
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Ernst M, Dührsen U, Hellwig D, Lenz G, Skoetz N, Borchmann P. Diffuse Large B-Cell Lymphoma and Related Entities. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:289-296. [PMID: 36942797 PMCID: PMC10391525 DOI: 10.3238/arztebl.m2023.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/15/2022] [Accepted: 02/02/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is the most common malignant B-cell neoplasm, with an incidence of 5.6 per 100 000 persons per year and a mean age of onset of approximately 65 years. It is an aggressive type of non-Hodgkin's lymphoma requiring urgent treatment with curative intent. Evidence-based guidelines have not been available to date. METHODS For this first international evidence-based DLBCL-specific guideline, various systematic literature searches were performed. 5 systematic reviews, 21 randomized controlled trials (RCTs), and 36 non-randomized studies were used to formulate 42 recommendations. 142 were formulated on the basis of expert consensus. All recommendations were approved in a structured consensus-finding process. RESULTS For staging, combined positron emission tomography and computed tomography (PET/CT) should be performed (evidence: a prospective registry study). For all patients with a new diagnosis of DLBCL and without contraindications, R-CHOP based immunochemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) should be initiated with curative intent (evidence: RCTs). The individual treatment strategy is tailored to the patient's age and risk constellation. Once immunochemotherapy has been completed, PET/CT should be performed again to check for remission. Patients with PET-positive residual disease that is amenable to radiotherapy should be treated with consolidating irradiation (evidence: retrospective cohort study). CONCLUSION This clinical practice guideline on the diagnosis, treatment, and followup of patients with DLBCL and related entities provides a standardized clinical management approach, identifies areas where improvement would be desirable, and can serve as a basis for the development of further studies.
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Affiliation(s)
- Moritz Ernst
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne
| | | | - Dirk Hellwig
- Department for Nuclear Medicine, University Hospital Regensburg
| | - Georg Lenz
- Department of Medicine A for Hematology, Oncology, and Pneumology, University Hospital Münster
| | - Nicole Skoetz
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne
| | - Peter Borchmann
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne
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13
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Chen J, Wu Y, Kang Z, Qin S, Ruan G, Zhao H, Tao X, Xie Z, Peng J. A promising prognostic model for predicting survival of patients with HIV-related diffuse large B-cell lymphoma in the cART era. Cancer Med 2023. [PMID: 37081761 DOI: 10.1002/cam4.5957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/25/2023] [Accepted: 04/01/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Optimization of risk stratification is important for facilitating prognoses and therapeutic decisions regarding diffuse large B-cell lymphoma (DLBCL). However, a simple and applicable prognostic tool is lacking for individuals with human immunodeficiency virus (HIV)-related DLBCL in the era of combined antiretroviral therapy (cART). METHODS This retrospective multicenter observational study included 147 HIV-related DLBCL patients with histologically confirmed DLBCL from 2013 to 2020. The total group was divided into training (n = 78) and validation (n = 69) cohorts to derive the best prognostic score. Clinicopathological and characteristic biomarkers correlated with clinical outcomes were analyzed. RESULTS Age, Ann Arbor stage, lactate dehydrogenase (LDH) ratio, bulky disease, and red blood cell distribution width (RDW) ratio retained robust independent correlations with overall survival (OS) in multivariate analysis. A new and practical prognostic model was generated and externally validated, classifying patients into three categories with significantly different survival rates. Moreover, the new index outperformed the International Prognostic Index (IPI) score (area under the curve values of 0.94 vs. 0.81 in the training cohort and 0.85 vs. 0.74 in the validation cohort, C-indices of 0.80 vs. 0.70 in the training cohort and 0.74 vs. 0.70 in the validation cohort, and integrated discrimination improvement values of 0.203 in the training cohort and 0.175 in the validation cohort) and was better at defining intermediate- and high-risk groups. The calibration curves performed satisfactorily for predicting 3-year OS in the training and validation cohorts. CONCLUSIONS We developed and validated a simple and feasible prognostic model for patients with HIV-related DLBCL that had more discriminative and predictive accuracy than the IPI score for risk stratification and individualized treatment in the cART era.
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Affiliation(s)
- Juanjuan Chen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yihua Wu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zixin Kang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shanfang Qin
- Guangxi AIDS Diagnosis and Treatment Quality Control Center, Longtan Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Guangjing Ruan
- Guangxi AIDS Clinical Treatment Center, The Fourth People's Hospital of Nanning, Nanning, China
| | - Han Zhao
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xin Tao
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhiman Xie
- Guangxi AIDS Clinical Treatment Center, The Fourth People's Hospital of Nanning, Nanning, China
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
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14
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Jo JH, Chung HW, Kim SY, Lee MH, So Y. FDG PET/CT Maximum Tumor Dissemination to Predict Recurrence in Patients with Diffuse Large B-Cell Lymphoma. Nucl Med Mol Imaging 2023; 57:26-33. [PMID: 36643943 PMCID: PMC9832207 DOI: 10.1007/s13139-022-00782-2] [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: 06/12/2022] [Revised: 10/19/2022] [Accepted: 10/23/2022] [Indexed: 01/30/2023] Open
Abstract
Purpose We investigated the prognostic value of maximum tumor dissemination (Dmax), the distance between malignant lesions that were farthest apart, as assessed by fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT), and other clinical factors in patients with diffuse large B-cell lymphoma (DLBCL).We investigated the prognostic value of maximum tumor dissemination (Dmax), the distance between malignant lesions that were farthest apart, as assessed by fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT), and other clinical factors in patients with diffuse large B-cell lymphoma (DLBCL). Methods Patients who underwent FDG PET/CT for initial staging and treatment response evaluation of DLBCL were reviewed retrospectively. Baseline Dmax, maximum standardized uptake value, total summation of all metabolic tumor volumes (tMTV), and total summation of all total lesion glycolysis (tTLG) were measured. The treatment response was evaluated at the interim and end of first-line treatment (EOT) using the Deauville score (DS). FDG PET/CT parameters and other clinical factors including sex, age, serum lactate dehydrogenase (LDH) level, stage, performance status, and the International Prognostic Index (IPI) were analyzed to identify factors prognostic of the time to progression (TTP) and disease-specific survival (DSS). Results A total of 63 patients were included. Univariate survival analysis identified Dmax (> 275 mm), tMTV (> 180 mL), tTLG (> 1300), interim DS (≥ 4), and EOT DS (≥ 4) as significant predictors of poor TTP. Serum LDH level (> 640 IU/L), IPI (≥ 4), tMTV (> 180 mL), tTLG (> 1300), interim DS (≥ 4), and EOT DS (≥ 4) were significant predictors of DSS. After multivariate survival analysis, Dmax (P = 0.008) and EOT DS (P = 0.005) were independent predictors of TTP. EOT DS was an independent predictor of DSS (P = 0.029). Conclusions Dmax at the time of diagnosis and the EOT response assessed by FDG PET/CT provide useful prognostic information additive to the IPI in patients with DLBCL.
