Interim PET/CT in diffuse large B-cell lymphoma may facilitate identification of good-prognosis patients among IPI-stratified patients

Nyilas, Renáta; Farkas, Bence; Bicskó, Réka Ráhel; Magyari, Ferenc; Pinczés, László Imre; Illés, Árpád; Gergely, Lajos

doi:10.1007/s12185-019-02690-2

Cited by 12 publications

(6 citation statements)

References 29 publications

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“…This difference can be explained by the fact that 40.3% of the patients with an I-PET scan after 2 cycles were from the PETAL trial, and the PPV of DS4-5 in the PETAL trial was 26.4% (data not shown). Nyilas et al 23 retrospectively included mainly patients with an I-PET after 4 cycles and reported a PPV of 48%, which is slightly higher than our PPV of 42.6% at I-PET4. The PPV of DSUV max -positivity criteria was higher in our study, which confirms the higher PPV using DSUV max -positivity criteria in the PETAL trial.…”

Section: Discussioncontrasting

confidence: 70%

“…11,20,21 Our results showed that I-PET scans of patients with DLBCL have an NPV .80% for 2-year PFS, which is in line with previously published results. 3,22,23 In the literature, PPVs at I-PET2 ranged between 37% and 74% using DS4-5 criteria, 3 which were higher than the PPV of 30.5% for DS4-5-positive patients at I-PET2 in this study. This difference can be explained by the fact that 40.3% of the patients with an I-PET scan after 2 cycles were from the PETAL trial, and the PPV of DS4-5 in the PETAL trial was 26.4% (data not shown).…”

Section: Discussioncontrasting

confidence: 56%

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Optimal timing and criteria of interim PET in DLBCL: a comparative study of 1692 patients

Eertink¹,

Burggraaff²,

Heymans

et al. 2021

Blood Advances

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Interim 18F-fluorodeoxyglucose positron emission tomography (Interim-18F-FDG-PET, hereafter I-PET) has the potential to guide treatment of patients with diffuse large B-cell lymphoma (DLBCL) if the prognostic value is known. The aim of this study was to determine the optimal timing and response criteria for evaluating prognosis with I-PET in DLBCL. Individual patient data from 1692 patients with de novo DLBCL were combined and scans were harmonized. I-PET was performed at various time points during treatment with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. Scans were interpreted using the Deauville score (DS) and change in maximum standardized uptake value (ΔSUVmax). Multilevel Cox proportional hazards models corrected for International Prognostic Index (IPI) score were used to study the effects of timing and response criteria on 2-year progression-free survival (PFS). I-PET after 2 cycles (I-PET2) and I-PET4 significantly discriminated good responders from poor responders, with the highest hazard ratios (HRs) for I-PET4. Multivariable HRs for a PET-positive result at I-PET2 and I-PET4 were 1.71 and 2.95 using DS4-5, 4.91 and 6.20 using DS5, and 2.93 and 4.65 using ΔSUVmax, respectively. ΔSUVmax identified a larger proportion of poor responders than DS5 did. For all criteria, the negative predictive value was >80%, and positive predictive values ranged from 30% to 70% at I-PET2 and I-PET4. Unlike I-PET1, I-PET3 discriminated good responders from poor responders using DS4-5 and DS5 thresholds (HRs, 2.94 and 4.67, respectively). I-PET2 and I-PET4 predict good response equally during R-CHOP therapy in DLBCL. Optimal timing and response criteria depend on the clinical context. Good response at I-PET2 is suggested for de-escalation trials, and poor response using ΔSUVmax at I-PET4 is suggested for randomized trials that are evaluating new therapies.

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Section: Discussioncontrasting

confidence: 70%

Section: Discussioncontrasting

confidence: 56%

Optimal timing and criteria of interim PET in DLBCL: a comparative study of 1692 patients

Eertink¹,

Burggraaff²,

Heymans

et al. 2021

Blood Advances

View full text Add to dashboard Cite

show abstract

“…Assessment of response to treatment of lymphoma is usually performed by radiologic or nuclear medicine studies. Together with radiotherapy, the use of radiological or nuclear medicine examinations causes signi cant radiation exposure (9,12,13). Considering the cost of radiological and nuclear medicine examinations and the risk of radiation-induced disease, studies have been conducted on less expensive and radiation-free examinations.…”

