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Zwezerijnen GJC, Eertink JJ, Ferrández MC, Wiegers SE, Burggraaff CN, Lugtenburg PJ, Heymans MW, de Vet HCW, Zijlstra JM, Boellaard R. Reproducibility of [18F]FDG PET/CT liver SUV as reference or normalisation factor. Eur J Nucl Med Mol Imaging 2023; 50:486-493. [PMID: 36166080 PMCID: PMC9816285 DOI: 10.1007/s00259-022-05977-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/15/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Although visual and quantitative assessments of [18F]FDG PET/CT studies typically rely on liver uptake value as a reference or normalisation factor, consensus or consistency in measuring [18F]FDG uptake is lacking. Therefore, we evaluate the variation of several liver standardised uptake value (SUV) measurements in lymphoma [18F]FDG PET/CT studies using different uptake metrics. METHODS PET/CT scans from 34 lymphoma patients were used to calculate SUVmaxliver, SUVpeakliver and SUVmeanliver as a function of (1) volume-of-interest (VOI) size, (2) location, (3) imaging time point and (4) as a function of total metabolic tumour volume (MTV). The impact of reconstruction protocol on liver uptake is studied on 15 baseline lymphoma patient scans. The effect of noise on liver SUV was assessed using full and 25% count images of 15 lymphoma scans. RESULTS Generally, SUVmaxliver and SUVpeakliver were 38% and 16% higher compared to SUVmeanliver. SUVmaxliver and SUVpeakliver increased up to 31% and 15% with VOI size while SUVmeanliver remained unchanged with the lowest variability for the largest VOI size. Liver uptake metrics were not affected by VOI location. Compared to baseline, liver uptake metrics were 15-18% and 9-18% higher at interim and EoT PET, respectively. SUVliver decreased with larger total MTVs. SUVmaxliver and SUVpeakliver were affected by reconstruction protocol up to 62%. SUVmax and SUVpeak moved 22% and 11% upward between full and 25% count images. CONCLUSION SUVmeanliver was most robust against VOI size, location, reconstruction protocol and image noise level, and is thus the most reproducible metric for liver uptake. The commonly recommended 3 cm diameter spherical VOI-based SUVmeanliver values were only slightly more variable than those seen with larger VOI sizes and are sufficient for SUVmeanliver measurements in future studies. TRIAL REGISTRATION EudraCT: 2006-005,174-42, 01-08-2008.
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Affiliation(s)
- Gerben J C Zwezerijnen
- Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Jakoba J Eertink
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Hematology, Amsterdam, The Netherlands
| | - Maria C Ferrández
- Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Sanne E Wiegers
- Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Coreline N Burggraaff
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Hematology, Amsterdam, The Netherlands
| | | | - Martijn W Heymans
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Methodology, Amsterdam, The Netherlands
| | - Henrica C W de Vet
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Methodology, Amsterdam, The Netherlands
| | - Josée M Zijlstra
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Hematology, Amsterdam, The Netherlands
| | - Ronald Boellaard
- Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands.
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Burggraaff CN, Eertink JJ, Lugtenburg PJ, Hoekstra OS, Arens AI, de Keizer B, Heymans MW, van der Holt B, Wiegers SE, Pieplenbosch S, Boellaard R, de Vet HC, Zijlstra JM. 18F-FDG PET Improves Baseline Clinical Predictors of Response in Diffuse Large B-Cell Lymphoma: The HOVON-84 Study. J Nucl Med 2022; 63:1001-1007. [PMID: 34675112 PMCID: PMC9258573 DOI: 10.2967/jnumed.121.262205] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 09/29/2021] [Indexed: 01/03/2023] Open
Abstract
We aimed to determine the added value of baseline metabolic tumor volume (MTV) and interim PET (I-PET) to the age-adjusted international prognostic index (aaIPI) to predict 2-y progression-free survival (PFS) in diffuse large B-cell lymphoma. Secondary objectives were to investigate optimal I-PET response criteria (using Deauville score [DS] or quantitative change in SUVmax [ΔSUVmax] between baseline and I-PET4 [observational I-PET scans after 4 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone administered in 2-wk intervals with intensified rituximab in the first 4 cycles [R(R)-CHOP14]). Methods: I-PET4 scans in the HOVON-84 (Hemato-Oncologie voor Volwassenen Nederland [Haemato Oncology Foundation for Adults in the Netherlands]) randomized clinical trial (EudraCT 2006-005174-42) were centrally reviewed using DS (cutoff, 4-5). Additionally, ΔSUVmax (prespecified cutoff, 70%) and baseline MTV were measured. Multivariable hazard ratio (HR), positive predictive value (PPV), and negative predictive value (NPV) were obtained for 2-y PFS. Results: In total, 513 I-PET4 scans were reviewed according to DS, and ΔSUVmax and baseline MTV were available for 367 and 296 patients. The NPV of I-PET ranged between 82% and 86% for all PET response criteria. Univariate HR and PPV were better for ΔSUVmax (4.8% and 53%, respectively) than for DS (3.1% and 38%, respectively). aaIPI and ΔSUVmax independently predicted 2-y PFS (HR, 3.2 and 5.0, respectively); adding MTV brought about a slight improvement. Low or low-intermediate aaIPI combined with a ΔSUVmax of more than 70% (37% of patients) yielded an NPV of 93%, and the combination of high-intermediate or high aaIPI and a ΔSUVmax of 70% or less yielded a PPV of 65%. Conclusion: In this study on diffuse large B-cell lymphoma, I-PET after 4 cycles of R(R)-CHOP14 added predictive value to aaIPI for 2-y PFS, and both were independent response biomarkers in a multivariable Cox model. We externally validated that ΔSUVmax outperformed DS in 2-y PFS prediction.
