Pre-transplant 18F-fluorodeoxyglucose positron emission tomography-based survival model in patients with aggressive lymphoma undergoing high-dose chemotherapy and autologous SCT

Abstract

18F-fluorodeoxyglucose positron emission tomography (FDG-PET) documented response after salvage chemotherapy has been reported to impact survival in patients with aggressive non-Hodgkin's lymphoma, especially diffuse large B cell lymphoma (DLBCL) undergoing high dose chemotherapy and autologous SCT (HDC auto-SCT). We reviewed the impact of 19 different prognostic/ predictive factors before salvage chemotherapy and post-salvage chemotherapy FDG-PET results in patients with aggressive lymphoma and developed an FDG-PET integrated model for post-HDC auto-SCT outcome. The Fine and Gray method for competing risk analysis and a regression model was used to assess the risk associated with different factors on outcome. Fifty-five patients had FDG-PET after salvage chemotherapy; male 65%, female 45%, relapsed 55%, refractory 45%, DLBCL 82%, T cell lymphoma 18%, median age at auto-SCT 40 years, median follow-up 42.4 months. Multivariate analysis identified only positive FDG-PET (P ¼ 0.04) and mediastinal involvement (P ¼ 0.05) with higher hazard rate of disease-specific death (model P ¼ 0.008) but only positive FDG-PET (P ¼ 0.01) for disease-specific events (persistent, progressive or relapsed disease). Cumulative incidence of disease-specific death for patients with 0, 1 and 2 risk factors was 5, 30 and 62%, respectively (P ¼ 0.01). Our model is significant and showed an increasing risk of failure with mediastinal involvement and post-salvage positive FDG-PET.

Pretransplant FDG‐PET in aggressive non‐Hodgkin lymphoma: systematic review and meta‐analysis

“…This study reported a sensitivity of 8.3% and a specificity of 30.5% for pretransplant FDG-PET in predicting death in patients with newly diagnosed aggressive non-Hodgkin lymphoma (22). Three studies (17,20,26) reported sufficient data for the calculation of sensitivity and specificity of pretransplant FDG-PET in predicting treatment failure after ASCT in patients with refractory/relapsed aggressive non-Hodgkin lymphoma, which ranged between 58.8% and 73.3% and between 68.4% and 75.0%, respectively. There was no threshold effect (Spearman q = À1.000, P = 0.000) and no interstudy heterogeneity (I 2 = 0.0%).…”

“…Table 5 displays the results of the 11 included studies. Seven studies (17,18,20,(22)(23)(24)26) reported sufficient data for the calculation of sensitivity and specificity of pretransplant FDG-PET in predicting treatment failure after ASCT in all aggressive lymphomas (whether newly diagnosed aggressive, transformed indolent, or refractory/relapsed aggressive non-Hodgkin lymphoma), which ranged Four studies (18,20,22,26) reported sufficient data for the calculation of sensitivity and specificity of pretransplant FDG-PET in predicting death after ASCT in all aggressive lymphomas (whether newly diagnosed aggressive, transformed indolent, or refractory/relapsed aggressive non-Hodgkin lymphoma), which ranged between 8.3% and 87.5% and between 65.6% and 72.0%, respectively. There was no threshold effect (Spearman q = 0.000, P = 1.000), but there was interstudy heterogeneity (I 2 = 68.1%).…”

Pre-transplant FDG-PET-based survival model in relapsed and refractory Hodgkin’s lymphoma: outcome after high-dose chemotherapy and auto-SCT

“…Details of methodology and design are fully explained in our previous report. 17 This study evaluates the impact of post salvage chemotherapy or pre-HDC ASCT FDG-PET among other prognostic or predictive factors at the time of relapse or progression before the initiation of salvage chemotherapy on post HDC ASCT persistent disease, progression, relapse or death in patients who underwent HDC ASCT. We also constructed a score-based predictive model based on pre-transplant FDG-PET results and other prognostic factors for post HDC ASCT residual/progressive disease (PD), relapse and death due to disease in these patients.…”

Role of 2-Deoxy-2-[18F]-fluoro-d-glucose-PET/Computed Tomography in Lymphoma

“…[114][115][116][117] In a recent retrospective study of 55 patients with relapsed/refractory DLBCL who were treated with HDC and autologous stem cell transplant (ASCT), 19 prognostic factors were analyzed in an integrative model to predict the outcome of the treatment. 118 Only PET positivity before the ASCT and HDC was predictive of disease-specific events (hazards ratio [HR]: 3.9, P 5 .01) and deaths (HR: 3.4, P 5 .04) in multivariate analyses. 118 A similar study in 141 patients with refractory HL analyzed 21 prognostic factors and showed IPS 3 or more (HR: 3.7, P 5 .001) and positive pre-ASCT PET (HR: 3.4; P 5 .011) to be associated with higher hazard for disease-specific death.…”

“…118 Only PET positivity before the ASCT and HDC was predictive of disease-specific events (hazards ratio [HR]: 3.9, P 5 .01) and deaths (HR: 3.4, P 5 .04) in multivariate analyses. 118 A similar study in 141 patients with refractory HL analyzed 21 prognostic factors and showed IPS 3 or more (HR: 3.7, P 5 .001) and positive pre-ASCT PET (HR: 3.4; P 5 .011) to be associated with higher hazard for disease-specific death. 119 In another study of patients with refractory HL, FDG-PET/CT allowed identification of high-risk patients who would benefit from tandem ASCT.…”