FDG PET-CT in follicular lymphoma: a case-based evidence review

Smith, Stephen D.; Redman, Mary W.; Dunleavy, Kieron

doi:10.1182/blood-2014-11-537522

Cited by 19 publications

(23 citation statements)

References 48 publications

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“…This finding is in keeping with published results from analyses of FL patients in the PRIMA [30] and FOLL05 [31], in whom PET positivity within three months of completing therapy was only able to accurately identify those patients at high risk of progression and was a more powerful prognostic indicator than FLIPI [32]. Studies in which PET has robustly predicted for a significant difference in OS have often not included patients who have received maintenance rituximab therapy [10,32], which is now an established standard of care. Our cohort were all assigned to maintenance rituximab, and this difference in the significance of post treatment 18 F-FDG-PET/CT with respect to TTNT and OS may be accounted for by the beneficial effect and markedly improved OS seen in the rituximab era.…”

Section: Discussionsupporting

confidence: 88%

Imaging of Early Response to Predict Prognosis in the First-Line Management of Follicular Non-Hodgkin Lymphoma with Iodine-131-Rituximab Radioimmunotherapy

et al. 2017

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The purpose of this study was to evaluate prediction of prognosis after first-line radioimmunotherapy (RIT) of advanced follicular non-Hodgkin lymphoma (FL), by imaging with fluorine-18-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG-PET/CT) three months after induction treatment by Iodine-131-rituximab (131I-rituximab). Objective response was determined using the Deauville 5-point scale in 68 prospective clinical trial patients. Baseline 18F-FDG-PET/CT studies were used to calculate total-metabolic-tumor-volume (TMTV). Non-imaging studies included the Follicular lymphoma international prognostic index (FLIPI) and absolute baseline monocyte and lymphocyte counts. Patients were monitored for over ten years (median follow-up 59 months), and no patient was lost to follow-up. Complete response (CR) of 88% predicted excellent prognosis with median time-to-next-treatment (TTNT) not yet reached. Those patients (12%) who failed to achieve CR (Deauville ≤ 3) on 18F-FDG-PET/CT at three months had significantly poorer outcomes (p < 0.0001) with a median TTNT of 41 months. Requirement for re-treatment was predicted by FLIPI and absolute baseline monocyte count but not lymphocyte count. The TTNT was accurately predicted by 18F-FDG-PET/CT Deauville response at three months following first-line therapy of FL with RIT. Early response demonstrated by imaging does, therefore, foretell prognosis in the individual FL patients.

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Section: Discussionsupporting

confidence: 88%

Imaging of Early Response to Predict Prognosis in the First-Line Management of Follicular Non-Hodgkin Lymphoma with Iodine-131-Rituximab Radioimmunotherapy

et al. 2017

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“…[1][2][3][4] FL is usually FDGavid, and PET identifies a greater extent of disease sites than standard CT-based staging in up to 60% of patients. [1,[5][6][7][8][9][10] PET is useful for assessing response to front-line induction therapy (IT) in FL patients, and patients with positive post-treatment PET scans are likely to relapse sooner than PET-negative patients. [1][2][3][4] Pre-treatment risk stratification models such as the Follicular Lymphoma International Prognostic Index (FLIPI-1) [11] and the more recent FLIPI-2, [12] do not provide sufficient guidance for timing of initial therapy or treatment approach.…”

Section: Introductionmentioning

confidence: 99%

FDG-PET is prognostic and predictive for progression-free survival in relapsed follicular lymphoma: exploratory analysis of the GAUSS study

Kostakoğlu

Goy

Martinelli

et al. 2016

Leukemia & Lymphoma

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An exploratory analysis of 75 follicular lymphoma patients treated with obinutuzumab or rituximab induction therapy (IT) for 4 weeks in the phase II GAUSS study aimed to determine whether positron emission tomography (PET) results could predict progression-free survival (PFS) and tumor response. The proportion of patients with a PFS event (progression or death) was higher in those who were PET-positive after IT (assessed using Deauville five-point scale criteria; 35/52, 67%) than PET-negative (5/20, 25%); the hazard ratio for progression or death was 0.25 (95%CI: 0.01-0.64; p = 0.0018). A significant association was also found when PET results were assessed using International Harmonization Project and European Organisation for Research and Treatment of Cancer criteria. Change between baseline and end of IT in values of standardized uptake value and other PET parameters were associated with PFS and response. Validation of these results in prospective studies of larger cohorts is warranted.