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Affiliation(s)
- Coreline N. Burggraaff
- Department of Hematology, Amsterdam UMC, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jakoba J. Eertink
- Department of Hematology, Amsterdam UMC, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pieternella J. Lugtenburg
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Otto S. Hoekstra
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anne I.J. Arens
- Department of Radiology, Nuclear Medicine, and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martijn W. Heymans
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; and
| | - Bronno van der Holt
- Department of Hematology, HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Sanne E. Wiegers
- Department of Hematology, Amsterdam UMC, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Simone Pieplenbosch
- Department of Hematology, Amsterdam UMC, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henrica C.W. de Vet
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; and
| | - Josée M. Zijlstra
- Department of Hematology, Amsterdam UMC, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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3
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Greuter M, Eertink JJ, Jongeneel G, Dührsen U, Hüttmann A, Schmitz C, Lugtenburg PJ, Barrington SF, Mikhaeel NG, Ceriani L, Zucca E, Carr R, Györke T, Burggraaff CN, de Vet H, Hoekstra OS, Zijlstra JM, Coupé V. Cost-Effectiveness of Shortening Treatment Duration Based on Interim PET Outcome in Patients With Diffuse Large B-cell Lymphoma. Clin Lymphoma Myeloma Leuk 2022; 22:382-392. [PMID: 34953740 DOI: 10.1016/j.clml.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/14/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Guideline recommendations for diffuse large-B-cell lymphoma (DLBCL) treatment are shifting from long to short treatment duration, although it is still unclear whether shortening treatment duration does not cause any harm. As interim PET (I-PET) has high negative predictive value for progression, we evaluated the cost-effectiveness of shortening treatment duration dependent on I-PET result. MATERIALS AND METHODS We developed a Markov cohort model using the PET Re-Analysis (PETRA) database to evaluate a long treatment duration (LTD) strategy, ie 8x R-CHOP or 6x R-CHOP plus 2 R, and a short treatment duration (STD) strategy, ie 6x R-CHOP. Strategies were evaluated separately in I-PET2 positive and I-PET2 negative patients. Outcomes included total costs and quality-adjusted life-years (QALYs) per patient (pp) from a societal perspective. Net monetary benefit (NMB) per strategy was calculated using a willingness-to-pay threshold of €50,000/QALY. Robustness of model predictions was assessed in sensitivity analyses. RESULTS In I-PET2 positive patients, shortening treatment duration led to 50.4 additional deaths per 1000 patients. The STD strategy was less effective (-0.161 [95%CI: -0.343;0.028] QALYs pp) and less costly (-€2768 [95%CI: -€8420;€1105] pp). Shortening treatment duration was not cost-effective (incremental NMB -€5281). In I-PET2 negative patients, shortening treatment duration led to 5.0 additional deaths per 1000 patients and a minor difference in effectiveness (-0.007 [95%CI: -0.136;0.140] QALY pp). The STD strategy was less costly (-€5807 [95%CI: -€10,724;-€2685] pp) and led to an incremental NMB of €5449, indicating that it is cost-effective to shorten treatment duration. Robustness of these findings was underpinned by deterministic and probabilistic sensitivity analyses. CONCLUSION Treatment duration should not be shortened in I-PET2 positive patients whereas it is cost-effective to shorten treatment duration in I-PET2 negative patients.
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Affiliation(s)
- Mje Greuter
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University, Amsterdam, The Netherlands..