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Affiliation(s)
- Joon-Hyung Jo
- Department of Nuclear Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, 05030 South Korea
| | - Hyun Woo Chung
- Department of Nuclear Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, 05030 South Korea
- Research Institute of Biomedical Science, Konkuk University School of Medicine, Seoul, 05030 South Korea
| | - Sung-Yong Kim
- Research Institute of Biomedical Science, Konkuk University School of Medicine, Seoul, 05030 South Korea
- Division of Hematology-Oncology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Mark Hong Lee
- Research Institute of Biomedical Science, Konkuk University School of Medicine, Seoul, 05030 South Korea
- Division of Hematology-Oncology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Young So
- Department of Nuclear Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, 05030 South Korea
- Research Institute of Biomedical Science, Konkuk University School of Medicine, Seoul, 05030 South Korea
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15
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Oertel M, Berdel C, Held G, Herfarth K, Schmidberger H, Ernst M, Lenz G, Borchmann P, Eich HT. The new German evidence-based guideline on diffuse large B-cell lymphoma-key aspects for radiation oncologists. Strahlenther Onkol 2023; 199:115-120. [PMID: 36598520 PMCID: PMC9877084 DOI: 10.1007/s00066-022-02035-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/20/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Diffuse large B‑cell lymphoma (DLBCL) is an aggressive lymphoma subtype treated successfully with immunochemotherapy. However, there are conflicting data on the role and impact of consolidative radiation therapy (RT). The publication of the national evidence-based guideline on DLBCL prompted us to review relevant passages on radiation oncology. METHODS The following article reviews the evidence and recommendations given in the current German evidence-based guideline on DLBCL regarding RT and summarizes pivotal aspects. Additional literature is presented to provide a comprehensive background for the published recommendations. RESULTS RT shall be administered to all patients with localized positron emission tomography(PET)-positive residues after completion of immunochemotherapy and should use a dose of 30-40 Gray in normofractionation. For RT planning, PET information before and after immunochemotherapy shall be used, with either a PET-CT in the RT treatment position or an image fusion to the planning CT. Conformal techniques shall be used for target volume coverage, with a risk-benefit evaluation for the individual patient. Additionally, RT may be used in the treatment context of various subtypes of DLBCL as well as in the recurrent or refractory treatment situation. CONCLUSION RT remains an integral part of the treatment repertoire of DLBCL. With the use of PET-guided treatment, RT is indicated for patients with metabolically active tumors. In the context of the ongoing development of targeted therapies, new RT indications may evolve.
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Affiliation(s)
- Michael Oertel
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, building A1, 48149 Muenster, Germany
| | - Christian Berdel
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Gerhard Held
- Department of Hematology/Oncology, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Heinz Schmidberger
- Department of Radiotherapy and Radiation Oncology, University Hospital Mainz, Mainz, Germany
| | - Moritz Ernst
- Evidence-based Oncology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Muenster, Germany
| | - Peter Borchmann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, University Hospital of Cologne, Cologne, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, building A1, 48149 Muenster, Germany
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16
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Vodicka P, Klener P, Trneny M. Diffuse Large B-Cell Lymphoma (DLBCL): Early Patient Management and Emerging Treatment Options. Onco Targets Ther 2022; 15:1481-1501. [PMID: 36510607 PMCID: PMC9739046 DOI: 10.2147/ott.s326632] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) represents a curable disease with a 60-70% chance of cure with current R-CHOP chemoimmunotherapy. However, 30-40% of patients are refractory or relapsing. Many attempts failed to improve the outcome of DLBCL patients, including the intensification of R-CHOP regimen, consolidation, or maintenance therapy since the introduction of R-CHOP in 2000. Better understanding of both molecular biology of lymphoma cells and the tumor microenvironment raised the hope for future improvement of DLBCL patients' survival. Novel molecular findings have initiated clinical trials exploring targeted therapy based on driver genetic alterations with an intent to improve survival of high-risk subsets of patients. But the preliminary results remain ambiguous. The approach "agnostic" to specific molecular alterations of lymphoma cell includes antibody-drug conjugates (especially polatuzumab vedotin), immunotherapy comprising different antibodies with immunomodulatory effect (tafasitamab, lenalidomide), and T-cell engaging therapy (bispecific antibodies, early use of CAR T-cell). This approach could increase the cure rates and change the current therapeutic paradigm. However, better prognostic stratification, smarter designs of clinical trials, modification of endpoints including the use of ctDNA are needed. This review covers the complexity of DLBCL management.
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Affiliation(s)
- Prokop Vodicka
- First Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavel Klener
- First Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Marek Trneny
- First Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic,Correspondence: Marek Trneny, First Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, U Nemocnice 499/2, Prague, 128 08, Czech Republic, Tel +420 224 96 25 27, Fax +420 224 96 35 56, Email
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Salem AE, Shah HR, Covington MF, Koppula BR, Fine GC, Wiggins RH, Hoffman JM, Morton KA. PET-CT in Clinical Adult Oncology: I. Hematologic Malignancies. Cancers (Basel) 2022; 14:cancers14235941. [PMID: 36497423 PMCID: PMC9738711 DOI: 10.3390/cancers14235941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/28/2022] [Accepted: 11/24/2022] [Indexed: 12/03/2022] Open
Abstract
PET-CT is an advanced imaging modality with many oncologic applications, including staging, assessment of response to therapy, restaging and evaluation of suspected recurrence. The goal of this 6-part series of review articles is to provide practical information to providers and imaging professionals regarding the best use of PET-CT for the more common adult malignancies. In the first article of this series, hematologic malignancies are addressed. The classification of these malignancies will be outlined, with the disclaimer that the classification of lymphomas is constantly evolving. Critical applications, potential pitfalls, and nuances of PET-CT imaging in hematologic malignancies and imaging features of the major categories of these tumors are addressed. Issues of clinical importance that must be reported by the imaging professionals are outlined. The focus of this article is on [18F] fluorodeoxyglucose (FDG), rather that research tracers or those requiring a local cyclotron. This information will serve as a resource for the appropriate role and limitations of PET-CT in the clinical management of patients with hematological malignancy for health care professionals caring for adult patients with hematologic malignancies. It also serves as a practical guide for imaging providers, including radiologists, nuclear medicine physicians and their trainees.
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Affiliation(s)
- Ahmed Ebada Salem
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA
- Department of Radiodiagnosis and Intervention, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt
| | - Harsh R. Shah
- Department of Medicine, Division of Hematology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84132, USA
| | - Matthew F. Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA
| | - Bhasker R. Koppula
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA
| | - Gabriel C. Fine
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA
| | - Richard H. Wiggins
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA
| | - John M. Hoffman
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA
| | - Kathryn A. Morton
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA
- Intermountain Healthcare Hospitals, Murray, UT 84123, USA
- Correspondence: ; Tel.: +1-1801-581-7553
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18F-FDG PET-Based Combined Baseline and End-Of-Treatment Radiomics Model Improves the Prognosis Prediction in Diffuse Large B Cell Lymphoma After First-Line Therapy. Acad Radiol 2022:S1076-6332(22)00548-7. [DOI: 10.1016/j.acra.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/22/2022] [Accepted: 10/11/2022] [Indexed: 11/27/2022]
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19
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Campbell BA, Bakst RL, Milgrom SA, Seymour JF. Balancing the Therapeutic Ratio in DLBCL Requires Appropriate, Individualized Patient Selection Rather Than Broad Elimination of Radiation Therapy. Int J Radiat Oncol Biol Phys 2022; 113:479-488. [PMID: 35777387 DOI: 10.1016/j.ijrobp.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Belinda A Campbell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; Department of Clinical Pathology, University of Melbourne, Parkville, Victoria, Australia.
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sarah A Milgrom
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado
| | - John F Seymour
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Ritter Z, Papp L, Zámbó K, Tóth Z, Dezső D, Veres DS, Máthé D, Budán F, Karádi É, Balikó A, Pajor L, Szomor Á, Schmidt E, Alizadeh H. Two-Year Event-Free Survival Prediction in DLBCL Patients Based on In Vivo Radiomics and Clinical Parameters. Front Oncol 2022; 12:820136. [PMID: 35756658 PMCID: PMC9216187 DOI: 10.3389/fonc.2022.820136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/18/2022] [Indexed: 12/11/2022] Open
Abstract
Purpose For the identification of high-risk patients in diffuse large B-cell lymphoma (DLBCL), we investigated the prognostic significance of in vivo radiomics derived from baseline [18F]FDG PET/CT and clinical parameters. Methods Pre-treatment [18F]FDG PET/CT scans of 85 patients diagnosed with DLBCL were assessed. The scans were carried out in two clinical centers. Two-year event-free survival (EFS) was defined. After delineation of lymphoma lesions, conventional PET parameters and in vivo radiomics were extracted. For 2-year EFS prognosis assessment, the Center 1 dataset was utilized as the training set and underwent automated machine learning analysis. The dataset of Center 2 was utilized as an independent test set to validate the established predictive model built by the dataset of Center 1. Results The automated machine learning analysis of the Center 1 dataset revealed that the most important features for building 2-year EFS are as follows: max diameter, neighbor gray tone difference matrix (NGTDM) busyness, total lesion glycolysis, total metabolic tumor volume, and NGTDM coarseness. The predictive model built on the Center 1 dataset yielded 79% sensitivity, 83% specificity, 69% positive predictive value, 89% negative predictive value, and 0.85 AUC by evaluating the Center 2 dataset. Conclusion Based on our dual-center retrospective analysis, predicting 2-year EFS built on imaging features is feasible by utilizing high-performance automated machine learning.
