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

Abstract

This study aimed to systematically review and meta-analyze the value of pretransplant FDG-PET in predicting outcome after autologous stem cell transplantation in aggressive non-Hodgkin lymphoma. MEDLINE was systematically searched; included studies were methodologically assessed and metaanalyzed, when possible. Overall methodological quality of included studies (n = 11) was poor, with moderate risk of bias in the domains of study participation (n = 7) and prognostic factor measurement (n = 7), and high risk of bias in the domains of outcome measurement (n = 10), and study confounding (n = 11). In all aggressive non-Hodgkin lymphomas, pooled sensitivity and specificity were 54.0% and 73.1% in predicting treatment failure, and 54.5% and 68.7% in predicting death. Because of interstudy heterogeneity, additional subgroup analyses were performed. In newly diagnosed aggressive non-Hodgkin lymphoma, pooled sensitivity and specificity were 20.0% and 70.0% in predicting treatment failure, and 8.3% % and 30.5% in predicting death. In refractory/relapsed aggressive non-Hodgkin lymphoma, pooled sensitivity and specificity were 68.1% and 72.1% in predicting treatment failure, and 77.3% and 69.6% in predicting death. At present, pretransplant FDG-PET cannot be recommended in aggressive non-Hodgkin lymphoma, because available studies suffer from major methodological flaws, and reported prognostic estimates are low (i.e., poor in newly diagnosed and moderate in refractory/relapsed aggressive nonHodgkin lymphoma).

Bendamustine as part of conditioning of autologous stem cell transplantation in patients with aggressive lymphoma: a phase 2 study from the GELTAMO group

“…This was the single prognostic factor influencing OS in the univariate and multivariate analysis, although, with only 20 events, any multivariable analysis of survival is likely to be unreliable. The prognostic impact of pre-ASCT FDG-PET in patients with relapsed or refractory DLBCL has been shown previously in multiple retrospective studies and uncontrolled prospective series (Schot et al, 2007;Derenzini et al, 2008;Hoppe et al, 2009;Terasawa et al, 2010;Armand et al, 2013a;Sauter et al, 2015;Ulaner et al, 2015;Adams & Kwee, 2017). Our results confirm this finding in a prospective and controlled way, and indicate that incorporation of bendamustine into the conditioning regimen does not overcome the relative chemotherapy insensitivity and poor prognosis of patients undergoing ASCT in metabolic PR.…”

Evidence-Based PET for Haematological Tumours

“…Adams et al [20] aimed to analyse the value of pretransplant 18 F-FDG PET in predicting outcome after autologous stem cell transplantation in aggressive NHL. Pooled sensitivity and specificity of 18 F-FDG PET were 54 and 73.1% in predicting treatment failure, and 54.5 and 68.7% in predicting death.…”

Positron emission tomography (PET) for prediction of glioma histology: protocol for an individual-level data meta-analysis of test performance

“…Its usefulness has been proven in lung cancer 5 and aggressive lymphomas. 6 Several studies have evaluated PET using various tracers such as 18-Fludeoxyglucose (18F-FDG), l-[Methyl-()11C]Methionine (11C-MET), 18F-Fluoro-Ethyl-Tyrosine (18F-FET) or (18)F-Fluorothymidine (18F-FLT) for pretherapy histological prediction to differentiate high-grade from low-grade glioma and reported promising results. 7–9 The sample sizes of these studies, however, are typically small, resulting in imprecise estimates of diagnostic accuracy and use heterogeneous designs/protocols for PET assessment, making interpretation of the published data difficult.…”