| | - J J Eertink
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - G Jongeneel
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - U Dührsen
- Department of Hematology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - A Hüttmann
- Department of Hematology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - C Schmitz
- Department of Hematology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - P J Lugtenburg
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, department of Hematology, The Netherlands
| | - S F Barrington
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's Health Partners, Kings College London, London, United Kingdom
| | - N G Mikhaeel
- Department of Clinical Oncology, Guy's Cancer Centre and King's College London University, London, United Kingdom
| | - L Ceriani
- Department of Nuclear Medicine and PET/CT Centre, IIMSI - Imaging Institute of Southern Switzerland, Bellinzona, Switzerland;; SAKK - Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - E Zucca
- SAKK - Swiss Group for Clinical Cancer Research, Bern, Switzerland; Medical Oncology Clinics, IOSI - Oncology Institute of Southern Switzerland, Bellinzona; Università della Svizzera Italiana, Bellinzona, Switzerland
| | - R Carr
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust and Cancer Division, Kings College London, London, United Kingdom
| | - T Györke
- Department of Nuclear Medicine, Semmelweis University, Budapest, Hungary
| | - C N Burggraaff
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Hcw de Vet
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - O S Hoekstra
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - J M Zijlstra
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Vmh Coupé
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University, Amsterdam, The Netherlands
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4
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Eertink JJ, Arens AIJ, Huijbregts JE, Celik F, de Keizer B, Stroobants S, de Jong D, Wiegers SE, Zwezerijnen GJC, Burggraaff CN, Boellaard R, de Vet HCW, Hoekstra OS, Lugtenburg PJ, Chamuleau MED, Zijlstra JM. Aberrant patterns of PET response during treatment for DLBCL patients with MYC gene rearrangements. Eur J Nucl Med Mol Imaging 2021; 49:943-952. [PMID: 34476551 PMCID: PMC8803795 DOI: 10.1007/s00259-021-05498-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
Purpose MYC gene rearrangements in diffuse large B-cell lymphoma (DLBCL) patients are associated with poor prognosis. Our aim was to compare patterns of 2[18F]fluoro-2-deoxy-D-glucose positron emission tomography computed tomography (PET/CT) response in MYC + and MYC- DLBCL patients. Methods Interim PET/CT (I-PET) and end of treatment PET/CT (EoT-PET) scans of 81 MYC + and 129 MYC- DLBCL patients from 2 HOVON trials were reviewed using the Deauville 5-point scale (DS). DS1-3 was regarded as negative and DS4-5 as positive. Standardized uptake values (SUV) and metabolic tumor volume (MTV) were quantified at baseline, I-PET, and EoT-PET. Negative (NPV) and positive predictive values (PPV) were calculated using 2-year overall survival. Results MYC + DLBCL patients had significantly more positive EoT-PET scans than MYC- patients (32.5 vs 15.7%, p = 0.004). I-PET positivity rates were comparable (28.8 vs 23.8%). In MYC + patients 23.2% of the I-PET negative patients converted to positive at EoT-PET, vs only 2% for the MYC- patients (p = 0.002). Nine (34.6%) MYC + DLBCL showed initially uninvolved localizations at EoT-PET, compared to one (5.3%) MYC- patient. A total of 80.8% of EoT-PET positive MYC + patients showed both increased lesional SUV and MTV compared to I-PET. In MYC- patients, 31.6% showed increased SUV and 42.1% showed increased MTV. NPV of I-PET and EoT-PET was high for both MYC subgroups (81.8–94.1%). PPV was highest at EoT-PET for MYC + patients (61.5%). Conclusion MYC + DLBCL patients demonstrate aberrant PET response patterns compared to MYC- patients with more frequent progression during treatment after I-PET negative assessment and new lesions at sites that were not initially involved. Trial registration number and date of registration HOVON-84: EudraCT: 2006–005,174-42, retrospectively registered 01–08-2008. HOVON-130: EudraCT: 2014–002,654-39, registered 26–01-2015 Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05498-7.
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Affiliation(s)
- J J Eertink
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - A I J Arens
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands
| | - J E Huijbregts
- Department of Radiology and Nuclear Medicine, Gelre Ziekenhuizen, Albert Schweitzerlaan 31, Apeldoorn, The Netherlands
| | - F Celik
- Department of Radiology and Nuclear Medicine, Deventer Ziekenhuis, Nico Bolkesteinlaan 75, Deventer, The Netherlands
| | - B de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - S Stroobants
- Department of Nuclear Medicine, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - D de Jong
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
| | - S E Wiegers
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - G J C Zwezerijnen
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
| | - C N Burggraaff
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - R Boellaard
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
| | - H C W de Vet
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
| | - O S Hoekstra
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
| | - P J Lugtenburg
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Wytemaweg 80, Rotterdam, The Netherlands
| | - M E D Chamuleau
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - J M Zijlstra
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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Kersten MJ, Driessen J, Zijlstra JM, Plattel WJ, Morschhauser F, Lugtenburg PJ, Brice P, Hutchings M, Gastinne T, Liu R, Burggraaff CN, Nijland M, Tonino SH, Arens AIJ, Valkema R, van Tinteren H, Lopez-Yurda M, Diepstra A, De Jong D, Hagenbeek A. Combining brentuximab vedotin with dexamethasone, high-dose cytarabine and cisplatin as salvage treatment in relapsed or refractory Hodgkin lymphoma: the phase II HOVON/LLPC Transplant BRaVE study. Haematologica 2021; 106:1129-1137. [PMID: 32273476 PMCID: PMC8018114 DOI: 10.3324/haematol.2019.243238] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/19/2020] [Indexed: 12/13/2022] Open
Abstract
Achieving a metabolic complete response (mCR) before high-dose chemotherapy (HDC) and autologous peripheral blood stem-cell transplant (auto-PBSCT) predicts progression free survival (PFS) in relapsed/refractory classical Hodgkin lymphoma (R/R cHL). We added brentuximab vedotin (BV) to DHAP to improve the mCR rate. In a Phase I dose-escalation part in 12 patients, we showed that BV-DHAP is feasible. This Phase II study included 55 R/R cHL patients (23 primary refractory). Treatment consisted of three 21-day cycles of BV 1.8 mg/kg on day 1, and DHAP (dexamethasone 40mg days 1-4, cisplatin 100mg/m2; day 1 and cytarabine 2x2g/m2; day 2). Patients with a metabolic partial response (mPR) or mCR proceeded to HDC/auto-PBSCT. Based on independent central FDG-PET-CT review, 42 of 52 evaluable patients (81% [95% CI: 67-90]) achieved an mCR before HDC/auto-PBSCT, five had an mPR and five had progressive disease (three were not evaluable). After HDC/auto-PBSCT, four patients with an mPR converted to an mCR. The 2-year PFS was 74% [95% CI: 63-86], and the overall survival 95% [95% CI: 90-100]. Toxicity was manageable and mainly consisted of grade 3/4 hematological toxicity, fever, nephrotoxicity, ototoxicity (grade 1/2) and transiently elevated liver enzymes during BV-DHAP. Eighteen patients developed new onset peripheral neuropathy (maximum grade 1/2) and all recovered. In conclusion, BV-DHAP is a very effective salvage regimen in R/R cHL patients, but patients should be monitored closely for toxicity. ClinicalTrials.gov identifier: NCT02280993.
