Positron emission tomography with [18F]2-fluoro-D-2-deoxyglucose (FDG-PET) predicts relapse of malignant lymphoma after high-dose therapy with stem cell transplantation

Abstract

We have determined the predictive value of [ 18 F]2-fluoro-2-deoxy-glucose (FDG-PET) in patients with Hodgkin's disease (HD) and aggressive non-Hodgkin's lymphoma (NHL) scheduled for high-dose therapy with stem cell transplantation (HDT/SCT). Inclusion criteria were the presence of an FDG-PET scan after chemotherapy (ChT) within 8 weeks prior to HDT/SCT and available follow-up data. Sixteen patients (10 NHL and six HD) were observed during a follow-up period of 4 to 28 months (median 13 months). Before SCT, five patients had a negative PET, three were weakly positive, two moderately positive, and six strongly positive. None of the five patients with a negative PET before HDT/SCT relapsed and two of three patients with a weakly positive scan are still in remission after HDT/SCT. Of eight patients with a moderate or high positive PET before HDT/SCT, seven relapsed and one died of early HDT/SCT related complications (P Ͻ 0.01). Three of eight relapsing patients died of lymphoma 5 to 10 months after SCT and in one additional patient not responding to HDT/SCT, the main cause of death was chronic toxicity 4 months after transplantation. After 12 months, in PET-negative patients the overall and relapse-free survival was 100%, in PET-positive patients 55% and 18%, respectively. In NHL, two patients with negative PET, but with an age-adjusted international prognostic index (AaIPI) of 2 and one with AaIPI ‫؍‬ 1 are still in remission. In the seven PET-positive subjects, one patient with AaIPI = 0, three with AaIPI ‫؍‬ 1, and two with AaIPI ‫؍‬ 2 relapsed. We conclude that FDG-PET is accurate in the prediction of relapse prior to HDT/SCT in patients with lymphoma. It provides additional information when compared with the AaIPI.

Pre-transplant positron emission tomography (PET) using fluorine-18-fluoro-deoxyglucose (FDG) predicts outcome in patients treated with high-dose chemotherapy and autologous stem cell transplantation for non-Hodgkin's lymphoma

“…19 Thus it seems reasonable to assume that in NHL containing high-grade and low-grade components, PET will preferably assess the therapy response of high-grade components, while low-grade components may escape detection. This may also be the reason for higher sensitivity of PET in the study of Becherer et al, 18 because only one patient among their study population had low-grade NHL.…”

Pretransplant positive positron emission tomography/gallium scans predict poor outcome in patients with recurrent/refractory Hodgkin lymphoma

“…15,16 To our knowledge, the current study, although retrospective, is the first large series of HL patients where FI before ASCT was shown to play an important prognostic role. In this study, although negative FI could not completely exclude minimal residual disease, patients with negative FI had a favorable PFS and OS compared with those with positive FI, particularly for patients considered to be in PR by CDM.…”

“…Published reports usually contain small numbers or a mix of HL and NHL patients. 15,16 In this study we assessed the prognostic value of pretransplantation PET and 67 Ga scans in recurrent/ refractory HL patients treated with high-dose chemotherapy (HDCT) followed by ASCT.…”

Positron emission tomography using F-18 fluorodeoxyglucose pre- and post-autologous stem cell transplant in non-Hodgkin's lymphoma

“…In the original study by Becherer et al 8 post-SCT FDG PET scans were performed and reported, but were not independently analyzed with regard to outcome.…”