Clinical pretreatment risk factors and Ga‐67 scintigraphy early during treatment for prediction of outcome of patients with aggressive non‐Hodgkin lymphoma

Abstract

BACKGROUNDClinical pretreatment risk factors indicate the severity of disease in patients with aggressive non‐Hodgkin lymphoma (NHL). Ga‐67 scintigraphy during treatment is an early indicator of treatment‐related features of lymphoma cells. The ability of risk factors and Ga‐67 to predict disease outcome was compared in 139 patients with aggressive NHL.METHODSPretreatment clinical risk factors and Ga‐67 scintigraphy performed after one cycle and at mid‐treatment were evaluated for their correlation with response rate and as predictors of 5‐year failure‐free survival (FFS). Univariate analysis was performed to determine the ability of pretreatment risk factors and Ga‐67 early during treatment to predict FFS. Subsequently, multivariate analysis was performed on the variables with significant univariate results using the Cox proportional hazards method. The predictive value of risk factors and Ga‐67 scintigraphy was calculated to determine their suitability in selecting patients with poor outcome.RESULTSResponse rate correlated with stage of disease (P < 0.01) and the international prognostic index (IPI) score (P < 0.05). Five‐year FFS was predicted by stage of disease (P < 0.004), performance status (P < 0.02), and the IPI score (P < 0.01). Response rate correlated with results of Ga‐67 scintigraphy after one cycle of chemotherapy (P < 0.001) and at mid‐treatment (P < 0.001). Five‐year FFS was predicted by Ga‐67 after one cycle of chemotherapy (P < 0.0004) and at mid‐treatment (P < 0.0001). Positive Ga‐67 after the first cycle of treatment predicted 64% of patients who had failure of treatment. A positive study at mid‐treatment predicted 77% of patients who had treatment failure. Cox analysis showed Ga‐67 after one course (P < 0.0012) and at mid‐treatment (P < 0.0002) as being the most significant variables in predicting FFS.CONCLUSIONSGa‐67 scintigraphy demonstrates early the effect of treatment in patients with aggressive NHL. It is a better predictor than pretreatment risk factors of both response rate and FFS. Positive Ga‐67 early during treatment may be used as an independent test in selecting patients who will not respond favorably to current protocol treatment for early therapeutic modifications. Cancer 2002;94:873–8. © 2002 American Cancer Society.DOI 10.1002/cncr.10344

Prognostic value of early 18 fluorodeoxyglucose positron emission tomography and gallium-67 scintigraphy in aggressive lymphoma: a prospective comparative study

“…This finding has not been previously reported and should be confirmed in larger series. The subtype of GS false negatives was not indicated in the series reported by Israel et al [9]. Regarding FDG, false negatives were only detailed in the paper by Spaepen et al [13].…”

“…The early response to chemotherapy is strongly associated with long-term outcome [8]. GS performed after one [9] or two cycles of chemotherapy [10] has been proved to accurately predict outcome in patients with aggressive NHL. Similar results were also obtained with FDG-PET performed after one to three cycles of chemotherapy [11 -15].…”

[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in aggressive lymphoma: an early prognostic tool for predicting patient outcome

“…Seventy percent of patients with negative interim scan remained disease free, whereas only 25% of gallium-positive patients at the same therapeutic point achieved durable remission. More recently, Israel and colleagues 15 confirmed that gallium after 1 cycle was the most significant predictor of patient outcome, compared with pretreatment risk factors such as performance status, stage, and IPI, in 57 patients with aggressive lymphoma. Unfortunately, gallium scintigraphy is limited by its low sensitivity and by poor spatial resolution of ␥ cameras.…”

Prognostic impact of pre-transplantation computed tomography and 67gallium scanning in chemosensitive diffuse large B cell lymphoma patients undergoing hematopoietic stem-cell transplantation

“…Whereas some authors [16,27] found no differences between these two groups of patients, others [23,28] have reported that patients transplanted with measurable disease at ASCT have a worse outcome. In this sense, 67 Ga scan has successfully been used for many years for this purpose in patients with lymphoma after standard chemotherapy [29][30].…”