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Affiliation(s)
- Marie José Kersten
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, and LYMMCARE, Amsterdam, The Netherlands
| | - Julia Driessen
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, and LYMMCARE, Amsterdam, The Netherlands
| | - Josée M Zijlstra
- Dept of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wouter J Plattel
- Dept of Hematology, University of Groningen, UMC Groningen, Groningen, The Netherlands
| | | | | | - Pauline Brice
- Dept of Hematology, Hopital Saint Louis, Paris, France
| | | | - Thomas Gastinne
- Dept of Hematology, Centre Hospitalier Universitaire, Nantes, France
| | - Roberto Liu
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Coreline N Burggraaff
- Dept of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marcel Nijland
- Dept of Hematology, University of Groningen, UMC Groningen, Groningen, The Netherlands
| | - Sanne H Tonino
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, and LYMMCARE, Amsterdam, The Netherlands
| | - Anne I J Arens
- Dept of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Roelf Valkema
- Dept of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Harm van Tinteren
- Dept of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marta Lopez-Yurda
- Dept of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Arjan Diepstra
- Dept. of Pathology and Medical Biology, UMC Groningen, University of Groningen, the Netherlands
| | - Daphne De Jong
- Dept of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anton Hagenbeek
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, and LYMMCARE, Amsterdam, The Netherlands
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6
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Zwezerijnen GJ, Eertink JJ, Burggraaff CN, Wiegers SE, Shaban EA, Pieplenbosch S, Oprea-Lager DE, Lugtenburg PJ, Hoekstra OS, de Vet HC, Zijlstra JM, Boellaard R. Interobserver agreement in automated metabolic tumor volume measurements of Deauville score 4 and 5 lesions at interim 18F-FDG PET in DLBCL. J Nucl Med 2021; 62:1531-1536. [PMID: 33674403 DOI: 10.2967/jnumed.120.258673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/16/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Metabolic tumor volume (MTV) on interim-PET (I-PET) is a potential prognostic biomarker for diffuse large B-cell lymphoma (DLBCL). Implementation of MTV on I-PET requires consensus which semi-automated segmentation method delineates lesions most successfully with least user interaction. Methods used for baseline PET are not necessarily optimal for I-PET due to lower lesional standardized uptake values (SUV) at I-PET. Therefore, we aimed to evaluate which method provides the best delineation quality of Deauville-score (DS) 4-5 DLBCL lesions on I-PET at best interobserver agreement on delineation quality and, secondly, to assess the effect of lesional SUVmax on delineation quality and performance agreements. Methods: DS4-5 lesions from 45 I-PET scans were delineated using six semi-automated methods i) SUV 2.5, ii) SUV 4.0, iii) adaptive threshold [A50%peak], iv) 41% of maximum SUV [41%max], v) majority vote including voxels detected by ≥2 methods [MV2] and vi) detected by ≥3 methods [MV3]. Delineation quality per MTV was rated by three independent observers as acceptable or non-acceptable. For each method, observer scores on delineation quality, specific agreements and MTV were assessed for all lesions, and per category of lesional SUVmax (<5, 5-10, >10). Results: In 60 DS4-5 lesions on I-PET, MV3 performed best, with acceptable delineation in 90% of lesions, with a positive agreement (PA) of 93%. Delineation quality scores and agreements per method strongly depended on lesional SUV: the best delineation quality scores were obtained using MV3 in lesions with SUVmax<10 and SUV4.0 in more FDG-avid lesions. Consequently, overall delineation quality and PA improved by applying the most preferred method per SUV category instead of using MV3 as single best method. MV3- and SUV4.0-derived MTVs of lesions with SUVmax>10, were comparable after excluding visually failed MV3 contouring. For lesions with SUVmax<10, MTVs using different methods correlated poorly. Conclusion: On I-PET, MV3 performed best and provided the highest interobserver agreement regarding acceptable delineations of DS4-5 DLBCL lesions. However, delineation method preference strongly depended on lesional SUV. Therefore, we suggest to explore an approach that identifies the optimal delineation method per lesion as function of tumor FDG uptake characteristics, i.e. SUVmax.
