Association of pre-transplantation positron emission tomography/computed tomography and outcome in mantle cell lymphoma

Abstract

Positron emission tomography/computed tomography (PET/CT)-positive findings before autologous SCT (auto-SCT) are associated with inferior PFS and OS in patients with relapsed Hodgkin's and diffuse large B-cell lymphoma. We classified pre-transplant PET/CT performed before auto-SCT as positive or negative to evaluate the impact of pre-transplant PET/CT in mantle cell lymphoma (MCL). In 29 patients, 17 were PET/CT( À ) and 12 were PET/CT( þ ). PET/CT( þ ) patients were younger (P ¼ 0.04), had lower MCL International Prognostic Index (MIPI, P ¼ 0.04) scores, but increased bulky adenopathy 45 cm (45% vs 13%, P ¼ 0.09). With a median follow-up of 27 months (range: 5-55 months), 7 patients relapsed (4 in the PET/CT( À ) group and 3 in the PET/CT( þ ) group) with 2 deaths in the PET/CT( þ ) group without a documented relapse. The estimated 2-year PFS was 64% (95% confidence interval (CI): 0.30-0.85) vs 87% (95% CI: 0.57-0.97) in PET/CT( þ ) and PET/CT( À ) patients, respectively (P ¼ 0.054). OS was significantly decreased in PET/CT( þ ) patients (P ¼ 0.007), with 2-year estimates of 60% (95% CI: 0.23-0.84) vs 100% in PET/CT( À ) patients. A positive pre-transplant PET/CT is associated with a poor prognosis in patients with MCL. Additional factors may impact the prognostic value of PET/CT, as several PET/CT( þ ) patients remain in remission.

Pretransplantation Fluorine-18-Deoxyglucose–Positron Emission Tomography Scan Lacks Prognostic Value in Chemosensitive B Cell Non-Hodgkin Lymphoma Patients Undergoing Nonmyeloablative Allogeneic Stem Cell Transplantation

“…While most of the predictive power of pre-HDT-ASCT FDG-PET is seen in patients with aggressive histology lymphomas 4,5 , FDG-PET has proven significantly prognostic for both two-year progression-free and overall survival on interim restaging during induction chemotherapy utilizing the same criteria as our enclosed analysis 20 . Additionally, positive FDG-PET for MCL, a disease considered of more indolent histology relative to DLBCL or HL, has recently demonstrated prognostic significance for OS pre-HDT-ASCT 21 . Findings from our study warrant prospective confirmation.…”

Nordic MCL3 study: 90Y-ibritumomab-tiuxetan added to BEAM/C in non-CR patients before transplant in mantle cell lymphoma

“…Recent retrospective reports, however, suggest a relevance of PET in response assessment. [24][25][26] In our prospective study, a positive PET scan pretransplant was associated with a median PFS of ,2 years, significantly shorter than in the PET-negative cohort. The PETpositive PR group is of particular interest: according to the revised response criteria 27 , any PET-negative residual mass is compatible with CR.…”

“…In multivariate analysis (including MIPI-B, response by CT prior to transplant, and MRD after transplant), a positive PET scan before transplant was shown to be an independent predictor of PFS, EFS, and particularly OS. In retrospective studies, 25,26 a positive posttreatment PET scan also predicted early relapse. Our prospective PET-based results strongly suggest a value of this modality in the evaluation of response in MCL.…”

Next-generation surveillance strategies for patients with lymphoma

“…High-risk patients continue to have poor OS despite currently available therapies. In addition to MIPI, several additional variables appear to predict the duration of response to therapy in patients with MCL, including Ki67 proliferative index, pre-transplant PET/CT and pretreatment cytogenetics [23,28–32]. Identification of minimal amounts of residual lymphoma also has been associated with early relapse in patients completing induction therapy for MCL [33].…”