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Affiliation(s)
- Zsombor Ritter
- Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary
| | - László Papp
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - Katalin Zámbó
- Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary
| | - Zoltán Tóth
- University of Kaposvár, PET Medicopus Nonprofit Ltd., Kaposvár, Hungary
| | - Dániel Dezső
- Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary
| | - Dániel Sándor Veres
- Department of Biophysics and Radiation Biology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Domokos Máthé
- Department of Biophysics and Radiation Biology, Faculty of Medicine, Semmelweis University, Budapest, Hungary.,In Vivo Imaging Advanced Core Facility, Hungarian Centre of Excellence for Molecular Medicine, Budapest, Hungary
| | - Ferenc Budán
- Institute of Transdisciplinary Discoveries, Medical School, University of Pécs, Pécs, Hungary.,Institute of Physiology, Medical School, University of Pécs, Pécs, Hungary
| | - Éva Karádi
- Department of Hematology, University of Kaposvár, Kaposvár, Hungary
| | - Anett Balikó
- County Hospital Tolna, János Balassa Hospital, Szekszárd, Hungary
| | - László Pajor
- Department of Pathology, Medical School, University of Pécs, Pécs, Hungary
| | - Árpád Szomor
- 1st Department of Internal Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Erzsébet Schmidt
- Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary
| | - Hussain Alizadeh
- 1st Department of Internal Medicine, Medical School, University of Pécs, Pécs, Hungary
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Desai SH, Pederson L, LaPlant B, Mwangi R, Maurer M, Young JR, Macon WR, King RL, Wang Y, Cerhan JR, Feldman A, Inwards DJ, Micallef I, Johnston P, Porrata LF, Ansell SM, Habermann TM, Witzig TE, Nowakowski GS. PET2 response associated with survival in newly diagnosed diffuse large B-cell lymphoma: results of two independent prospective cohorts. Blood Cancer J 2022; 12:78. [PMID: 35504884 PMCID: PMC9065135 DOI: 10.1038/s41408-022-00649-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/23/2022] [Accepted: 03/14/2022] [Indexed: 02/07/2023] Open
Abstract
Studies evaluating Positron Emission Tomography scan after 2 cycles of chemotherapy (PET2) in newly diagnosed diffuse large B cell lymphoma (DLBCL) are heterogeneous in patient characteristics, treatments and have conflicting results. Here we report association of PET2 with outcomes in two large independent prospective cohorts of newly diagnosed DLBCL pts treated with two RCHOP-based regimens. The discovery cohort consisted of pts enrolled in single arm phase 2 MC078E study of lenalidomide with RCHOP (R2CHOP). The validation cohort consisted of RCHOP-treated pts from the Molecular Epidemiology Resource (MER) cohort. Pts who received 3-6 cycles of therapy and had PET2 were included in the study. Patients who progressed on PET2 were excluded. Revised response criteria 2007 were used to define PET2 response PET2 positive (PET2 + ) pts had inferior EFS [24-month EFS 45.5% vs 87.9%, HR 4.0, CI95 (2.1-7.9), p < 0.0001) with a trend towards lower OS [24-months OS 77% vs 94.8%, HR 2.0, CI95 (0.9-4.8), P = 0.1] than PET2 negative (PET2-) pts in MC078E cohort. PET2 + pts had an inferior EFS (24 month EFS 48.7% vs 81.6%, HR 2.9, CI95 2.0-4.2, p < 0.0001) and OS (24-month OS 68.6% vs 88.1%, HR 2.3, CI95: 1.5-3.5, p < 0.0001) in the MER cohort. These results were consistent regardless of age, sex and in the subgroup of advanced stage and high-risk international prognostic index (IPI). For MER, PET2 + pts also had higher odds of positive end of treatment PET (OR: 17.3 (CI95 7.9-37.7), p < 0.001). PET2 is an early predictor DLBCL pts at high risk of progression and death in two independent prospective cohorts. PET2-guided risk-adapted strategies may improve outcomes, and should be explored in clinical trials.
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Affiliation(s)
- Sanjal H. Desai
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Levi Pederson
- grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Betsy LaPlant
- grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Raphael Mwangi
- grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Matthew Maurer
- grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Jason R. Young
- grid.417467.70000 0004 0443 9942Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Jacksonville, FL USA
| | - William R. Macon
- grid.66875.3a0000 0004 0459 167XDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
| | - Rebecca L. King
- grid.66875.3a0000 0004 0459 167XDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
| | - Yucai Wang
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - James R. Cerhan
- grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Andrew Feldman
- grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - David J. Inwards
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Ivana Micallef
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Patrick Johnston
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Luis F. Porrata
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Stephen M. Ansell
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Thomas M. Habermann
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Thomas E. Witzig
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Grzegorz S. Nowakowski
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
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22
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Ngu H, Takiar R, Phillips T, Okosun J, Sehn LH. Revising the Treatment Pathways in Lymphoma: New Standards of Care-How Do We Choose? Am Soc Clin Oncol Educ Book 2022; 42:1-14. [PMID: 35594501 DOI: 10.1200/edbk_349307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Diffuse large B-cell lymphoma and follicular lymphoma are the most commonly encountered non-Hodgkin lymphomas in clinical practice. Both are biologically heterogeneous, with management strategies that are becoming increasingly complex. Diffuse large B-cell lymphoma typically exhibits aggressive behavior but can be cured in the majority of cases with immunochemotherapy. While R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) has been the standard of care for decades, the recent combination of polatuzumab-vedotin-R-CHP (rituximab plus cyclophosphamide, doxorubicin, and prednisone) has demonstrated improved progression-free survival for patients with intermediate- and intermediate-high-risk disease. Numerous novel therapies, including targeted agents and immunotherapy-based approaches, have recently been approved for relapsed/refractory disease and have led to improved outcomes. Follicular lymphoma is an indolent lymphoma that remains incurable with standard approaches. Overall survival in most patients is excellent, although a proportion of patients will have early relapsing disease and poorer outcomes. The availability of novel agents in the relapsed/refractory setting has shifted the treatment algorithm, which requires thoughtful consideration of sequencing. This article will review recent developments in the treatment of diffuse large B-cell lymphoma and relapsed/refractory follicular lymphoma.