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Affiliation(s)
- Gerben Jc Zwezerijnen
- Amsterdam UMC, Vrije Universiteit Amsterdam, department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Netherlands
| | - Jakoba J Eertink
- Amsterdam UMC, Vrije Universiteit Amsterdam, department of Hematology, Cancer Center Amsterdam, Netherlands
| | - Coreline N Burggraaff
- Amsterdam UMC, Vrije Universiteit Amsterdam, department of Hematology, Cancer Center Amsterdam, Netherlands
| | - Sanne E Wiegers
- Amsterdam UMC, Vrije Universiteit Amsterdam, department of Hematology, Cancer Center Amsterdam, Netherlands
| | - Ekhlas A Shaban
- Radiodiagnosis and medical imaging department, Faculty of Medicine, Tanta University, Egypt
| | - Simone Pieplenbosch
- Amsterdam UMC, Vrije Universiteit Amsterdam, department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Netherlands
| | - Daniela E Oprea-Lager
- Amsterdam UMC, Vrije Universiteit Amsterdam, department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Netherlands
| | | | - Otto S Hoekstra
- Amsterdam UMC, Vrije Universiteit Amsterdam, department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Netherlands
| | - Henrica Cw de Vet
- Amsterdam UMC, Vrije Universiteit Amsterdam, department of Epidemiology and Data Science, Amsterdam Public Health research institute, Netherlands
| | - Josee M Zijlstra
- Amsterdam UMC, Vrije Universiteit Amsterdam, department of Hematology, Cancer Center Amsterdam, Netherlands
| | - Ronald Boellaard
- Amsterdam UMC, Vrije Universiteit Amsterdam, department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Netherlands
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Chamuleau ME, Burggraaff CN, Nijland M, Bakunina K, Mous R, Lugtenburg PJ, Dierickx D, van Imhoff GW, Vermaat JS, A.F.Marijt E, Visser O, Mandigers C, Bilgin YM, Beeker A, Durian MF, van Rees BP, Bohmer LH, Tick LW, Boersma RS, Snijders TJ, Schouten HC, Koene HR, de Jongh E, Hijmering N, Diepstra A, van de Berg A, Arens AI, Huijbregts J, Hoekstra O, Zijlstra JM, de Jong D, Kersten MJ. Treatment of patients with MYC rearrangement positive large B-cell lymphoma with R-CHOP plus lenalidomide: results of a multicenter HOVON phase II trial. Haematologica 2020; 105:2805-2812. [PMID: 33256379 PMCID: PMC7716355 DOI: 10.3324/haematol.2019.238162] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/06/2019] [Indexed: 11/09/2022] Open
Abstract
Patients with MYC-rearrangement positive large B-cell lymphoma (MYC+ LBCL) have an inferior prognosis following standard first-line therapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) as compared to patients without MYC rearrangement. Although intensive chemotherapy regimens yield higher remission rates, toxicity remains a concern. Lenalidomide is an oral immunomodulatory drug which downregulates MYC and its target genes thereby providing support using lenalidomide as additional therapeutic option for MYC+ LBCL. A phase II trial was conducted evaluating the efficacy of lenalidomide (15 mg day 1-14) in combination with R-CHOP (R2CHOP) in newly diagnosed MYC+ LBCL patients identified through a nationwide MYC-FISH screening program. The primary endpoint was complete metabolic response (CMR) on centrally reviewed 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)-computer tomography (CT)-scan at end-of-treatment. Secondary endpoints were overall survival (OS), disease-free survival (DFS) and event-free survival (EFS). Eighty-two patients with stage II-IV MYC+ LBCL were treated with 6 cycles of R2CHOP. At EOT, 67% (confidence interval (CI) 58-75%) of the patients reached CMR. With a median follow-up of 25.4 months, 2-year estimates (95% CI) for OS, DFS, EFS were 73% (62-82%), 75% (63-84%) and 63% (52-73%) respectively. In this prospective trial for newly diagnosed MYC+ LBCL patients, we found that administering R2CHOP was safe, and yields comparable CMR and survival rates as in studies applying more intensive chemotherapy regimens. Hence, these findings offer new prospects for MYC+ LBCL patients and warrant comparison in prospective randomized clinical trials. This trial was registered at www.clinicaltrialsregister.eu (#2014-002654-39).
