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AlShehry NF, Shanker R, Zaidi SZA, AlGhmlas F, Motabi IH, Iqbal S, Butt AA, AlShehri H, Tailor IK, Altaf SY, AlGhamdi M, Marie M, AlFayez M, Al Zahrani K, Dwaimah M, Al-Halouli T, Al-Shakweer W, AlShehery MZ, Zaidi ARZ, Gill AM, Albtoosh BM, Ahmed M. Role of 18F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography Imaging in the Prediction of Prognosis in Patients With Indolent Lymphoma: Prospective Study. JMIR Form Res 2021; 5:e24936. [PMID: 34508363 PMCID: PMC8663482 DOI: 10.2196/24936] [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: 10/10/2020] [Revised: 07/23/2021] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The role of fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in indolent lymphoma has been minimally studied. OBJECTIVE This study aims to assess the value of FDG-PET/CT in predicting the prognosis of indolent lymphoma. METHODS We prospectively recruited 42 patients with indolent lymphoma. A total of 2 patients were excluded, and 40 underwent baseline PET/CT and follow-up at various time points. A total of 9 patients were observed only, 7 received 4 doses of rituximab alone, and 24 received chemoimmunotherapy. Metabolic response on follow-up PET/CT was assessed using the maximum standardized uptake value (SUVmax) and Deauville criteria (DC). We aimed to obtain the best SUVmax and DC to predict optimal survival rates, risk stratification, and optimize therapeutic strategies. The mean follow-up from the initial diagnosis was 33.83 months. RESULTS SUVmax <4.35 at interim PET/CT provided the best discrimination, with a progression-free survival (PFS) of 100% and a median survival time of 106.67 months compared with SUVmax ≥4.35 (P=.04), which had a PFS of 43.8% and a median survival time of 50.17 months. This cutoff was also valuable in predicting overall survival at baseline, that is, 100% overall survival with baseline SUVmax <4.35, versus 58.4% for SUVmax ≥4.35 (P=.13). The overall survival of patients with a baseline DC score <3.0 was 100%, with a median overall survival of 106.67 months. CONCLUSIONS We demonstrated the utility of PET/CT in indolent lymphomas. SUVmax (<4.35 vs ≥4.35) on interim PET/CT performed best in predicting PFS.
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Affiliation(s)
- Nawal Faiez AlShehry
- Department of Adult Hematology/Bone Marrow Transplantation, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Raja Shanker
- Department of Radiology and Nuclear Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Syed Ziauddin Ahmed Zaidi
- Department of Adult Hematology/Bone Marrow Transplantation, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fahad AlGhmlas
- Department of Radiology and Nuclear Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ibraheem Hussein Motabi
- Department of Adult Hematology/Bone Marrow Transplantation, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shahid Iqbal
- Department of Adult Hematology/Bone Marrow Transplantation, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmad Ali Butt
- Department of Adult Hematology/Bone Marrow Transplantation, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hassan AlShehri
- Department of Adult Hematology/Bone Marrow Transplantation, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Imran Khan Tailor
- Department of Adult Hematology/Bone Marrow Transplantation, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Syed Yasir Altaf
- Department of Adult Hematology/Bone Marrow Transplantation, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mubarak AlGhamdi
- Department of Adult Hematology/Bone Marrow Transplantation, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Marie
- Department of Adult Hematology/Bone Marrow Transplantation, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mansour AlFayez
- Department of Adult Hematology/Bone Marrow Transplantation, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Kamal Al Zahrani
- Department of Adult Hematology/Bone Marrow Transplantation, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Dwaimah