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Affiliation(s)
- Henry Ngu
- BC Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Radhika Takiar
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Tycel Phillips
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Jessica Okosun
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Laurie H Sehn
- BC Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
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23
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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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24
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DLBCL 1L—What to Expect beyond R-CHOP? Cancers (Basel) 2022; 14:cancers14061453. [PMID: 35326604 PMCID: PMC8946010 DOI: 10.3390/cancers14061453] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/26/2022] Open
Abstract
Simple Summary Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive non-Hodgkin’s lymphoma. About two-thirds of patients are cured by the first-line (1L) standard of care (SOC), the R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisolone) immunochemotherapy protocol. The profound molecular heterogeneity of DLBCL is the underlying reason why many patients, despite improved next-line options, eventually succumb to the disease. Hence, enhancing the efficacy of 1L treatment is critical for improving long-term outcomes in DLBCL. A plethora of novel treatment options with potential in later lines is currently under evaluation in 1L settings. We summarize here the established and emerging strategies for newly diagnosed DLBCL and emphasize the need for individualized treatment decisions. Abstract The R-CHOP immunochemotherapy protocol has been the first-line (1L) standard of care (SOC) for diffuse large B-cell lymphoma (DLBCL) patients for decades and is curative in approximately two-thirds of patients. Numerous randomized phase III trials, most of them in an “R-CHOP ± X” design, failed to further improve outcomes. This was mainly due to increased toxicity, the large proportion of patients not in need of more than R-CHOP, and the extensive molecular heterogeneity of the disease, raising the bar for “one-size-fits-all” concepts. Recently, an R-CHP regimen extended by the anti-CD79b antibody–drug conjugate (ADC) Polatuzumab Vedotin proved superior to R-CHOP in terms of progression-free survival (PFS) in the POLARIX phase III trial. Moreover, a number of targeted agents, especially the Bruton’s tyrosine kinase (BTK) inhibitor Ibrutinib, seem to have activity in certain patient subsets in 1L and are currently being tested in front-line regimens. Chimeric antigen receptor (CAR) T-cells, achieving remarkable results in ≥3L scenarios, are being exploited in earlier lines of therapy, while T-cell-engaging bispecific antibodies emerge as conceptual competitors of CAR T-cells. Hence, we present here the findings and lessons learnt from phase III 1L trials and piloting phase II studies in relapsed/refractory (R/R) and 1L settings, and survey chemotherapy-free regimens with respect to their efficacy and future potential in 1L. Novel agents and their mode of action will be discussed in light of the molecular landscape of DLBCL and personalized 1L perspectives for the challenging patient population not cured by the SOC.
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25
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Perrone S, Lopedote P, Levis M, Di Rocco A, Smith SD. Management of relapsed or refractory large B-cell lymphoma in patients ineligible for CAR-T cell therapy. Expert Rev Hematol 2022; 15:215-232. [PMID: 35184664 DOI: 10.1080/17474086.2022.2044778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chimeric antigen receptor T (CAR-T) therapy has revolutionized the treatment of relapsed/refractory large B-cell lymphoma (LBCL). However, patients who are excluded or have no access to CAR-T represent a challenge for clinicians and have generally a dismal outcome. The landscape for this category of patients is constantly evolving: new agents have been approved in the last 2-3 years, alone or in combination, and novel treatment modalities are under investigations. AREAS COVERED Thereafter, we reviewed the currently available therapeutic strategies: conventional chemotherapy, Antibody-drug conjugate ADC (mainly polatuzumab and loncastuxumab), bispecific antibodies (CD19/CD3 and focus on novel CD20/CD3 Abs), immunomodulatory drugs (covering tafasitamab and lenalidomide, checkpoint inhibitors mainly in PMBL), small molecules (selinexor, BTK and PI3K inhibitors), and the role of radiotherapy. EXPERT OPINION Navigating this scenario, will uncover new challenges, including identifying an ideal sequence for these therapies, the most effective combinations, and search for consistent predictive factors to help selecting the appropriate population of LBCL patients. At present, supporting clinical research for CAR-T ineligible patients, a new and challenging group, must remain a major focus that is complementary to advances in CAR T-cell therapy.
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Affiliation(s)
- Salvatore Perrone
- Hematology, Polo Universitario Pontino, S.M. Goretti Hospital, Latina, Italy
| | - Paolo Lopedote
- Internal Medicine, St Elizabeth's Medical Center, Boston University, Boston, U.S
| | - Mario Levis
- Department of Oncology, University of Torino, Torino, Italy
| | - Alice Di Rocco
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Stephen Douglas Smith
- Division of Medical Oncology, Department of Internal Medicine, University of Washington, Seattle, WA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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26
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Husby T, Johansen H, Bogsrud T, Hustad KV, Evensen BV, Boellard R, Giskeødegård GF, Fagerli UM, Eikenes L. A comparison of FDG PET/MR and PET/CT for staging, response assessment, and prognostic imaging biomarkers in lymphoma. Ann Hematol 2022; 101:1077-1088. [PMID: 35174405 PMCID: PMC8993743 DOI: 10.1007/s00277-022-04789-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/08/2022] [Indexed: 12/16/2022]
Abstract
The aim of the current study was to investigate the diagnostic performance of FDG PET/MR compared to PET/CT in a patient cohort including Hodgkins lymphoma, diffuse large B-cell lymphoma, and high-grade B-cell lymphoma at baseline and response assessment. Sixty-one patients were examined with FDG PET/CT directly followed by PET/MR. Images were read by two pairs of nuclear medicine physicians and radiologists. Concordance for lymphoma involvement between PET/MR and the reference standard PET/CT was assessed at baseline and response assessment. Correlation of prognostic biomarkers Deauville score, criteria of response, SUVmax, SUVpeak, and MTV was performed between PET/MR and PET/CT. Baseline FDG PET/MR showed a sensitivity of 92.5% and a specificity 97.9% compared to the reference standard PET/CT (κ 0.91) for nodal sites. For extranodal sites, a sensitivity of 80.4% and a specificity of 99.5% were found (κ 0.84). Concordance in Ann Arbor was found in 57 of 61 patients (κ 0.92). Discrepancies were due to misclassification of region and not lesion detection. In response assessment, a sensitivity of 100% and a specificity 99.9% for all sites combined were found (κ 0.92). There was a perfect agreement on Deauville scores 4 and 5 and criteria of response between the two modalities. Intraclass correlation coefficient (ICC) for SUVmax, SUVpeak, and MTV values showed excellent reliability (ICC > 0.9). FDG PET/MR is a reliable alternative to PET/CT in this patient population, both in terms of lesion detection at baseline staging and response assessment, and for quantitative prognostic imaging biomarkers.
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Affiliation(s)
- Trine Husby
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8905, Trondheim, Norway.,Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Håkon Johansen
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Trond Bogsrud
- PET-Centre, University Hospital of North Norway, Tromsø, Norway.,Aarhus University Hosipital, Aarhus, Denmark
| | - Kari Vekseth Hustad
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Birte Veslemøy Evensen
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ronald Boellard
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands.,Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, University Medical Centers Amsterdam, VUMC, Amsterdam, The Netherlands
| | - Guro F Giskeødegård
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Unn-Merete Fagerli
- Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Live Eikenes
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8905, Trondheim, Norway.
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27
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Jiang H, Li A, Ji Z, Tian M, Zhang H. Role of Radiomics-Based Baseline PET/CT Imaging in Lymphoma: Diagnosis, Prognosis, and Response Assessment. Mol Imaging Biol 2022; 24:537-549. [PMID: 35031945 DOI: 10.1007/s11307-022-01703-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 02/07/2023]
Abstract
Radiomic analysis provides information on the underlying tumour heterogeneity in lymphoma, reflecting the real-time evolution of malignancy. 2-Deoxy-2-[18F] fluoro-D-glucose positron emission tomography ([18F] FDG PET/CT) imaging is recommended before, during, and at the end of treatment for almost all lymphoma patients. This methodology offers high specificity and sensitivity, which can aid in accurate staging and assist in prompt treatment. Pretreatment [18F] FDG PET/CT-based radiomics facilitates improved diagnostic ability, guides individual treatment regimens, and boosts outcome prognosis based on heterogeneity as well as the biological, pathological, and metabolic status of the lymphoma. This technique has attracted considerable attention given its numerous applications in medicine. In the current review, we will briefly describe the basic radiomics workflow and types of radiomic features. Details of current applications of baseline [18F] FDG PET/CT-based radiomics in lymphoma will be discussed, such as differential diagnosis from other primary malignancies, diagnosis of bone marrow involvement, and response and prognostic prediction. We will also describe how this technique provides a unique noninvasive platform to assess tumour heterogeneity. Newly emerging PET radiotracers and multimodality technology will improve diagnostic specificity and further clarify tumor biology and even genetic variations in lymphoma, potentially promoting the development of precision medicine.
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Affiliation(s)
- Han Jiang
- PET-CT Center, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Ang Li
- PET-CT Center, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Zhongyou Ji
- PET-CT Center, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Mei Tian
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China. .,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China. .,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, 8 Hangzhou, Hangzhou, China.
| | - Hong Zhang
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China. .,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China. .,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, 8 Hangzhou, Hangzhou, China. .,College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China. .,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.