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Affiliation(s)
- Martine E.D. Chamuleau
- Department of Hematology, Amsterdam UMC, VU University Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Coreline N. Burggraaff
- Department of Hematology, Amsterdam UMC, VU University Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Marcel Nijland
- Department of Hematology, UMC Groningen, University of Groningen, Groningen, the Netherlands
| | - Katerina Bakunina
- Department of Hematology, HOVON Data Centre, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Rogier Mous
- Department of Hematology, UMC Utrecht Cancer Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Daan Dierickx
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Gustaaf W. van Imhoff
- Department of Hematology, UMC Groningen, University of Groningen, Groningen, the Netherlands
| | - Joost S.P. Vermaat
- Department of Hematology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Eric A.F.Marijt
- Department of Hematology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Otto Visser
- Department of Hematology, Oncology Centre Isala, Zwolle, the Netherlands
| | - Caroline Mandigers
- Department of Hematology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Yavuz M. Bilgin
- Department of Internal Medicine, Admiraal de Ruijter Hospital Goes, the Netherlands
| | - Aart Beeker
- Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Mark F. Durian
- Department of Internal Medicine, Tweesteden Hospital, Tilburg, the Netherlands
| | - Bas P. van Rees
- Department of Internal Medicine, Tjongerschans Hospital, Heerenveen, the Netherlands
| | - Lara H. Bohmer
- Department of Internal Medicine, Haga Hospital, Den Haag, the Netherlands
| | - Lidwine W. Tick
- Department of Internal Medicine, Maxima Medisch Centrum, Veldhoven, the Netherlands
| | - Rinske S. Boersma
- Department of Internal Medicine, Amphia Hospital, Breda, the Netherlands
| | | | - Harry C. Schouten
- Department of Hematology, Maastricht UMC, Maastricht, the Netherlands
| | - Harry R. Koene
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Eva de Jongh
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Nathalie Hijmering
- Department of Pathology, Amsterdam UMC, location VU University Amsterdam, Amsterdam, the Netherlands
| | - Arjan Diepstra
- Department of Pathology and Medical Biology, UMC Groningen, University of Groningen, Groningen, the Netherlands
| | - Anke van de Berg
- Department of Pathology and Medical Biology, UMC Groningen, University of Groningen, Groningen, the Netherlands
| | - Anne I.J. Arens
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Julia Huijbregts
- Department of Radiology and Nuclear Medicine, Gelre Hospital, Apeldoorn, the Netherlands
| | - Otto Hoekstra
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Josee M. Zijlstra
- Department of Hematology, Amsterdam UMC, VU University Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Daphne de Jong
- Department of Pathology, Amsterdam UMC, location VU University Amsterdam, Amsterdam, the Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
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Lugtenburg PJ, de Nully Brown P, van der Holt B, D'Amore FA, Koene HR, de Jongh E, Fijnheer R, van Esser JW, Böhmer LH, Pruijt JF, Verhoef GE, Hoogendoorn M, Bilgin MY, Nijland M, van der Burg-de Graauw NC, Oosterveld M, Jie KSG, Larsen TS, van der Poel MW, Leijs MB, Silbermann MH, van Marwijk Kooy M, Beeker A, Kersten MJ, Doorduijn JK, Tick LW, Brouwer RE, Lam KH, Burggraaff CN, de Keizer B, Arens AI, de Jong D, Hoekstra OS, Zijlstra-Baalbergen JM. Rituximab-CHOP With Early Rituximab Intensification for Diffuse Large B-Cell Lymphoma: A Randomized Phase III Trial of the HOVON and the Nordic Lymphoma Group (HOVON-84). J Clin Oncol 2020; 38:3377-3387. [PMID: 32730183 DOI: 10.1200/jco.19.03418] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Immunochemotherapy with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) has become standard of care for patients with diffuse large B-cell lymphoma (DLBCL). This randomized trial assessed whether rituximab intensification during the first 4 cycles of R-CHOP could improve the outcome of these patients compared with standard R-CHOP. PATIENTS AND METHODS A total of 574 patients with DLBCL age 18 to 80 years were randomly assigned to induction therapy with 6 or 8 cycles of R-CHOP-14 with (RR-CHOP-14) or without (R-CHOP-14) intensification of rituximab in the first 4 cycles. The primary end point was complete remission (CR) on induction. Analyses were performed by intention to treat. RESULTS CR was achieved in 254 (89%) of 286 patients in the R-CHOP-14 arm and 249 (86%) of 288 patients in the RR-CHOP-14 arm (hazard ratio [HR], 0.82; 95% CI, 0.50 to 1.36; P = .44). After a median follow-up of 92 months (range, 1-131 months), 3-year failure-free survival was 74% (95% CI, 68% to 78%) in the R-CHOP-14 arm versus 69% (95% CI, 63% to 74%) in the RR-CHOP-14 arm (HR, 1.26; 95% CI, 0.98 to 1.61; P = .07). Progression-free survival at 3 years was 74% (95% CI, 69% to 79%) in the R-CHOP-14 arm versus 71% (95% CI, 66% to 76%) in the RR-CHOP-14 arm (HR, 1.20; 95% CI, 0.94 to 1.55; P = .15). Overall survival at 3 years was 81% (95% CI, 76% to 85%) in the R-CHOP-14 arm versus 76% (95% CI, 70% to 80%) in the RR-CHOP-14 arm (HR, 1.27; 95% CI, 0.97 to 1.67; P = .09). Patients between ages 66 and 80 years experienced significantly more toxicity during the first 4 cycles in the RR-CHOP-14 arm, especially neutropenia and infections. CONCLUSION Early rituximab intensification during R-CHOP-14 does not improve outcome in patients with untreated DLBCL.
