Early risk stratification for diffuse large B-cell lymphoma integrating interim Deauville score and International Prognostic Index

Yim, Sung Kyun; Yhim, Ho‐Young; Han, Young Jin; Jeon, Soyeon; Lee, Na-Ri; Song, Eun-Kee; Jeong, Hwan-Jeong; Kim, Hee Sun; Kwak, Jae-Yong

doi:10.1007/s00277-019-03834-4

Cited by 15 publications

(12 citation statements)

References 27 publications

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“…This article is part of the Topical Collection on Hematology involvement, serum lactate dehydrogenase (LDH) level, and performance status [3]. However, IPI is not suitable for predicting refractory disease, which might be due to its lack of information on intratumoral functional and metabolic profiles [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Over the past two decades, the International Prognostic Index (IPI) has been recognized as a prognostic model, which is based on the properties of several clinical factors including age, Ann Arbor stage, extranodal involvement, serum lactate dehydrogenase (LDH) level, and performance status [ 3 ]. However, IPI is not suitable for predicting refractory disease, which might be due to its lack of information on intratumoral functional and metabolic profiles [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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A novel analytic approach for outcome prediction in diffuse large B-cell lymphoma by [18F]FDG PET/CT

Zhang

Lin

Jiang

et al. 2021

Eur J Nucl Med Mol Imaging

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Purpose This study aimed to develop a novel analytic approach based on 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography ([18F]FDG PET/CT) radiomic signature (RS) and International Prognostic Index (IPI) to predict the progression-free survival (PFS) and overall survival (OS) of patients with diffuse large B-cell lymphoma (DLBCL). Methods We retrospectively enrolled 152 DLBCL patients and divided them into a training cohort (n = 100) and a validation cohort (n = 52). A total of 1245 radiomic features were extracted from the total metabolic tumor volume (TMTV) and the metabolic bulk volume (MBV) of pre-treatment PET/CT images. The least absolute shrinkage and selection operator (LASSO) algorithm was applied to develop the RS. Cox regression analysis was used to construct hybrid nomograms based on different RS and clinical variables. The performances of hybrid nomograms were evaluated using the time-dependent receiver operator characteristic (ROC) curve and the Hosmer–Lemeshow test. The clinical utilities of prediction nomograms were determined via decision curve analysis. The predictive efficiency of different RS, clinical variables, and hybrid nomograms was compared. Results The RS and IPI were identified as independent predictors of PFS and OS, and were selected to construct hybrid nomograms. Both TMTV- and MBV-based hybrid nomograms had significantly higher values of area under the curve (AUC) than IPI in training and validation cohorts (all P < 0.05), while no significant difference was found between TMTV- and MBV-based hybrid nomograms (P > 0.05). The Hosmer–Lemeshow test showed that both TMTV- and MBV-based hybrid nomograms calibrated well in the training and validation cohorts (all P > 0.05). Decision curve analysis indicated that hybrid nomograms had higher net benefits than IPI. Conclusion The hybrid nomograms combining RS with IPI could significantly improve survival prediction in DLBCL. Radiomic analysis on MBV may serve as a potential approach for prognosis assessment in DLBCL. Trial registration NCT04317313. Registered March 16, 2020. Public site: https://clinicaltrials.gov/ct2/show/NCT04317313

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A novel analytic approach for outcome prediction in diffuse large B-cell lymphoma by [18F]FDG PET/CT

Zhang

Lin

Jiang

et al. 2021

Eur J Nucl Med Mol Imaging

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“…80,99, Meta-analysis of baseline parameters, MTV, TLG, and SUVmax for PFS in studies on anti-CD20 therapy…”

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confidence: 99%

The value of FDG PET/CT imaging in outcome prediction and response assessment of lymphoma patients treated with immunotherapy: a meta-analysis and systematic review