- Department of Adult Hematology/Bone Marrow Transplantation, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tahani Al-Halouli
- Department of Pathology and Laboratory Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Wafaa Al-Shakweer
- Department of Pathology and Laboratory Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Abdul Rehman Zia Zaidi
- Department of Adult Hematology/Bone Marrow Transplantation, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Atta Munawar Gill
- Department of Adult Hematology/Bone Marrow Transplantation, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Belal Mohammed Albtoosh
- Department of Adult Hematology/Bone Marrow Transplantation, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Musab Ahmed
- Department of Radiology and Nuclear Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
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Lockmer S, Østenstad B, Hagberg H, Holte H, Johansson AS, Wahlin BE, Wader KF, Steen CB, Meyer P, Maisenhølder M, Smedby KE, Brown P, Kimby E. Chemotherapy-Free Initial Treatment of Advanced Indolent Lymphoma Has Durable Effect With Low Toxicity: Results From Two Nordic Lymphoma Group Trials With More Than 10 Years of Follow-Up. J Clin Oncol 2018; 36:JCO1800262. [PMID: 30285560 DOI: 10.1200/jco.18.00262] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
PURPOSE For indolent lymphoma, the optimal timing, sequence, and choice of therapeutic regimens remain a matter of debate. In two Nordic Lymphoma Group randomized trials, symptomatic or clearly progressing patients were treated first line with a rituximab-containing regimen without chemotherapy. The purpose of this study was to assess long-term survival, risk of transformation, and need of new therapies. METHODS Data were collected at cross-sectional follow-up for 321 patients with indolent lymphoma (84% with follicular lymphomas [FL]) included in one of two Nordic Lymphoma Group trials (accrual 1998 to 1999 and 2002 to 2008). All patients received first-line therapy with one or two cycles of four weekly infusions of rituximab 375 mg/m2, and 148 were randomly allocated to the addition of interferon alfa-2a. Follow-up data were retrieved from initial trial databases and medical records on repeated clinical evaluations. RESULTS At the end of follow-up, 73% of patients were alive, with a median follow-up after random assignment of 10.6 years. Among all, 36% (38% with FL) had never needed chemotherapy. For patients with FL who required new therapy within 24 months because of early disease progression, the 10-year survival rate was 59% versus 81% for those with longer remission. Interferon was not shown to improve long-term outcome. Transformation was diagnosed in 20% of all patients (2.4% per person-year) and in 18% with FL. An additional malignancy was found in 12%. CONCLUSION Approximately one third of patients with symptomatic indolent lymphoma (30% with FL, 23% without FL) did not need new therapy in the long term after first-line rituximab without chemotherapy. In the entire cohort, 10-year survival was excellent with no major safety issues, which suggests that chemotherapy can be delayed safely in the majority of patients.
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Affiliation(s)
- Sandra Lockmer
- Sandra Lockmer, Björn Engelbrekt Wahlin, Karin Ekström Smedby, and Eva Kimby, Karolinska Institutet; Sandra Lockmer, Björn Engelbrekt Wahlin, and Karin Ekström Smedby, Karolinska University Hospital, Stockholm; Hans Hagberg, Academic Hospital, Uppsala; Ann-Sofie Johansson, Norrlands University Hospital, Umeå, Sweden; Bjørn Østenstad and Harald Holte, Oslo University Hospital; Chloé Beate Steen, University of Oslo, Oslo; Karin Fahl Wader, St Olavs Hospital, Trondheim; Peter Meyer, Stavanger University Hospital, Stavanger; Martin Maisenhølder, University Hospital of Northern Norway, Tromsø, Norway; and Peter Brown, Rigshospitalet, Copenhagen, Denmark
| | - Bjørn Østenstad
