Predictive Value of Initial<sup>18</sup>F-FLT Uptake in Patients with Aggressive Non-Hodgkin Lymphoma Receiving R-CHOP Treatment

Herrmann, Ken; Buck, Andreas K.; Schuster, Tibor; Jünger, Alexandra; Wieder, Hinrich; Graf, Nicolas; Ringshausen, Ingo; Rudelius, Martina; Wester, Hans‐Jürgen; Schwaiger, Markus; Keller, Ulrich; Dechow, Tobias

doi:10.2967/jnumed.110.084566

Cited by 62 publications

(38 citation statements)

References 26 publications

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“…18 F-FLT uptake has been known to correlate well with tumor cell proliferation and early reduction of tumor cells (15,29). We hypothesized that 18 F-FLT uptake would reflect early cellular changes after the administration of chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, Hermann et al (29) investigated the early response of 18 F-FLT uptake in high-grade NHL, showing that patients with a marked reduction of 18 F-FLT uptake within 1 wk after the first dose of chemotherapy subsequently achieved a CR at the end of therapy. In our data, end-of-treatment 18 F-FLT PET scans identified more responders who achieved PET CR than did interim 18 F-FLT PET scans.…”

Section: Discussionmentioning

confidence: 99%

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Early Determination of Prognosis by Interim 3′-Deoxy-3′-¹⁸F-Fluorothymidine PET in Patients with Non-Hodgkin Lymphoma

Lee

Kim

et al. 2013

J Nucl Med

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PET is a potentially useful modality for response analysis and prognosis prediction in patients with high-grade non-Hodgkin lymphoma (NHL). The thymidine analog 39-deoxy-39-18 F-fluorothymidine ( 18 F-FLT) was recently introduced as a new tracer. 18 F-FLT uptake correlates with tumor cell proliferation and is suggested to reflect early response to treatment. We performed a prospective study to evaluate the prognostic value of early interim 18 F-FLT PET in patients with NHL. Methods: Patients with untreated NHL were enrolled between 2005 and 2007. Among them, 61 pairs of 18 F-FLT PET images were obtained at baseline (pre), after 1 cycle of chemotherapy (interim), and at the end of all scheduled first-line chemotherapy (final). All 18 F-FLT PET scans were interpreted by quantitative methods (maximum standardized uptake value [SUVmax] and mean standardized uptake value [SUVmean]). Receiver-operating-characteristic curve analysis was performed to define 18 F-FLT PET positivity using a cutoff value predicting disease progression, relapse, or death. Survival outcome was measured by progression-free survival (PFS) and overall survival (OS) rates. Results: Receiver-operating-characteristic curve analysis of SUVmax for prediction of disease progression and death showed the highest area under the curve (AUC) in interim 18 F-FLT PET scans (AUC of 0.841 for PFS and 0.834 for OS, with a cutoff of 1.86; P , 0.001), compared with pre and final 18 F-FLT PET scans. The SUVmean in interim 18 F-FLT PET scans also showed better prediction (AUC of 0.842 for PFS and 0.824 for OS, with a cutoff value of 1.65; P , 0.001) than pre and final 18 F-FLT PET scans. Patients with an interim 18 F-FLT PET SUVmax more than 1.86, who were defined as the interim PET-positive group, were associated with worse 5-y PFS and OS rates than the interim PET-negative group (for PFS: 52.0% vs. 80.7%, respectively, and P , 0.001; for OS: 56.2% vs. 81.4%, respectively, and P , 0.001). By multivariable analysis, the prognostic value of interim 18 F-FLT PET positivity by SUVmax remained significant after adjustment with other prognostic factors (for PFS: hazard ratio, 7.82, 95% confidence interval, 1.65-36.96, and P 5 0.009; for OS: hazard ratio, 5.55, 95% confidence interval, 1.47-33.77, and P 5 0.014). Conclusion: In patients with aggressive NHL, early interim 18 F-FLT PET is a significant predictor of PFS and OS. Early 18 F-FLT PET imaging also has a potential to identify patients with delayed response and nonfavorable prognosis despite achieving a clinical complete response.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Early Determination of Prognosis by Interim 3′-Deoxy-3′-¹⁸F-Fluorothymidine PET in Patients with Non-Hodgkin Lymphoma