Kiamanesh

Ayati

Sadeghi

et al. 2022

Eur J Nucl Med Mol Imaging

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Purpose Treatment strategies of lymphoid malignancies have been revolutionized by immunotherapy. Because of the inherent property of Hodgkin lymphoma and some subtypes of non-Hodgkin lymphoma as a highly FDG-avid tumor, functional 18F-FDG PET/CT imaging is already embedded in their routine care. Nevertheless, the question is whether it is still valuable in the context of these tumors being treated with immunotherapy. Herein, we will review the value of 18F-FDG PET/CT imaging lymphoid tumors treated with immunotherapy regimens. Methods A comprehensive literature search of the PubMed database was conducted on the value of the 18F-FDG PET/CT for immunotherapy response monitoring of patients with malignant lymphoma. The articles were considered eligible if they met all of the following inclusion criteria: (a) clinical studies on patients with different types of malignant lymphoma, (b) treatment with anti-CD20 antibodies, immune checkpoint inhibitors or immune cell therapies, (c) and incorporated PET/CT with 18F-FDG as the PET tracer. Results From the initial 1488 papers identified, 91 were ultimately included in our study. In anti-CD20 therapy, the highest pooled hazard ratios (HRs) of baseline, early, and late response monitoring parameters for progression-free survival (PFS) belong to metabolic tumor volume (MTV) (3.19 (95%CI: 2.36–4.30)), maximum standardized uptake value (SUVmax) (3.25 (95%CI: 2.08–5.08)), and Deauville score (DS) (3.73 (95%CI: 2.50–5.56)), respectively. These measurements for overall survival (OS) were MTV (4.39 (95%CI: 2.71–7.08)), DS (3.23 (95%CI: 1.87–5.58)), and DS (3.64 (95%CI: 1.40–9.43)), respectively. Early and late 18F-FDG PET/CT response assessment in immune checkpoint inhibitors (ICI) and immune cell therapy might be an effective tool for prediction of clinical outcome. Conclusion For anti-CD20 therapy of lymphoma, the MTV as a baseline 18F-FDG PET/CT-derived parameter has the highest HRs for PFS and OS. The DS as visual criteria in early and late response assessment has higher HRs for PFS and OS compared to the international harmonization project (IHP) visual criteria in anti-CD20 therapy. Early changes in 18F-FDG PET parameters may be predictive of response to ICIs and cell therapy in lymphoma patients.

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“…FDG-PET/CT uses quantitative indicators of metabolically active tissues, such as TMTV, as indicators of tumor volume (31). In previous studies, the prognosis of patients with DLBCL was often stratified based on interim PET-CT parameters, such as the Deauville score (32,33). The prognostic model presented here is based on baseline PET-CT parameters and clinical markers, and can predict the prognosis of patients earlier.…”

Section: Discussionmentioning

confidence: 99%

A modified prognostic model in patients with diffuse large B‑cell lymphoma treated with immunochemotherapy

Zhao

Zhu

et al. 2021

Oncol Lett

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In the era of immunochemotherapy, the traditional international prognostic index (IPI) has partially lost its predictive value in diffuse large B-cell lymphoma (DLBCL) and the National Comprehensive Cancer Network-IPI (NCCN-IPI) is unable to effectively identify high-risk patients. Thus, the present study aimed to develop a modified prognostic model (M-PM) to identify high-risk patients that require aggressive treatment. The present study included 169 patients with newly diagnosed DLBCL treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (RCHOP) or RCHOP-like regimens, between 2011–2017. The results demonstrated that the risk discrimination was improved in the NCCN-IPI compared with the IPI, and patients were divided into four risk groups with a 5-year overall survival rate of 93.8, 76.5, 54.3 and 39.4%, respectively. However, the NCCN-IPI failed to identify the high-risk DLBCL population. The newly developed M-PM presented here included four parameters: Age (≥65 years), an elevated lactate dehydrogenase level, Eastern Cooperative Oncology Group score ≥2 and total metabolic tumor volume ≥300 cm 3 . The M-PM also divided patients into four risk groups that comprised 40.8, 23.1, 26.0 and 10.1% of the patients, and the 5-year survival rates of these groups were 92.4, 70.6, 52.3 and 24.5%, respectively. Taken together, the results of the present study demonstrated that the M-PM was more accurate compared with the IPI and the NCCN-IPI, which served as an effective tool for identifying patients with DLBCL at high risk of an adverse prognosis.

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Early risk stratification for diffuse large B-cell lymphoma integrating interim Deauville score and International Prognostic Index

Cited by 15 publications

References 27 publications

A novel analytic approach for outcome prediction in diffuse large B-cell lymphoma by [18F]FDG PET/CT

A novel analytic approach for outcome prediction in diffuse large B-cell lymphoma by [18F]FDG PET/CT

The value of FDG PET/CT imaging in outcome prediction and response assessment of lymphoma patients treated with immunotherapy: a meta-analysis and systematic review

A modified prognostic model in patients with diffuse large B‑cell lymphoma treated with immunochemotherapy

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