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28
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PET imaging of lymphomas. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00047-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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29
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Miller JH, Gilbertson M, MacManus MP, Wirth A, Opat SS, Gregory GP. Salvage radiotherapy is associated with durable response for a subset of patients with limited-stage refractory DLBCL. Blood Adv 2021; 5:5112-5115. [PMID: 34625795 PMCID: PMC9153029 DOI: 10.1182/bloodadvances.2021005061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/03/2021] [Indexed: 02/07/2023] Open
Affiliation(s)
| | - Michael Gilbertson
- Monash Haematology, Monash Health, Melbourne, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Michael P. MacManus
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; and
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Wirth
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; and
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen S. Opat
- Monash Haematology, Monash Health, Melbourne, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Gareth P. Gregory
- Monash Haematology, Monash Health, Melbourne, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
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30
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Iftikhar R, Mir MA, Moosajee M, Rashid K, Bokhari SW, Abbasi AN, Shamsi TS, Ahmed P, Din HU, Chaudhry QUN, Ahmad IN, Shaikh MU, Ali N, Umair M, Khan A, Bangash M, Ahmad U, Sattar W, Zargham A, Shafi A, Shamshad GU, Rizvi Q, Irfan SM, Zaidi U, Naqi N, Mahmood H, Hussain A, Masood AI, Siddiqui N, Masood M, Faheem M, Adil SN, Aziz Z. Diagnosis and Management of Diffuse Large B-Cell Lymphoma: Society of Medical Oncology, Pakistan Society of Hematology, and Pakistan Society of Clinical Oncology Joint Clinical Practice Guideline. JCO Glob Oncol 2021; 7:1647-1658. [PMID: 34898246 PMCID: PMC9812455 DOI: 10.1200/go.21.00320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the commonest non-Hodgkin lymphoma encountered by hematopathologists and oncologists. Management guidelines for DLBCL are developed and published by countries with high income and do not cater for practical challenges faced in resource-constrained settings. This report by a multidisciplinary panel of experts from Pakistan is on behalf of three major national cancer societies: Society of Medical Oncology Pakistan, Pakistan Society of Hematology, and Pakistan Society of Clinical Oncology. The aim is to develop a practical and standardized guideline for managing DLBCL in Pakistan, keeping in view local challenges, which are similar across most of the low- and middle-income countries across the globe. Modified Delphi methodology was used to develop consensus guidelines. Guidelines questions were drafted, and meetings were convened by a steering committee to develop initial recommendations on the basis of local challenges and review of the literature. A consensus panel reviewed the initial draft recommendations and rated the guidelines on a five-point Likert scale; recommendations achieving more than 75% consensus were accepted. Resource grouping initially suggested by Breast Health Global Initiative was applied for resource stratification into basic, limited, and enhanced resource settings. The panel generated consensus ratings for 35 questions of interest and concluded that diagnosis and treatment recommendations in resource-constrained settings need to be based on available resources and management expertise.
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Affiliation(s)
- Raheel Iftikhar
- Armed Forces Bone Marrow Transplant Centre,
Rawalpindi, Pakistan,Raheel Iftikhar, CMH Medical Complex, Armed Forces Bone Marrow
Transplant Centre, Rawalpindi 46000, Pakistan; e-mail:
| | | | | | - Kamran Rashid
- Rashid Nursing Home and Cancer Clinic, Rawalpindi,
Pakistan
| | - Syed Waqas Bokhari
- Shaukat Khanum Memorial Cancer Hospital and Research
Centre, Lahore, Pakistan
| | | | - Tahir Sultan Shamsi
- National Institute of Blood Disease and Bone Marrow
Transplantation, Karachi, Pakistan
| | - Parvez Ahmed
- Quaid e Azam International Hospital, Islamabad,
Pakistan
| | - Hafeez Ud Din
- Armed Forces Institute of Pathology, Rawalpindi,
Pakistan
| | | | | | | | - Natasha Ali
- The Aga Khan University Hospital, Karachi,
Pakistan
| | | | - Amjad Khan
- Combined Military Hospital, Rawalpindi,
Pakistan
| | | | - Usman Ahmad
- Shaukat Khanum Memorial Cancer Hospital and Research
Centre, Lahore, Pakistan
| | | | | | - Azhar Shafi
- Shifa International Hospital, Islamabad,
Pakistan
| | | | - Qurratulain Rizvi
- National Institute of Blood Disease and Bone Marrow
Transplantation, Karachi, Pakistan
| | | | - Uzma Zaidi
- National Institute of Blood Disease and Bone Marrow
Transplantation, Karachi, Pakistan
| | | | - Humera Mahmood
- Nuclear Medicine, Oncology and Radiotherapy
Institute, Islamabad, Pakistan
| | | | | | - Neelam Siddiqui
- Shaukat Khanum Memorial Cancer Hospital and Research
Centre, Lahore, Pakistan
| | | | - Mohammad Faheem
- Nuclear Medicine, Oncology and Radiotherapy
Institute, Islamabad, Pakistan
| | | | - Zeba Aziz
- Hameed Latif Hospital, Lahore,
Pakistan
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Abstract
PURPOSE OF REVIEW Functional imaging with 18FDG-PET-CT has transformed the staging and response assessment of patients with Hodgkin (HL) and non-Hodgkin lymphoma (NHL). Herein, we review the current role and future directions for functional imaging in the management of patients with lymphoma. RECENT FINDINGS Because of its increased sensitivity, PET-CT is the preferred modality for staging of FDG-avid lymphomas. It appears to have a role for interim assessment in patients with HL with adaptive strategies that reduce toxicity in lower risk patients and increase efficacy in those at high risk. Such a role has yet to be demonstrated in other histologies. FDG-PET-CT is also the gold standard for response assessment posttreatment. Newer uses include assessment of total metabolic tumor volume and radiomics in pretreatment prognosis. Whereas PET-CT is more sensitive than other current modalities for staging and response assessment, the future of PET-CT will be in conjunction with other modalities, notably assessment of minimal residual disease and microenvironmental markers to develop risk adaptive strategies to improve the outcome of patients with lymphoma.
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32
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Xiang C, Ni H, Wang Z, Ji B, Wang B, Shi X, Wu W, Liu N, Gu Y, Ma D, Liu H. Agent Repurposing for the Treatment of Advanced Stage Diffuse Large B-Cell Lymphoma Based on Gene Expression and Network Perturbation Analysis. Front Genet 2021; 12:756784. [PMID: 34721544 PMCID: PMC8551569 DOI: 10.3389/fgene.2021.756784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/24/2021] [Indexed: 12/18/2022] Open
Abstract
Over 50% of diffuse large B-cell lymphoma (DLBCL) patients are diagnosed at an advanced stage. Although there are a few therapeutic strategies for DLBCL, most of them are more effective in limited-stage cancer patients. The prognosis of patients with advanced-stage DLBCL is usually poor with frequent recurrence and metastasis. In this study, we aimed to identify gene expression and network differences between limited- and advanced-stage DLBCL patients, with the goal of identifying potential agents that could be used to relieve the severity of DLBCL. Specifically, RNA sequencing data of DLBCL patients at different clinical stages were collected from the cancer genome atlas (TCGA). Differentially expressed genes were identified using DESeq2, and then, weighted gene correlation network analysis (WGCNA) and differential module analysis were performed to find variations between different stages. In addition, important genes were extracted by key driver analysis, and potential agents for DLBCL were identified according to gene-expression perturbations and the Crowd Extracted Expression of Differential Signatures (CREEDS) drug signature database. As a result, 20 up-regulated and 73 down-regulated genes were identified and 79 gene co-expression modules were found using WGCNA, among which, the thistle1 module was highly related to the clinical stage of DLBCL. KEGG pathway and GO enrichment analyses of genes in the thistle1 module indicated that DLBCL progression was mainly related to the NOD-like receptor signaling pathway, neutrophil activation, secretory granule membrane, and carboxylic acid binding. A total of 47 key drivers were identified through key driver analysis with 11 up-regulated key driver genes and 36 down-regulated key diver genes in advanced-stage DLBCL patients. Five genes (MMP1, RAB6C, ACCSL, RGS21 and MOCOS) appeared as hub genes, being closely related to the occurrence and development of DLBCL. Finally, both differentially expressed genes and key driver genes were subjected to CREEDS analysis, and 10 potential agents were predicted to have the potential for application in advanced-stage DLBCL patients. In conclusion, we propose a novel pipeline to utilize perturbed gene-expression signatures during DLBCL progression for identifying agents, and we successfully utilized this approach to generate a list of promising compounds.
