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Minamimoto R, Fayad L, Vose J, Meza J, Advani R, Hankins J, Mottaghy F, Macapinlac H, Heinzel A, Juweid ME, Quon A. 18F-Fluorothymidine PET is an early and superior predictor of progression-free survival following chemoimmunotherapy of diffuse large B cell lymphoma: a multicenter study. Eur J Nucl Med Mol Imaging 2021; 48:2883-2893. [PMID: 33909086 PMCID: PMC8263539 DOI: 10.1007/s00259-021-05353-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/04/2021] [Indexed: 12/14/2022]
Abstract
Purpose To determine whether interim 3′-deoxy-3′-[18F]fluorothymidine (iFLT) PET/CT is a superior predictor of progression-free survival (PFS) compared with interim 18F-fluorodeoxyglucose (iFDG) PET/CT in patients with diffuse large B cell lymphoma (DLBCL) treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (R-EPOCH). Methods Ninety-two prospectively enrolled patients with DLBCL underwent both FLT-PET/CT and FDG-PET/CT 18–24 days after two cycles of R-CHOP/R-EPOCH. Deauville-criteria, PERCIST1.0, standardized uptake value (SUV), total lesion glycolysis (TLG), and metabolic tumor volume were used to interpret iFDG-PET/CT while dichotomous visual interpretation was used to interpret iFLT-PET/CT and the results were compared with the 3- and 5-year PFS. Results iFLT-PET/CT was negative in 67 (73%) and positive in 25 (27%) patients. iFDG-PET/CT by Deauville criteria was negative (Deauville scores [DS] of 1–3) in 53 (58%) and positive (DS = 4–5) in 39 (42%) patients. Of the 67 iFLT-PET/CT-negative patients, 7 (10.4%) progressed at a median of 14.1 months whereas 14/25 (56.0%) iFLT-PET/CT-positive patients progressed at a median of 7.8 months (P < .0001). Of the 53 Deauville-negative patients, 9 (17.0%) progressed at a median of 14.1 months whereas 12/39 (30.8%) Deauville-positive patients progressed at a median of 5.6 months (P = .11). In multivariate analysis, including iFLT-PET/CT, PERCIST, interim TLG, and interim SUVmax, only iFLT-PET/CT was an independent predictor for 3- and 5-year PFS (P < .0001 and P = .001, respectively). Conclusions In patients with DLBCL given R-CHOP/R-EPOCH, iFLT-PET/CT is a superior independent predictor of outcome compared with iFDG-PET/CT. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05353-9.
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Affiliation(s)
- Ryogo Minamimoto
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University Medical Center, Stanford, CA, USA.,Division of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Luis Fayad
- Departments of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Julie Vose
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jane Meza
- Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, NE, USA
| | - Ranjana Advani
- Division of Medical Oncology, Department of Internal Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Jordan Hankins
- Department of Radiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Felix Mottaghy
- Departments of Nuclear Medicine and Oncology, Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Germany.,Cologne and Duesseldorf and Comprehensive Diagnostic Center Aachen (CDCA), University Hospital of Aachen, Aachen, Germany
| | - Homer Macapinlac
- Department of Nuclear Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Alexander Heinzel
- Departments of Nuclear Medicine and Oncology, Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Germany.,Cologne and Duesseldorf and Comprehensive Diagnostic Center Aachen (CDCA), University Hospital of Aachen, Aachen, Germany
| | - Malik E Juweid
- Department of Radiology and Nuclear Medicine, University of Jordan, Queen Rania Street, Al Jubeiha, Amman, 11942, Jordan.
| | - Andrew Quon
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University Medical Center, Stanford, CA, USA.,Division of Nuclear Medicine and Molecular Imaging, Department of Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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