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Li C, Yu H, Chen X, Han S, Peng S, Lei T, Yang H. The Prognostic Utility of 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography-Based Analyses of Metabolic Response Rates in Newly Diagnosed Diffuse Large B Cell Lymphoma Patients. Front Oncol 2022; 12:772773. [PMID: 35677166 PMCID: PMC9167950 DOI: 10.3389/fonc.2022.772773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundRoughly one third of diffuse large B cell lymphoma (DLBCL) patients experience relapsed or refractory disease, and their prognosis is unsatisfactory. It is thus important to identify patients who respond poorly to first-line treatment. Some studies have evaluated the prognostic value of interim PET-CT (iPET-CT) or end-of-treatment PET-CT (ePET-CT) in lymphoma patients, but there have been few studies exploring the prognostic value of metabolic response rates in the evaluation of DLBCL patients.MethodsConsecutive newly diagnosed DLBCL patients were screened from March 2013 to June 2020. Patients received at least four cycles of chemotherapy, and underwent baseline, iPET-CT and ePET-CT scanning. Kaplan-Meier survival curves with log-rank tests were employed to assess survival outcomes including overall survival (OS) and progression-free survival (PFS). Independent predictors of survival were identified through univariable and multivariable Cox regression analyses.Results307 patients were evaluated. At the time of iPET-CT scanning, 250, 45, and 12 patients exhibited complete response (CR), partial response (PR), and stable disease (SD)/progressive disease (PD), respectively. The percentage of negative iPET-CT was 81.4% (250/307). Among 295 patients with ePET-CT, 262 (88.8%) achieved negativity and 33 (11.2%) exhibited positivity including 26 PR and 7 PD. The 2-year PFS and 2-year OS for patients with iPET-CT positivity were 50.7% and 76.5%, respectively, and were significantly shorter than those for patients with iPET-CT negativity (2-year PFS 82.7%, p<0.001; 2-year OS 94.2%, p<0.001). Patients with ePET-CT positivity had significant poorer 2-year PFS (48.1%) and 2-year OS (78.5%) compared with those ePET-CT negativity (2-year PFS 83.8%, p<0.001; 2-year OS 94.9%, p<0.001). The positivity rates on iPET-CT and ePET-CT evaluation were significantly higher in patients in the high/high-intermediate risk group compared with patients in the low/low-intermediate group. In a multivariable analysis, high/high-intermediate international prognostic index (IPI) and ePET-CT positivity were independently associated with poor PFS and OS.ConclusionsOur results suggest that the speed of metabolic response to treatment is of limited prognostic value in newly diagnosed DLBCL patients. Patients exhibiting PR at iPET-CT evaluation should carefully consider whether to change chemotherapy regimen.
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Affiliation(s)
- Cong Li
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Haifeng Yu
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Xi Chen
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Shuiyun Han
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Shuailing Peng
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Tao Lei
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Haiyan Yang
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
- *Correspondence: Haiyan Yang,
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Mamot C, Klingbiel D, Hitz F, Renner C, Pabst T, Driessen C, Mey U, Pless M, Bargetzi M, Krasniqi F, Gigli F, Hany T, Samarin A, Biaggi C, Rusterholz C, Dirnhofer S, Zucca E, Martinelli G. Final Results of a Prospective Evaluation of the Predictive Value of Interim Positron Emission Tomography in Patients With Diffuse Large B-Cell Lymphoma Treated With R-CHOP-14 (SAKK 38/07). J Clin Oncol 2015; 33:2523-9. [DOI: 10.1200/jco.2014.58.9846] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Our main objective was to prospectively determine the prognostic value of [18F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) after two cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone given every 14 days (R-CHOP-14) under standardized treatment and PET evaluation criteria. Patients and Methods Patients with any stage of diffuse large B-cell lymphoma were treated with six cycles of R-CHOP-14 followed by two cycles of rituximab. PET/CT examinations were performed at baseline, after two cycles (and after four cycles if the patient was PET-positive after two cycles), and at the end of treatment. PET/CT examinations were evaluated locally and by central review. The primary end point was event-free survival at 2 years (2-year EFS). Results Median age of the 138 evaluable patients was 58.5 years with a WHO performance status of 0, 1, or 2 in 56%, 36%, or 8% of the patients, respectively. By local assessment, 83 PET/CT scans (60%) were reported as positive and 55 (40%) as negative after two cycles of R-CHOP-14. Two-year EFS was significantly shorter for PET-positive compared with PET-negative patients (48% v 74%; P = .004). Overall survival at 2 years was not significantly different, with 88% for PET-positive versus 91% for PET-negative patients (P = .46). By using central review and the Deauville criteria, 2-year EFS was 41% versus 76% (P < .001) for patients who had interim PET/CT scans after two cycles of R-CHOP-14 and 24% versus 72% (P < .001) for patients who had PET/CT scans at the end of treatment. Conclusion Our results confirmed that an interim PET/CT scan has limited prognostic value in patients with diffuse large B-cell lymphoma homogeneously treated with six cycles of R-CHOP-14 in a large prospective trial. At this point, interim PET/CT scanning is not ready for clinical use to guide treatment decisions in individual patients.
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Affiliation(s)
- Christoph Mamot
- Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos
| | - Dirk Klingbiel
- Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos
| | - Felicitas Hitz
- Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos
| | - Christoph Renner
- Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos
| | - Thomas Pabst
- Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos
| | - Christoph Driessen
- Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos
| | - Ulrich Mey
- Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos
| | - Miklos Pless
- Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos
| | - Mario Bargetzi
- Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos
| | - Fatime Krasniqi
- Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos
| | - Federica Gigli
- Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos
| | - Thomas Hany
- Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos
| | - Andrei Samarin
- Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos
| | - Christine Biaggi
- Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos
| | - Corinne Rusterholz
- Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos
| | - Stephan Dirnhofer
- Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos
| | - Emanuele Zucca
- Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos
| | - Giovanni Martinelli
- Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos
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