Baseline and interim functional imaging with PET effectively risk stratifies patients with peripheral T-cell lymphoma

Abstract

The prognosis of peripheral T-cell lymphoma (PTCL) is heterogenous. Baseline or interim imaging characteristics may inform risk-adapted treatment paradigms. We identified 112 patients with PTCL who were consecutively treated with cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP)/CHOP-like regimens with the intent to consolidate with an autologous transplant. Baseline (n = 93) and interim (after 4 cycles, n = 99) positron emission tomography (PET) images were reevaluated, and we calculated baseline total metabolic tumor volume (TMTV). Interim PET (iPET) responses were graded visually by 5-point score (i5PS) and by percentage change of standardized uptake value. By univariate analysis, predictors of event-free survival (EFS) included Prognostic Index for Peripheral TCL (PIT) higher than 1 (hazard ratio [HR], 1.83; P = .021), International Prognostic Index (IPI) higher than 3 (HR, 2.01; P = .021), high TMTV (>125 cm3; HR, 3.92; P = .003), and positive iPET (HR, 3.57; P < .001). By multivariate analysis, high baseline TMTV predicted worse overall survival (OS; HR, 6.025; P = .022) and EFS (HR, 3.861; P = .005). Patients with i5PS of 1 to 3 had a longer median OS and EFS (104 months, 64 months) than those with i5PS of 4 to 5 (19 months, 11 months; P < .001). Four-year OS and EFS for patients with i5PS of 1 to 3 and PIT of 1 or less were 85% and 62%, respectively. However, 4-year OS and EFS for those with i5PS of 4 to 5 and PIT higher than 1 were both 0% (P < .001). In multivariate analysis, after controlling for IPI and PIT, i5PS was independently prognostic for EFS (HR, 3.400 95% confidence interval, 1.750-6.750; P < .001) and OS (HR, 10.243; 95% confidence interval, 4.052-25.891; P < .001). In conjunction with clinical parameters, iPET helps risk stratify patients with PTCL and could inform risk-adapted treatment strategies. Prospective studies are needed to confirm these findings.

Baseline total metabolic tumor volume combined with international peripheral T-cell lymphoma project may improve prognostic stratification for patients with peripheral T-cell lymphoma (PTCL)

“…Our results confirm the strong prognostic value of baseline TMTV in patients with PTCL, and patients with a TMTV greater than 228.8 cm 3 had lower survival. This result is consistent with the results of published studies [11,12]. In the study of Cottereau et al, the baseline TMTV (cutoff value of 230 cm 3 ) was found to be the only significant independent predictor for both PFS (P = 0.013) and OS (P = 0.021) [11].…”

“…In the study of Cottereau et al, the baseline TMTV (cutoff value of 230 cm 3 ) was found to be the only significant independent predictor for both PFS (P = 0.013) and OS (P = 0.021) [11]. Mehta-Shah et al 's study also showed that a high baseline TMTV (cutoff value is 125 cm 3 ) predicted worse OS (HR 6.025; P = 0.022) and EFS (HR 3.861; P = 0.005) [12]. TMTV is a measure of the viable tumor fraction and may better represent the metabolic burden of tumors.…”

Baseline total lesion glycolysis combined with interim positron emission tomography‐computed tomography is a robust predictor of outcome in patients with peripheral T‐cell lymphoma

“…18 Moreover, TLG in combination with iPET more accurately predicted survival in PTCL. Mehta-Shah et al recently reported on the analysis of iPET and TMTV in PTCL, 28 indicating that the use of TMTV allowed for the further classification of patients with favorable prognoses into subgroups of excellent and poor prognoses. Notably, favorable characteristics (low TMTV and negative iPET results) could be used to identify groups with a 5-year event-free survival rate exceeding 60%.…”

Baseline total metabolic tumor volume combined with international peripheral T-cell lymphoma project may improve prognostic stratification for patients with peripheral T-cell lymphoma (PTCL)

“…The results among studies might be inconsistent due to the different thresholds used for delineating tumors. In some studies, the absolute threshold of an SUV ≥3.0 or 2.5 was used to calculate MTV [12,[25][26]] and proved to be easiest to apply in clinical settings. [27] In addition, PTCL are heterogeneous in their FDG-uptake, and TMTV estimated using xed value thresholding (SUV≥3.0 or 2.5) may re ect the total tumor burden more accurately.…”