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

Abstract

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.

Cerebellum/liver index in pretherapeutic 18F-FDG PET/CT as a predictive marker of progression-free survival in follicular lymphoma treated by immunochemotherapy and rituximab maintenance

“…By contrast to previous publications, [17,26] MTV using the 41% thresholding method is not significant. The median MTV in our study (382 cm 3 –41% patients above 510 cm 3 ) are within the upper limits compared to other studies: 116 cm 3 (8%) [27] ; 354 cm 3 (38%) [28] ; and 297 cm 3 (29%) [17] . This variability despite an identical methodology might highlight reproducibility difficulties in MTV measurement.…”

Time to Next Treatment as a Meaningful Endpoint for Trials of Primary Cutaneous Lymphoma

“…TTNT is a well-accepted endpoint in clinical trials of patients with multiple myeloma [18][19][20][21][22][23][24][25][26][27][28]. It also features in the published literature of clinical studies of patients with chronic lymphocytic leukaemia [29][30][31][32][33][34], follicular lymphoma [35][36][37][38][39], mantle cell lymphoma [40], amyloidosis [41], Waldenstrom macroglobulinaemia [42,43], autoimmune haemolytic anaemia [44], metastatic melanoma [45], and metastatic breast cancer [46]. TTNT has also been used as a valid endpoint within cost-benefit analyses in several published health-economic analyses [19,24,27,29].…”

“…TTNT has also been used as a valid endpoint within cost-benefit analyses in several published health-economic analyses [19,24,27,29]. Interestingly, the use of TTNT has also been applied to the use of positron emission tomography for the purposes of prognostication [23,39]. Common to all are the underlying disease behaviours: typically demonstrating intermediate to long natural histories, accumulated exposures to multiple lines of therapy, and low likelihoods of cure.…”

Improved Quantification of 18F-FDG PET during 131I-Rituximab Therapy on Mouse Lymphoma Models after 131I Prompt Emission Correction

“…The clinical significance of 18 F-FDG uptake by primary sites in patients with diffuse large B cell lymphoma in the head and neck, or in cervical lymph nodes, was reported [14,15]. The use of 18 F-FDG PET imaging of early response to predict prognosis in the first-line management of follicular non-Hodgkin lymphoma with 131 I Rituximab RIT was reported [16]. The value of 18 F-FDG PET/CT for the staging of primary extranodal head and neck lymphomas was also reported [17].…”