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“…These warning signs may be the occurrence of new nodal or extra-nodal lesions, progressive and rapid enlargement of pathological lymph nodes with short doubling time of the maximum diameter, bulky disease (greater diameter ≥ 7 cm) and serosal effusions [5]. These findings identified by WB-MRI may then be validated by additional 18 F-FDG-PET/CT, the capability of which in identifying the histological transformation of FL is well established [22]. Moreover, Wu et al have recently found that FL and diffuse large B-cell lymphoma could be differentiated by means of texture analysis on post-contrast T1-weighted images [41].…”

Section: Imaging Monitoring and Wwmentioning

confidence: 99%

“…18 F-FDG-PET/CT is highly sensitive for disease staging in FL, allowing better identification of nodal and extra-nodal disease locations in comparison with CT [21]. Moreover, it enables accurate detection of lymphoma transformation due to the significantly increased FDG uptake in histologically transformed areas [22]. Furthermore, it has to be stressed that, among all the i-NHL subtypes, FL has a higher risk of secondary tumours or transformation in a more aggressive lymphoma, most commonly diffuse large B-cell lymphoma [23].…”

Section: Imaging Monitoring and Wwmentioning

confidence: 99%

Whole body magnetic resonance in indolent lymphomas under watchful waiting: The time is now

et al. 2017

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The indolent non-Hodgkin lymphomas (i-NHLs) are characterised by 'indolent' clinical behaviour with slow growth and prolonged natural history. The watchful waiting (WW) strategy is a frequently employed treatment option in these patients. This implies a strict monitoring by imaging examinations, including 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) and CT. A major concern is radiation exposure due to regularly monitoring by conventional imaging procedures. Several studies have demonstrated the reliability of whole-body magnetic resonance imaging (WB-MRI) for lymphoma staging. WB-MRI could be useful for active surveillance in iNHLs providing the suspect of disease progression that can be then confirmed by additional diagnostic procedures, including 18F-FDG-PET/CT. The directive 2013/59 by the European Union claims that if a radiation-free imaging technique allows obtaining the same diagnostic results, it should be invariably used.In this setting, WB-MRI may be considered a reasonable option in i-NHLs under WW, replacing imaging modalities that cause exposure to ionising radiations. This will help to reduce the cancer risk in i-NHL patients for whom chemo-/radiotherapy remain the usual treatment options following the usually long WW phase. The scientific community should raise the awareness of the risk of ionising radiations in i-NHLs and the emphasise the need for establishing the proper place of WB-MRI in lymphoma imaging. Key Points• Watchful waiting is a reasonable option in patients with indolent non-Hodgkin lymphomas.• Imaging is crucial to monitor patients with indolent nonHodgkin lymphomas.• CT and 18 F-FDG-PET/CT are commonly used, implying a substantial radiation exposure.• WB-MRI is highly reliable in lymphoma staging.• WB-MRI may be considered to monitor indolent nonHodgkin lymphomas under watchful waiting.

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FDG PET-CT in follicular lymphoma: a case-based evidence review

Cited by 19 publications

References 48 publications

Imaging of Early Response to Predict Prognosis in the First-Line Management of Follicular Non-Hodgkin Lymphoma with Iodine-131-Rituximab Radioimmunotherapy

Imaging of Early Response to Predict Prognosis in the First-Line Management of Follicular Non-Hodgkin Lymphoma with Iodine-131-Rituximab Radioimmunotherapy

FDG-PET is prognostic and predictive for progression-free survival in relapsed follicular lymphoma: exploratory analysis of the GAUSS study

Whole body magnetic resonance in indolent lymphomas under watchful waiting: The time is now

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