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Affiliation(s)
| | | | - Bronno van der Holt
- Haemato Oncology Foundation for Adults in the Netherlands (HOVON) Data Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | | | - Eva de Jongh
- Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | | | | | | | | | | | | | | | - Marcel Nijland
- University Medical Center Groningen, Groningen, the Netherlands
| | | | | | | | | | | | | | | | | | - Aart Beeker
- Spaarne Gasthuis, Hoofddorp, the Netherlands
| | | | | | | | | | - King H Lam
- Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | | | | | - Daphne de Jong
- HOVON Pathology Facility and Biobank, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Otto S Hoekstra
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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9
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Barrington SF, Zwezerijnen BGJC, de Vet HCW, Heymans MW, Mikhaeel NG, Burggraaff CN, Eertink JJ, Pike LC, Hoekstra OS, Zijlstra JM, Boellaard R. Automated Segmentation of Baseline Metabolic Total Tumor Burden in Diffuse Large B-Cell Lymphoma: Which Method Is Most Successful? A Study on Behalf of the PETRA Consortium. J Nucl Med 2020; 62:332-337. [PMID: 32680929 DOI: 10.2967/jnumed.119.238923] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 06/17/2020] [Indexed: 12/22/2022] Open
Abstract
Metabolic tumor volume (MTV) is a promising biomarker of pretreatment risk in diffuse large B-cell lymphoma (DLBCL). Different segmentation methods can be used that predict prognosis equally well but give different optimal cutoffs for risk stratification. Segmentation can be cumbersome; a fast, easy, and robust method is needed. Our aims were to evaluate the best automated MTV workflow in DLBCL; determine whether uptake time, compliance or noncompliance with standardized recommendations for 18F-FDG scanning, and subsequent disease progression influence the success of segmentation; and assess differences in MTVs and discriminatory power of segmentation methods. Methods: One hundred forty baseline 18F-FDG PET/CT scans were selected from U.K. and Dutch studies on DLBCL to provide a balance between scans at 60 and 90 min of uptake, parameters compliant and noncompliant with standardized recommendations for scanning, and patients with and without progression. An automated tool was applied for segmentation using an SUV of 2.5 (SUV2.5), an SUV of 4.0 (SUV4.0), adaptive thresholding (A50P), 41% of SUVmax (41%), a majority vote including voxels detected by at least 2 methods (MV2), and a majority vote including voxels detected by at least 3 methods (MV3). Two independent observers rated the success of the tool to delineate MTV. Scans that required minimal interaction were rated as a success; scans that missed more than 50% of the tumor or required more than 2 editing steps were rated as a failure. Results: One hundred thirty-eight scans were evaluable, with significant differences in success and failure ratings among methods. The best performing was SUV4.0, with higher success and lower failure rates than any other method except MV2, which also performed well. SUV4.0 gave a good approximation of MTV in 105 (76%) scans, with simple editing for a satisfactory result in additionally 20% of cases. MTV was significantly different for all methods between patients with and without progression. The 41% segmentation method performed slightly worse, with longer uptake times; otherwise, scanning conditions and patient outcome did not influence the tool's performance. The discriminative power was similar among methods, but MTVs were significantly greater using SUV4.0 and MV2 than using other thresholds, except for SUV2.5. Conclusion: SUV4.0 and MV2 are recommended for further evaluation. Automated estimation of MTV is feasible.
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Affiliation(s)
- Sally F Barrington
- King's College London and Guy's and St. Thomas' PET Center, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Ben G J C Zwezerijnen
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Henrica C W de Vet
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - N George Mikhaeel
- Department of Clinical Oncology, Guy's and St. Thomas' NHS Foundation Trust and School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom; and
| | - Coreline N Burggraaff
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jakoba J Eertink
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lucy C Pike
- King's College London and Guy's and St. Thomas' PET Center, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Josée M Zijlstra
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Kaalep A, Burggraaff CN, Pieplenbosch S, Verwer EE, Sera T, Zijlstra J, Hoekstra OS, Oprea-Lager DE, Boellaard R. Quantitative implications of the updated EARL 2019 PET-CT performance standards. EJNMMI Phys 2019; 6:28. [PMID: 31879795 PMCID: PMC6933045 DOI: 10.1186/s40658-019-0257-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 10/23/2019] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Recently, updated EARL specifications (EARL2) have been developed and announced. This study aims at investigating the impact of the EARL2 specifications on the quantitative reads of clinical PET-CT studies and testing a method to enable the use of the EARL2 standards whilst still generating quantitative reads compliant with current EARL standards (EARL1). METHODS Thirteen non-small cell lung cancer (NSCLC) and seventeen lymphoma PET-CT studies were used to derive four image datasets-the first dataset complying with EARL1 specifications and the second reconstructed using parameters as described in EARL2. For the third (EARL2F6) and fourth (EARL2F7) dataset in EARL2, respectively, 6 mm and 7 mm Gaussian post-filtering was applied. We compared the results of quantitative metrics (MATV, SUVmax, SUVpeak, SUVmean, TLG, and tumor-to-liver and tumor-to-blood pool ratios) obtained with these 4 datasets in 55 suspected malignant lesions using three commonly used segmentation/volume of interest (VOI) methods (MAX41, A50P, SUV4). RESULTS We found that with EARL2 MAX41 VOI method, MATV decreases by 22%, TLG remains unchanged and SUV values increase by 23-30% depending on the specific metric used. The EARL2F7 dataset produced quantitative metrics best aligning with EARL1, with no significant differences between most of the datasets (p>0.05). Different VOI methods performed similarly with regard to SUV metrics but differences in MATV as well as TLG were observed. No significant difference between NSCLC and lymphoma cancer types was observed. CONCLUSIONS Application of EARL2 standards can result in higher SUVs, reduced MATV and slightly changed TLG values relative to EARL1. Applying a Gaussian filter to PET images reconstructed using EARL2 parameters successfully yielded EARL1 compliant data.