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Affiliation(s)
- Chenxi Xiang
- Department of Pathology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Huimin Ni
- Department of Pathology, Xuzhou Medical University, Xuzhou, China
| | - Zhina Wang
- Department of Oncology, Emergency General Hospital, Beijing, China
| | - Binbin Ji
- Genies Beijing Co., Ltd., Beijing, China.,Qingdao Geneis Institute of Big Data Mining and Precision Medicine, Qingdao, China
| | - Bo Wang
- Genies Beijing Co., Ltd., Beijing, China.,Qingdao Geneis Institute of Big Data Mining and Precision Medicine, Qingdao, China
| | - Xiaoli Shi
- Genies Beijing Co., Ltd., Beijing, China.,Qingdao Geneis Institute of Big Data Mining and Precision Medicine, Qingdao, China
| | - Wanna Wu
- Department of Pathology, Xuzhou Medical University, Xuzhou, China
| | - Nian Liu
- Department of Pathology, Xuzhou Medical University, Xuzhou, China
| | - Ying Gu
- Department of Pathology, Xuzhou Medical University, Xuzhou, China
| | - Dongshen Ma
- Department of Pathology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Hui Liu
- Department of Pathology, Xuzhou Medical University, Xuzhou, China
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33
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Phillips EH, Iype R, Wirth A. PET-guided treatment for personalised therapy of Hodgkin lymphoma and aggressive non-Hodgkin lymphoma. Br J Radiol 2021; 94:20210576. [PMID: 34520242 DOI: 10.1259/bjr.20210576] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
FDG-PET scanning has a central role in lymphoma staging and response assessment. There is a growing body of evidence that PET response assessment during and after initial systemic therapy can provide useful prognostic information, and PET response has an evolving role in guiding patient care. This review provides a perspective on the role of PET response assessment for individualised management of patients with the most common aggressive lymphomas, Hodgkin lymphoma and diffuse large B-cell lymphoma.
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Affiliation(s)
- Elizabeth H Phillips
- Division of Cancer Sciences, University of Manchester, Manchester, UK.,Department of Medical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Rohan Iype
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Andrew Wirth
- Department of Clinical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Australia
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34
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Brooks ED, Fang P, Pinnix CC. Salvage radiotherapy for primary refractory and relapsed diffuse large B-Cell lymphoma. Br J Radiol 2021; 94:20210360. [PMID: 34378402 PMCID: PMC8553185 DOI: 10.1259/bjr.20210360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/08/2021] [Accepted: 07/27/2021] [Indexed: 12/13/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, accounting for 30-40% of all non-Hodgkin lymphoma cases and presenting later in life, most often in the sixth decade. Although DLBCL is curable, long-term remission rates are only 60-80%. The most recent major advance in upfront therapy for DLBCL was the monoclonal anti-CD20 antibody rituximab, which was approved in the late 1990s; now, 25 years later, up to 40% of patients will experience primary refractory or relapsed disease, thereby underscoring the importance of salvage therapy. Radiation therapy can be highly effective in DLBCL, both initially as consolidation therapy and later as salvage therapy and is currently being explored in the context of immune and cellular therapies. The aim of this review is to examine the therapeutic approaches for relapsed or refractory DLBCL, with a focus on whether using radiation therapy as salvage therapy can improve the likelihood of cure.
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Affiliation(s)
- Eric D. Brooks
- Department of Radiation Oncology, University of Florida Health Proton Therapy Institute, Jacksonville, FL, United States
| | - Penny Fang
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Chelsea C. Pinnix
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
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35
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Li YH, Zhao YM, Jiang YL, Tang S, Chen MT, Xiao ZZ, Fan W, Hu YY, Zhang X. The prognostic value of end-of-treatment FDG-PET/CT in diffuse large B cell lymphoma: comparison of visual Deauville criteria and a lesion-to-liver SUV max ratio-based evaluation system. Eur J Nucl Med Mol Imaging 2021; 49:1311-1321. [PMID: 34651231 DOI: 10.1007/s00259-021-05581-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/03/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE The aim of this study was to determine a better criterion for end-of-treatment PET (EoT-PET) assessment and prognostic evaluation of patients with diffuse large B cell lymphoma (DLBCL). METHOD EoT-PET scans were assessed using the visual Deauville 5-point scale (5PS) and LLR, the maximum standard uptake value ratio between the lesion and the liver. The cutoff value of LLR was obtained by receiver operator characteristic curve analysis. Patient outcomes were compared using Kaplan-Meier survival analysis. Prognostic indexes of different criteria were compared. Multivariate Cox regression analysis was performed to evaluate the prognostic factors. RESULTS Four hundred forty-nine newly diagnosed DLBCL patients who received rituximab-based immunochemotherapy were included, and the median follow-up duration was 41.4 months. Patients with Deauville score (DS) 4 displayed significantly longer PFS and OS compared with patients with DS 5 (both p < 0.001), and they had significantly shorter PFS (p < 0.01) but similar OS (p = 0.057) compared with patients with DS 1-3. The differences in PFS and OS between groups were all significant whether positive EoT-PET was defined as DS 4-5 or DS 5 (all p < 0.001). The optimal cutoff of LLR was 1.83, and both PFS and OS were significantly different between EoT-PET-positive and EoT-PET-negative patients as defined by the cutoff (both p < 0.001). LLR-based criterion displayed higher specificity, positive predictive value, and accuracy than 5PS-based criterion in the prediction of disease progression and death events. In the multivariate analysis, positive EoT-PET (as defined by LLR) was related to unfavorable PFS and OS (both p < 0.001). Additional treatment was not correlated with outcomes of EoT-PET-negative patients either defined by LLR or 5PS or EoT-PET-positive patients classified by 5PS, but it was the only beneficial factor for OS (p < 0.05) in EoT-PET-positive patients with LLR ≥ 1.83. CONCLUSION The optimal cutoff of LLR may be superior to Deauville criteria in identifying low-risk DLBCL patients with negative EoT-PET after the first-line immunochemotherapy and sparing them the cost and toxicity of additional treatment.
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Affiliation(s)
- Ying-He Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
| | - Yu-Mo Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
| | - Yong-Luo Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
| | - Si Tang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
| | - Mei-Ting Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
| | - Zi-Zheng Xiao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
| | - Wei Fan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China. .,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China.
| | - Ying-Ying Hu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China. .,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China.
| | - Xu Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China. .,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China.
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36
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Jia J, Chen W. Role of radiation therapy in primary tonsil large B cell lymphoma: a SEER-based analysis. Radiat Oncol 2021; 16:193. [PMID: 34600539 PMCID: PMC8487472 DOI: 10.1186/s13014-021-01919-x] [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: 07/12/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
Backgroud Primary tonsil diffuse large B cell lymphoma (PT-DLBCL) is an uncommon disease entity. The role of radiation therapy (RT) in PT-DLBCL is debatable in both the pre- and post- rituximab era. The purpose of this study was to evaluate the treatment outcome and establish a prognostic model in PT-DLBCL based on the Surveillance, Epidemiology, and End Results (SEER) database. Materials and methods Data of 1214 PT-DLBCL patients diagnosed between 1975 and 2016 were extracted from SEER 18. The effect of RT was assessed for the entire cohort and subgroups by stages using univariate, multivariate Cox regression analyses and propensity score matching (PSM). Results The entire cohort included 1043 patients with early-stage (ES) PT-DLBCL and 171 patients with advanced-stage (AS) disease. A decreasing trend of RT utilization in the ES cohort after 2002 was observed. 47.4% of patients in ES received RT, whereas 25.1% in AS underwent RT. RT significantly improved overall survival in both univariate (P < 0.001) and multivariate (P = 0.002) analyses. PSM analysis further validated the survival advantage of RT (P = 0.002). A nomogram was established to predict the potential survival benefit. Subgroup analysis revealed RT was significantly associated with overall survival in ES patients of PT-DLBCL (P = 0.001) and in the rituximab era (P = 0.001) but not in those with AS disease (P = 0.241). Conclusions This population-based study encloses the largest sample of PT-DLBCL to date and demonstrates a favorable survival role of RT in early stages rather than advanced stages. The established nomogram helps to identify high risk patients to improve prognosis.