- Sandra Lockmer, Björn Engelbrekt Wahlin, Karin Ekström Smedby, and Eva Kimby, Karolinska Institutet; Sandra Lockmer, Björn Engelbrekt Wahlin, and Karin Ekström Smedby, Karolinska University Hospital, Stockholm; Hans Hagberg, Academic Hospital, Uppsala; Ann-Sofie Johansson, Norrlands University Hospital, Umeå, Sweden; Bjørn Østenstad and Harald Holte, Oslo University Hospital; Chloé Beate Steen, University of Oslo, Oslo; Karin Fahl Wader, St Olavs Hospital, Trondheim; Peter Meyer, Stavanger University Hospital, Stavanger; Martin Maisenhølder, University Hospital of Northern Norway, Tromsø, Norway; and Peter Brown, Rigshospitalet, Copenhagen, Denmark
| | - Hans Hagberg
- Sandra Lockmer, Björn Engelbrekt Wahlin, Karin Ekström Smedby, and Eva Kimby, Karolinska Institutet; Sandra Lockmer, Björn Engelbrekt Wahlin, and Karin Ekström Smedby, Karolinska University Hospital, Stockholm; Hans Hagberg, Academic Hospital, Uppsala; Ann-Sofie Johansson, Norrlands University Hospital, Umeå, Sweden; Bjørn Østenstad and Harald Holte, Oslo University Hospital; Chloé Beate Steen, University of Oslo, Oslo; Karin Fahl Wader, St Olavs Hospital, Trondheim; Peter Meyer, Stavanger University Hospital, Stavanger; Martin Maisenhølder, University Hospital of Northern Norway, Tromsø, Norway; and Peter Brown, Rigshospitalet, Copenhagen, Denmark
| | - Harald Holte
- Sandra Lockmer, Björn Engelbrekt Wahlin, Karin Ekström Smedby, and Eva Kimby, Karolinska Institutet; Sandra Lockmer, Björn Engelbrekt Wahlin, and Karin Ekström Smedby, Karolinska University Hospital, Stockholm; Hans Hagberg, Academic Hospital, Uppsala; Ann-Sofie Johansson, Norrlands University Hospital, Umeå, Sweden; Bjørn Østenstad and Harald Holte, Oslo University Hospital; Chloé Beate Steen, University of Oslo, Oslo; Karin Fahl Wader, St Olavs Hospital, Trondheim; Peter Meyer, Stavanger University Hospital, Stavanger; Martin Maisenhølder, University Hospital of Northern Norway, Tromsø, Norway; and Peter Brown, Rigshospitalet, Copenhagen, Denmark
| | - Ann-Sofie Johansson
- Sandra Lockmer, Björn Engelbrekt Wahlin, Karin Ekström Smedby, and Eva Kimby, Karolinska Institutet; Sandra Lockmer, Björn Engelbrekt Wahlin, and Karin Ekström Smedby, Karolinska University Hospital, Stockholm; Hans Hagberg, Academic Hospital, Uppsala; Ann-Sofie Johansson, Norrlands University Hospital, Umeå, Sweden; Bjørn Østenstad and Harald Holte, Oslo University Hospital; Chloé Beate Steen, University of Oslo, Oslo; Karin Fahl Wader, St Olavs Hospital, Trondheim; Peter Meyer, Stavanger University Hospital, Stavanger; Martin Maisenhølder, University Hospital of Northern Norway, Tromsø, Norway; and Peter Brown, Rigshospitalet, Copenhagen, Denmark
| | - Björn Engelbrekt Wahlin
- Sandra Lockmer, Björn Engelbrekt Wahlin, Karin Ekström Smedby, and Eva Kimby, Karolinska Institutet; Sandra Lockmer, Björn Engelbrekt Wahlin, and Karin Ekström Smedby, Karolinska University Hospital, Stockholm; Hans Hagberg, Academic Hospital, Uppsala; Ann-Sofie Johansson, Norrlands University Hospital, Umeå, Sweden; Bjørn Østenstad and Harald Holte, Oslo University Hospital; Chloé Beate Steen, University of Oslo, Oslo; Karin Fahl Wader, St Olavs Hospital, Trondheim; Peter Meyer, Stavanger University Hospital, Stavanger; Martin Maisenhølder, University Hospital of Northern Norway, Tromsø, Norway; and Peter Brown, Rigshospitalet, Copenhagen, Denmark
| | - Karin Fahl Wader
- Sandra Lockmer, Björn Engelbrekt Wahlin, Karin Ekström Smedby, and Eva Kimby, Karolinska Institutet; Sandra Lockmer, Björn Engelbrekt Wahlin, and Karin Ekström Smedby, Karolinska University Hospital, Stockholm; Hans Hagberg, Academic Hospital, Uppsala; Ann-Sofie Johansson, Norrlands University Hospital, Umeå, Sweden; Bjørn Østenstad and Harald Holte, Oslo University Hospital; Chloé Beate Steen, University of Oslo, Oslo; Karin Fahl Wader, St Olavs Hospital, Trondheim; Peter Meyer, Stavanger University Hospital, Stavanger; Martin Maisenhølder, University Hospital of Northern Norway, Tromsø, Norway; and Peter Brown, Rigshospitalet, Copenhagen, Denmark
| | - Chloé Beate Steen