Section: Discussionmentioning

confidence: 99%

Biochemical Response Evaluation on Lymphomas: Proposing a Scoring System

Erdat

Arık²,

Barışta³

2023

Preprint

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Biochemical tests are used for prognostic stratification of lymphoma, but there is no reasonable way to use biochemical tests for response assessment. This study involved 108 patients treated with lymphoma at the Department of Medical Oncology, Hacettepe University, between January 2015 and December 2017. Patients were classified into "good responders" and "poor responders". The changes in biochemical parameters were evaluated for their usefulness in assessing the response of patients with good and poor response. Fifty-seven patients were male, 51 patients were female, and the mean age of the patients was 49.0 years. 27 patients had HL, 71 patients had B-cell NHL, 9 patients had T-cell NHL, and one patient had EBV-related lymphoproliferative disease. Levels of total protein (from 7.12 to 6.79 gr/dL, p < 0.01), ß2-microglobulin (from 2287 to 2039 ng/mL, p = 0.07) and lactate dehydrogenase (from 297.8 to 230.1 U/L, p < 0.01) decreased in patients with good response. After transformation of parameters, a 4-point ordinal system consisting of total protein, ß2-microglobulin and lactate dehydrogenase values was proposed. Further analysis showed a nearly high effect size (Cramer's V 0.461). Our study is the first to propose a scoring system for response assessment in lymphoma. Structured abstract Background: Lymphomas are different groups of lymphoid malignancies, but their classification and evaluation of response is done in a similar manner. Biochemical tests are used for prognostic stratification of lymphomas, but there is no reasonable way to use biochemical tests to assess response. Patients and Methods: We enrolled 108 patients treated with lymphoma in the Department of Medical Oncology, Hacettepe University, between January 2015 and December 2017. Patients were divided into good and poor responders. The changes in biochemical parameters were evaluated for their usefulness in assessing the response of patients with good and poor response. The proposed scoring system was evaluated for its effect size using Cramer's V test. Results: Fifty-seven patients were male, 51 patients were female, and the mean age of the patients was 49.0 years. 27 patients had HL, 71 patients had B-cell NHL, 9 patients had T-cell NHL, and one patient had EBV-related lymphoproliferative disease. 53 patients had stage IV, nine patients had stage III, 23 patients had stage II, and 22 patients had stage I disease. Levels of total protein (from 7.12 to 6.79 gr/dL, p < 0.01), ß2-microglobulin (from 2287 to 2039 ng/mL, p = 0.07), and lactate dehydrogenase (from 297.8 to 230.1 U/L, p < 0.01) decreased in patients with good response, whereas nothing significant was found in patients with poor response. After transformation of parameters, a 4-point ordinal system consisting of total protein, ß2-microglobulin, and lactate dehydrogenase values was proposed. Further analysis showed a nearly high effect size (Cramer's V 0.461) and significance in logistic regression (p < 0.01). Conclusion: Our study is the first to propose a scoring system for response assessment in lymphoma. Further studies are needed to confirm our scoring system.

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“…Assessment of response to treatment of lymphoma is usually performed by radiologic or nuclear medicine studies. Together with radiotherapy, the use of radiological or nuclear medicine examinations causes considerable radiation exposure 10,12,13 . Considering the cost of radiological and nuclear medicine examinations and the risk of radiation-induced disease, there have been studies of less expensive and radiation-free examinations, but since no satisfactory results have been obtained so far, no new method of response assessment is available to guide clinical practice 14 .…”

Section: Discussionmentioning

confidence: 99%

Assessment of Chemotherapy Response With Simple Biochemistry on Lymphoma Patients

Erdat

2022

Preprint

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Background Response to treatment is evaluated with radiologic and/or nuclear medicine studies in addition to a complete physical examination. Biochemical investigations have been used for many years in risk and prognostic stratification of lymphoma, but there is no clinically useful method to assess response to treatment in lymphoma. In our study, we investigated the suitability of routine biochemical assays for assessing response to treatment in lymphoma. Patients and Methods: We retrospectively collected 108 patients’ routine biochemical examinations and examined the changes in biochemical parameters in terms of good or poor response. Logistic regression modelling was done on biochemical parameters and the results were used for development an ordinal scoring system. Results Most of the changes in biochemical parameters before and after treatment were significant (p < 0.05). The levels of total protein, beta-2-microglobulin, lactate dehydrogenase and C-reactive protein and erythrocyte sedimentation rate had decreased in the patients with good response to treatment, while no change was observed in the patients with poor response to treatment. Cross-interaction between pre- and post-treatment beta-2-microglobulin, lactate dehydrogenase and total protein levels was significant (p = 0.02–0.03). We developed a 4-point ordinal scoring system for lymphoma response evaluation using biochemical parameters. Logistic regression showed significance (p < 0.01) and effect size was close to high effect (Cramer’s V test 0.46) Conclusion A 4-point ordinal scoring system for lymphoma response evaluation is proposed.

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Interim PET/CT in diffuse large B-cell lymphoma may facilitate identification of good-prognosis patients among IPI-stratified patients

Cited by 12 publications

References 29 publications

Optimal timing and criteria of interim PET in DLBCL: a comparative study of 1692 patients

Optimal timing and criteria of interim PET in DLBCL: a comparative study of 1692 patients

Biochemical Response Evaluation on Lymphomas: Proposing a Scoring System

Assessment of Chemotherapy Response With Simple Biochemistry on Lymphoma Patients

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