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Affiliation(s)
- Jing Jia
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Wenming Chen
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
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37
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Wight J, Hamad N, Campbell BA, Ku M, Lee K, Rose H, Armytage T, Latimer M, Lee HP, Lee ST, Dickinson M, Khor R, Verner E. Diffuse large B-cell lymphoma: A consensus practice statement from the Australasian Lymphoma Alliance. Intern Med J 2021; 52:1609-1623. [PMID: 34532916 DOI: 10.1111/imj.15533] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/29/2021] [Accepted: 09/12/2021] [Indexed: 11/28/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma subtype, accounting for 30-40% of lymphoma diagnoses. Though aggressive, cure is achievable in approximately 60% of cases with primary chemo-immunotherapy, and in a further substantial minority by salvage therapy and autologous stem cell transplantation. Despite promising activity in early phase clinical trials, no intensified or novel treatment regimen has improved outcomes over R-CHOP21 in randomised studies. However, there remain several areas of controversy including the most appropriate prognostic markers, CNS prophylaxis and the optimal treatment for patients with high-risk disease. This position statement presents an evidence-based synthesis of the literature for application in Australasian practice. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- J Wight
- Townsville University Hospital, Townsville, Australia.,Austin Health, Heidelberg, Australia.,The University of Melbourne, Melbourne, Australia.,James Cook University, Townsville, Australia
| | - N Hamad
- Department of Haematology, St Vincent's Hospital Sydney, Australia.,School of Medicine, Sydney, University of Notre Dame Australia.,St Vincent's Clinical School, Sydney, University of New South UK
| | - B A Campbell
- Department of Radiation oncology, Peter MacCallum Cancer Centre, Parkville, Victoria.,Department of Clinical Pathology, University of Melbourne, Parkville, Victoria
| | - M Ku
- St Vincent's Hospital, Melbourne, Victoria
| | - K Lee
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Anatomical Pathology Department, NSW Health Pathology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - H Rose
- University Hospital Geelong, Victoria.,School of Medicine, Deakin University Geelong, Victoria
| | - T Armytage
- Department of haematology, Gosford Hospital, Gosford, New South, UK
| | - M Latimer
- Canberra Hospital, Canberra, Australia.,Australian National University, Canberra, Australia
| | - H P Lee
- Flinders Medical Centre, Adelaide, Australia
| | - S T Lee
- Austin Health, Heidelberg, Australia
| | - M Dickinson
- The University of Melbourne, Melbourne, Australia.,Department of Haematology, Peter MacCallum Cancer Centre, Parkville, Victoria
| | - R Khor
- Austin Health, Heidelberg, Australia
| | - E Verner
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Department of Haematology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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38
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Rogasch JMM, Boellaard R, Pike L, Borchmann P, Johnson P, Wolf J, Barrington SF, Kobe C. Moving the goalposts while scoring-the dilemma posed by new PET technologies. Eur J Nucl Med Mol Imaging 2021; 48:2696-2710. [PMID: 33990846 PMCID: PMC8263433 DOI: 10.1007/s00259-021-05403-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 05/06/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Julian M M Rogasch
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Ronald Boellaard
- Radiology and Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam UMC, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Lucy Pike
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK
| | - Peter Borchmann
- German Hodgkin Study Group, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Peter Johnson
- Cancer Research UK Centre, University of Southampton, Southampton, UK
| | - Jürgen Wolf
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital Cologne and University of Cologne, Cologne, Germany
| | - Sally F Barrington
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK
| | - Carsten Kobe
- Department of Nuclear Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
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39
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Wight J, Wai SH, Shen E, Lee ST, Berlangieri S, Fancourt T, Hawkes E, Hannah A, Leung T, Chong G. Predicting primary treatment failure using interim FDG-PET scanning in diffuse large B-cell lymphoma. Eur J Haematol 2021; 107:475-483. [PMID: 34240453 DOI: 10.1111/ejh.13684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/28/2022]
Abstract
Interim FDG-PET (iPET) in diffuse large B-cell lymphoma (DLBCL) is increasingly practised and used in clinical trials to adapt further therapy. However, the optimum timing and methodology of iPET remains controversial. We retrospectively analysed the iPET results and outcomes of 200 DLBCL patients where FDG-PET was routinely performed at baseline, after 2 cycles (iPET2) and at completion of chemoimmunotherapy. iPET was also performed after 4 cycles (iPET4) where at iPET2, Deauville score (DS) was ≥4. Scans were assessed by blinded expert lymphoma PET physicians for DS, maximum standard uptake value (SUVmax), total metabolic tumour volume (TMTV) and total lesion glycolysis (TLG). Treatment failure was defined as death, progression or refractory disease. 95.5% of patients received R-CHOP. No baseline PET parameter was predicted for EFS or OS independent of the NCCN-IPI. The multivariable analysis at iPET2 showed DS5 (19.5% of cases) predicted treatment failure (HR 6.29, 95% CI 3.01-13.17, P < .001), but DS4 was equivalent to DS1-3. At iPET4, ΔSUVmax < 66% predicted treatment failure (HR 5.49, 95% CI 3.03-9.99, P < .001). By multivariable analysis of all time points, high NCCN-IPI and DS5 at iPET2 were negative predictors of survival. These findings were independent of novel prognostic markers.
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Affiliation(s)
- Joel Wight
- Austin Health, Heidelberg, Australia.,Olivia Newton John Cancer Research Institute, Heidelberg, VIC, Australia.,The University of Melbourne, Melbourne, VIC, Australia.,Townsville University Hospital, Townsville, QLD, Australia
| | - Shin Hnin Wai
- Austin Health, Heidelberg, Australia.,Olivia Newton John Cancer Research Institute, Heidelberg, VIC, Australia
| | - Edward Shen
- Austin Health, Heidelberg, Australia.,The University of Melbourne, Melbourne, VIC, Australia
| | - Sze-Ting Lee
- Austin Health, Heidelberg, Australia.,Olivia Newton John Cancer Research Institute, Heidelberg, VIC, Australia.,La Trobe University, Melbourne, VIC, Australia
| | | | | | - Eliza Hawkes
- Austin Health, Heidelberg, Australia.,Olivia Newton John Cancer Research Institute, Heidelberg, VIC, Australia.,The University of Melbourne, Melbourne, VIC, Australia.,La Trobe University, Melbourne, VIC, Australia
| | | | - Teresa Leung
- The Northern Hospital, Melbourne, VIC, Australia
| | - Geoffrey Chong
- Austin Health, Heidelberg, Australia.,Olivia Newton John Cancer Research Institute, Heidelberg, VIC, Australia.,The University of Melbourne, Melbourne, VIC, Australia.,The Northern Hospital, Melbourne, VIC, Australia
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40
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41
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Mercier M, Orvain C, Drieu La Rochelle L, Marchand T, Nunes Gomes C, Giltat A, Paillassa J, Clavert A, Farhi J, Rousselet MC, Gyan E, Houot R, Moles-Moreau MP, Hunault-Berger M. Impact of High-Dose Methotrexate on the Outcome of Patients with Diffuse Large B-Cell Lymphoma and Skeletal Involvement. Cancers (Basel) 2021; 13:cancers13122945. [PMID: 34204600 PMCID: PMC8231126 DOI: 10.3390/cancers13122945] [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: 05/18/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) with extra nodal skeletal involvement is rare. It is currently unclear whether these lymphomas should be treated in the same manner as those without skeletal involvement. We retrospectively analyzed the impact of combining high-dose methotrexate (HD-MTX) with an anthracycline-based regimen and rituximab as first-line treatment in a cohort of 93 patients with DLBCL and skeletal involvement with long follow-up. Fifty patients (54%) received upfront HD-MTX for prophylaxis of CNS recurrence (high IPI score and/or epidural involvement) or because of skeletal involvement. After adjusting for age, ECOG, high LDH levels, and type of skeletal involvement, HD-MTX was associated with an improved PFS and OS (HR: 0.2, 95% CI: 0.1-0.3, p < 0.001 and HR: 0.1, 95% CI: 0.04-0.3, p < 0.001, respectively). Patients who received HD-MTX had significantly better 5-year PFS and OS (77% vs. 39%, p <0.001 and 83 vs. 58%, p < 0.001). Radiotherapy was associated with an improved 5-year PFS (74 vs. 48%, p = 0.02), whereas 5-year OS was not significantly different (79% vs. 66%, p = 0.09). A landmark analysis showed that autologous stem cell transplantation was not associated with improved PFS or OS. The combination of high-dose methotrexate and an anthracycline-based immunochemotherapy is associated with an improved outcome in patients with DLBCL and skeletal involvement and should be confirmed in prospective trials.