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Affiliation(s)
- Andres Kaalep
- 0000 0004 0631 377Xgrid.454953.aDepartment of Medical Technology, North Estonia Medical Centre Foundation, J. Sutiste Str 19, Tallinn, 13419 Republic of Estonia
| | - Coreline N. Burggraaff
- 0000 0004 1754 9227grid.12380.38Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Simone Pieplenbosch
- 0000 0004 1754 9227grid.12380.38Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, 1081HV the Netherlands
| | - Eline E. Verwer
- 0000 0004 1754 9227grid.12380.38Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, 1081HV the Netherlands
| | - Terez Sera
- 0000 0001 1016 9625grid.9008.1Department of Nuclear Medicine, University of Szeged, Szeged, Hungary ,0000000110156808grid.488256.5On behalf of EANM Research Limited (EARL), Vienna, Austria
| | - Josee Zijlstra
- 0000 0004 1754 9227grid.12380.38Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Otto S. Hoekstra
- 0000 0004 1754 9227grid.12380.38Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, 1081HV the Netherlands
| | - Daniela E. Oprea-Lager
- 0000 0004 1754 9227grid.12380.38Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, 1081HV the Netherlands
| | - Ronald Boellaard
- 0000 0004 1754 9227grid.12380.38Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, 1081HV the Netherlands ,0000000110156808grid.488256.5On behalf of EANM Research Limited (EARL), Vienna, Austria ,Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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11
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Burggraaff CN, Cornelisse AC, Hoekstra OS, Lugtenburg PJ, De Keizer B, Arens AIJ, Celik F, Huijbregts JE, De Vet HCW, Zijlstra JM. Interobserver Agreement of Interim and End-of-Treatment 18F-FDG PET/CT in Diffuse Large B-Cell Lymphoma: Impact on Clinical Practice and Trials. J Nucl Med 2018; 59:1831-1836. [PMID: 29728515 DOI: 10.2967/jnumed.118.210807] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/24/2018] [Indexed: 12/29/2022] Open
Abstract
We aimed to assess the interobserver agreement of interim PET (I-PET) and end-of-treatment PET (EoT-PET) using the Deauville score (DS) in first-line diffuse large B-cell lymphoma (DLBCL) patients. Methods: I-PET and EoT-PET scans of DLBCL patients were performed in the HOVON84 study (2007-2012), an international multicenter randomized controlled trial. Patients received R-CHOP14 and were randomized to receive rituximab intensification in the first 4 cycles or not. I-PET was performed after 4 cycles (for observational purposes), and EoT-PET after 6 or 8 cycles. Two independent central reviewers retrospectively scored all scans according to the DS system, masked to clinical outcomes. Results were dichotomized as negative (DS of 1-3) or positive (DS of 4-5). Besides percentage overall agreement (OA), we calculated agreement for positive and negative scores, expressed as positive agreement (PA) and negative agreement (NA), respectively. Results: 465 I-PET and 457 EoT-PET scans were centrally reviewed; baseline 18F-FDG PET or PET/CT was available in 75%-77%, and CT in the remaining cases. Percentage OA for I-PET and EoT-PET were 87.7% and 91.7% (P = 0.049), with NA of 92.0% and 95.0% (P = 0.091), and PA of 73.7% and 76.3% (P = 0.656), respectively. Conclusion: Interobserver agreement using DS in DLBCL patients in I-PET and EoT-PET yields high OA and NA. The lower PA suggests that EoT-PET/CT treatment evaluation in daily practice and I-PET-adapted trials may benefit from dual reads and central review, respectively.
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Affiliation(s)
- Coreline N Burggraaff
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Alexander C Cornelisse
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Bart De Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne I J Arens
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Filiz Celik
- Department of Radiology and Nuclear Medicine, Deventer Ziekenhuis, Deventer, The Netherlands
| | - Julia E Huijbregts
- Department of Radiology and Nuclear Medicine, Gelre Ziekenhuis, Apeldoorn, The Netherlands; and
| | - Henrica C W De Vet
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Zijlstra JM, Burggraaff CN, Kersten MJ, Barrington SF. FDG-PET as a biomarker for early response in diffuse large B-cell lymphoma as well as in Hodgkin lymphoma? Ready for implementation in clinical practice? Haematologica 2016; 101:1279-1283. [PMID: 27799345 PMCID: PMC5394882 DOI: 10.3324/haematol.2016.142752] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Josée M Zijlstra
- Department of Hematology, VU University medical center, Amsterdam, the Netherlands
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