Lee

Kim

et al. 2013

J Nucl Med

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“…50 In MCL, FLT uptake was higher than FDG-uptake and was strongly correlated to Ki67 proliferation index. 51 FLT SUVmax was significantly higher in DLBCL than in MCL.…”

Section: Novel Tracers In Lymphomamentioning

confidence: 96%

The Role of Functional Imaging in Lymphoma: Current Controversies and Future Directions

2014

Lymphoma and Chronic Lymphocytic Leukemias

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Fluorodeoxyglucose positron emission tomography (FDG-PET)/computerized tomography (CT) has revolutionized the management of several lymphoma subtypes, yet controversy remains regarding its cost-effectiveness and the appropriate interpretation of equivocal or false-positive PET scans. In this review, we examine the current evidence base informing the management of these controversial aspects of PET, and look ahead to the emerging uses of PET imaging and the application of novel tracers and quantification tools.

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“…On the other hand, this tracer is a typical example of the potential of PET to provide quantitative measurements of specific biologic processes related to oncogenesis as a tool for the in vivo phenotyping of cancer. Initial research results suggest a high sensitivity of 18 F-FLT imaging for the early detection of a therapy response (14,15). An alteration in the rate of proliferation, as assessed with 18 F-FLT, may help to identify cytostatic responses; in contrast, in most instances, 18 F-FDG is used to define cytotoxic effects resulting in cell death.…”

Section: Molecular Imagingmentioning

confidence: 99%

How Many PET Tracers Do We Need?

Schwaiger¹,

Wester²

2011

J Nucl Med

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The recognized need for new PET tracers is associated with increases in available PET instrumentation and with unmet clinical challenges in the early diagnosis and staging of diseases. The clinical success of 18 F-FDG PET has resulted in the acceptance of biologic signals as part of disease management. The advantages of PET technology over SPECT will lead to the introduction of new PET tracers for established nuclear medicine imaging indications. Disease-specific markers such as amyloid ligands will lead to new applications of PET to neurodegenerative diseases that are prevalent in aging societies. The translation of molecular imaging to clinical applications will require combining specific tracer approaches with targeted therapy for the realization of personalized medicine. An important aspect of the introduction of new PET tracers will be the emergence of a specialized radiopharmaceutical industry and professional distribution networks. The number of available PET tracers not only will follow rules of demand and supply but also will be dependent on the regulatory environment of individual health care systems.

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Predictive Value of Initial¹⁸F-FLT Uptake in Patients with Aggressive Non-Hodgkin Lymphoma Receiving R-CHOP Treatment

Cited by 62 publications

References 26 publications

Early Determination of Prognosis by Interim 3′-Deoxy-3′-¹⁸F-Fluorothymidine PET in Patients with Non-Hodgkin Lymphoma

Early Determination of Prognosis by Interim 3′-Deoxy-3′-¹⁸F-Fluorothymidine PET in Patients with Non-Hodgkin Lymphoma

The Role of Functional Imaging in Lymphoma: Current Controversies and Future Directions

How Many PET Tracers Do We Need?

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Predictive Value of Initial18F-FLT Uptake in Patients with Aggressive Non-Hodgkin Lymphoma Receiving R-CHOP Treatment

Cited by 62 publications

References 26 publications

Early Determination of Prognosis by Interim 3′-Deoxy-3′-18F-Fluorothymidine PET in Patients with Non-Hodgkin Lymphoma

Early Determination of Prognosis by Interim 3′-Deoxy-3′-18F-Fluorothymidine PET in Patients with Non-Hodgkin Lymphoma

The Role of Functional Imaging in Lymphoma: Current Controversies and Future Directions

How Many PET Tracers Do We Need?

Contact Info

Product

Resources

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Predictive Value of Initial¹⁸F-FLT Uptake in Patients with Aggressive Non-Hodgkin Lymphoma Receiving R-CHOP Treatment

Early Determination of Prognosis by Interim 3′-Deoxy-3′-¹⁸F-Fluorothymidine PET in Patients with Non-Hodgkin Lymphoma

Early Determination of Prognosis by Interim 3′-Deoxy-3′-¹⁸F-Fluorothymidine PET in Patients with Non-Hodgkin Lymphoma