- Sandra Lockmer, Björn Engelbrekt Wahlin, Karin Ekström Smedby, and Eva Kimby, Karolinska Institutet; Sandra Lockmer, Björn Engelbrekt Wahlin, and Karin Ekström Smedby, Karolinska University Hospital, Stockholm; Hans Hagberg, Academic Hospital, Uppsala; Ann-Sofie Johansson, Norrlands University Hospital, Umeå, Sweden; Bjørn Østenstad and Harald Holte, Oslo University Hospital; Chloé Beate Steen, University of Oslo, Oslo; Karin Fahl Wader, St Olavs Hospital, Trondheim; Peter Meyer, Stavanger University Hospital, Stavanger; Martin Maisenhølder, University Hospital of Northern Norway, Tromsø, Norway; and Peter Brown, Rigshospitalet, Copenhagen, Denmark
| | - Peter Meyer
- Sandra Lockmer, Björn Engelbrekt Wahlin, Karin Ekström Smedby, and Eva Kimby, Karolinska Institutet; Sandra Lockmer, Björn Engelbrekt Wahlin, and Karin Ekström Smedby, Karolinska University Hospital, Stockholm; Hans Hagberg, Academic Hospital, Uppsala; Ann-Sofie Johansson, Norrlands University Hospital, Umeå, Sweden; Bjørn Østenstad and Harald Holte, Oslo University Hospital; Chloé Beate Steen, University of Oslo, Oslo; Karin Fahl Wader, St Olavs Hospital, Trondheim; Peter Meyer, Stavanger University Hospital, Stavanger; Martin Maisenhølder, University Hospital of Northern Norway, Tromsø, Norway; and Peter Brown, Rigshospitalet, Copenhagen, Denmark
| | - Martin Maisenhølder
- Sandra Lockmer, Björn Engelbrekt Wahlin, Karin Ekström Smedby, and Eva Kimby, Karolinska Institutet; Sandra Lockmer, Björn Engelbrekt Wahlin, and Karin Ekström Smedby, Karolinska University Hospital, Stockholm; Hans Hagberg, Academic Hospital, Uppsala; Ann-Sofie Johansson, Norrlands University Hospital, Umeå, Sweden; Bjørn Østenstad and Harald Holte, Oslo University Hospital; Chloé Beate Steen, University of Oslo, Oslo; Karin Fahl Wader, St Olavs Hospital, Trondheim; Peter Meyer, Stavanger University Hospital, Stavanger; Martin Maisenhølder, University Hospital of Northern Norway, Tromsø, Norway; and Peter Brown, Rigshospitalet, Copenhagen, Denmark
| | - Karin Ekström Smedby
- Sandra Lockmer, Björn Engelbrekt Wahlin, Karin Ekström Smedby, and Eva Kimby, Karolinska Institutet; Sandra Lockmer, Björn Engelbrekt Wahlin, and Karin Ekström Smedby, Karolinska University Hospital, Stockholm; Hans Hagberg, Academic Hospital, Uppsala; Ann-Sofie Johansson, Norrlands University Hospital, Umeå, Sweden; Bjørn Østenstad and Harald Holte, Oslo University Hospital; Chloé Beate Steen, University of Oslo, Oslo; Karin Fahl Wader, St Olavs Hospital, Trondheim; Peter Meyer, Stavanger University Hospital, Stavanger; Martin Maisenhølder, University Hospital of Northern Norway, Tromsø, Norway; and Peter Brown, Rigshospitalet, Copenhagen, Denmark
| | - Peter Brown
- Sandra Lockmer, Björn Engelbrekt Wahlin, Karin Ekström Smedby, and Eva Kimby, Karolinska Institutet; Sandra Lockmer, Björn Engelbrekt Wahlin, and Karin Ekström Smedby, Karolinska University Hospital, Stockholm; Hans Hagberg, Academic Hospital, Uppsala; Ann-Sofie Johansson, Norrlands University Hospital, Umeå, Sweden; Bjørn Østenstad and Harald Holte, Oslo University Hospital; Chloé Beate Steen, University of Oslo, Oslo; Karin Fahl Wader, St Olavs Hospital, Trondheim; Peter Meyer, Stavanger University Hospital, Stavanger; Martin Maisenhølder, University Hospital of Northern Norway, Tromsø, Norway; and Peter Brown, Rigshospitalet, Copenhagen, Denmark
| | - Eva Kimby
- Sandra Lockmer, Björn Engelbrekt Wahlin, Karin Ekström Smedby, and Eva Kimby, Karolinska Institutet; Sandra Lockmer, Björn Engelbrekt Wahlin, and Karin Ekström Smedby, Karolinska University Hospital, Stockholm; Hans Hagberg, Academic Hospital, Uppsala; Ann-Sofie Johansson, Norrlands University Hospital, Umeå, Sweden; Bjørn Østenstad and Harald Holte, Oslo University Hospital; Chloé Beate Steen, University of Oslo, Oslo; Karin Fahl Wader, St Olavs Hospital, Trondheim; Peter Meyer, Stavanger University Hospital, Stavanger; Martin Maisenhølder, University Hospital of Northern Norway, Tromsø, Norway; and Peter Brown, Rigshospitalet, Copenhagen, Denmark
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