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Affiliation(s)
- Mélanie Mercier
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
- Service d’Hématologie, CH Bretagne Atlantique, 56000 Vannes, France
- Correspondence: (M.M.); (C.O.); Tel.: +33-(0)-241-35-44-72 (C.O.); Fax: +33-(0)-241-35-53-81 (C.O.)
| | - Corentin Orvain
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
- Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia (FHU-GOAL), 49033 Angers, France; (L.D.L.R.); (E.G.)
- Université d’Angers, Inserm, CRCINA, 49000 Angers, France
- Correspondence: (M.M.); (C.O.); Tel.: +33-(0)-241-35-44-72 (C.O.); Fax: +33-(0)-241-35-53-81 (C.O.)
| | - Laurianne Drieu La Rochelle
- Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia (FHU-GOAL), 49033 Angers, France; (L.D.L.R.); (E.G.)
- Service d’Hématologie et Thérapie Cellulaire, Centre Hospitalier Universitaire, Université de Tours, 37000 Tours, France
| | - Tony Marchand
- Service d’Hématologie Clinique, CHU de Rennes, 35000 Rennes, France; (T.M.); (R.H.)
| | - Christopher Nunes Gomes
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
| | - Aurélien Giltat
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
| | - Jérôme Paillassa
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
| | - Aline Clavert
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
| | - Jonathan Farhi
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
| | | | - Emmanuel Gyan
- Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia (FHU-GOAL), 49033 Angers, France; (L.D.L.R.); (E.G.)
- Service d’Hématologie et Thérapie Cellulaire, Centre Hospitalier Universitaire, Université de Tours, 37000 Tours, France
| | - Roch Houot
- Service d’Hématologie Clinique, CHU de Rennes, 35000 Rennes, France; (T.M.); (R.H.)
| | - Marie-Pierre Moles-Moreau
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
| | - Mathilde Hunault-Berger
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
- Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia (FHU-GOAL), 49033 Angers, France; (L.D.L.R.); (E.G.)
- Université d’Angers, Inserm, CRCINA, 49000 Angers, France
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Wright CM, Koroulakis AI, Baron JA, Chong EA, Tseng YD, Kurtz G, LaRiviere M, Venigalla S, Jones JA, Maity A, Mohindra P, Plastaras JP, Paydar I. Palliative Radiotherapy for Diffuse Large B-cell Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:650-658. [PMID: 34127417 DOI: 10.1016/j.clml.2021.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/13/2021] [Accepted: 05/09/2021] [Indexed: 11/17/2022]
Abstract
Recent improvements in chemoimmunotherapies, targeted agents, hematopoietic stem cell transplants, and cellular therapies have revolutionized treatment paradigms for patients with diffuse large B-cell lymphoma (DLBCL). Even in the relapsed or refractory setting, contemporary treatment options are delivered with curative intent and can lead to lasting remissions. Although such therapies have improved overall outcomes, they have increasingly led to a wide variety of presentations of recurrent tumors in need of palliation. Here, we review the use of radiotherapy (RT) in the palliation of DLBCL. We draw particular attention to the evolving role for hypofractionated RT and low-dose RT for DLBCL. We review the available literature on these topics and focus on commonly encountered clinical scenarios.
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Affiliation(s)
- Christopher M Wright
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Antony I Koroulakis
- Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA
| | - Jonathan A Baron
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Elise A Chong
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Yolanda D Tseng
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Goldie Kurtz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael LaRiviere
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sriram Venigalla
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua A Jones
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Amit Maity
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA
| | - John P Plastaras
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ima Paydar
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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43
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Abstract
Large B-cell lymphomas, with an estimated 150,000 new cases annually worldwide, represent almost 30% of all cases of non-Hodgkin’s lymphoma. Patients typically present with progressive lymphadenopathy, extranodal disease, or both and require therapy. Despite the advanced stage at presentation in the majority of patients, more than 60% can be cured with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) immunochemotherapy (Fig. 1A). Patients with treatment failure after R-CHOP often have a poor outcome — in particular, those with disease that is refractory to frontline or subsequent therapies — although some patients can have a durable remission and be cured after secondary therapies. Over the past two decades, improved insights into large B-cell lymphomas, in terms of epidemiology, prognostic factors, and biologic heterogeneity, have led to a refinement of disease classification and the development of new therapeutic approaches.
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Affiliation(s)
- Laurie H Sehn
- From the BC Cancer Centre for Lymphoid Cancer and the University of British Columbia, Vancouver, Canada (L.H.S.); and the Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (G.S.)
| | - Gilles Salles
- From the BC Cancer Centre for Lymphoid Cancer and the University of British Columbia, Vancouver, Canada (L.H.S.); and the Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (G.S.)
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44
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Binkley MS, Hiniker SM, Younes S, Yoo C, Wignarajah A, Jin M, Guo HH, Gupta NK, Natkunam Y, Advani RH, Hoppe RT. Stage I-II diffuse large B-cell lymphoma treated with rituximab and chemotherapy with or without radiotherapy. Leuk Lymphoma 2021; 62:1840-1849. [PMID: 33622155 DOI: 10.1080/10428194.2021.1876859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We set to identify prognostic factors in a retrospective cohort of consecutive patients with stage I-II diffuse large B-cell lymphoma treated with rituximab-chemotherapy with or without radiotherapy from 2001 through 2017 at our institution. We identified 143 patients with median follow-up of 7.7 years. The majority were male (59.4%), had stage II (53.1%), had stage-modified IPI 0-1 (smIPI, 58.1%), and had non-bulky disease (<7 cm, 68.5%). 99 patients (69.2%) received rituximab-chemotherapy followed by radiotherapy, and 44 patients (30.8%) received rituximab-chemotherapy alone. The 5-year progression-free survival (PFS) and overall survival (OS) were 81.2% and 88.9%, respectively. The 5-year PFS for those with smIPI 0-1 versus 2-4 was 89.5% versus 69.7%, respectively (P = 0.005). Bulky disease (≥7 cm) was associated with worse PFS and OS on univariable and multivariable analyses (P < 0.05). Patients with smIPI 0-1 without bulky disease have excellent outcomes. However, patients with smIPI 2-4 or bulky disease have a high risk of progression.
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Affiliation(s)
- Michael S Binkley
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Susan M Hiniker
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Sheren Younes
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Christopher Yoo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Anjali Wignarajah
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Jin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - H Henry Guo
- Department of Nuclear Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Neel K Gupta
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Yasodha Natkunam
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ranjana H Advani
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Richard T Hoppe
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
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