Pretransplantation positron emission tomography scan is the main predictor of autologous stem cell transplantation outcome in aggressive B‐cell non‐Hodgkin lymphoma

Derenzini, Enrico; Musuraca, Gerardo; Fanti, Stefano; Stefoni, Vittorio; Tani, Monica; Alinari, Lapo; Venturini, Filippo; Gandolfi, Letizia; Baccarani, Michele; Zinzani, Pier Luigi

doi:10.1002/cncr.23861

Cited by 69 publications

(68 citation statements)

References 22 publications

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“…More recently, some studies indicated that 18 FDG-FDG-PET also provides useful information about disease status before ASCT and even allogeneic stem cell transplantation in relapsed or refractory HL and non-Hodgkin's lymphoma, with a significant correlation between pretransplant PET status and prognosis [20][21][22][23][24][25][26]. CT scan is the most used in restaging lymphoma; however, some authors reported that history and physical examination could be the standard approach to follow-up because in most cases early recurrence is first suspected by the patient himself or by the physician, even with routine screening including CT scans [27,28].…”

Section: Discussionmentioning

confidence: 99%

Role of 18FDG-PET/CT in detecting relapse during follow-up of patients with Hodgkin’s lymphoma

et al. 2009

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The role of 18 FDG-PET/CT during follow-up of patients affected by Hodgkin's lymphoma (HL) in complete remission after treatment is not fully elucidated, since a wide use of 18 F fluorodeoxyglucose positron emission tomography/computed tomography ( 18 FDG-PET/CT) in this setting could be limited by a relative high rate of false-positive results. Herein, we summarize a retrospective analysis of 27 patients with Hodgkin's lymphoma in complete remission after the first-line (n=20) or salvage (n=7) therapy receiving serial 18 FDG-PET/CT scans during follow-up. Out of 165 scans, 13 were suspected for relapse, which was confirmed in seven patients. All relapses were correctly identified by 18 FDG-PET/CT positivity, with a 100% sensitivity; false-positive rate was 46% and negative predictive value was 100%. True-positive findings were mostly associated with multiple sites, subdiaphragmatic involvement, and/or previous sites of disease. According to our results, we conclude that performing routine PET/CT scan during follow-up of those patients who are at high risk of relapse would be advisable, although caution must be adopted when interpreting PET/CT results due to the relatively high rate of false-positive findings. If FDG abnormal uptake is present at multiple nodal sites, subdiaphragmatic lymph nodes, or previous sites of disease, histological verification of PET abnormal findings is warranted.

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Section: Discussionmentioning

confidence: 99%

Role of 18FDG-PET/CT in detecting relapse during follow-up of patients with Hodgkin’s lymphoma

et al. 2009

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“…who are PET-positive) do very poorly after ASCT. 15 To improve the outcome of this group of patients, RIT has been used as part of the transplantation preparative regimen. Phase II studies have shown promising results in relapsed DLBCL patients.…”

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confidence: 99%

Post-thrombotic syndrome is an independent determinant of health-related quality of life following both first proximal and distal deep vein thrombosis

et al. 2014

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© F e r r a t a S t o r t i F o u n d a t i o nclinical trial on the safety and efficacy of a standard dose of 90 Y-ibritumomab tiuxetan combined with high-dose BEAM chemotherapy followed by ASCT in patients with DLBCL refractory to a rituximab-containing chemotherapy. Methods EligibilityThis study included patients with histologically confirmed DLBCL, either de novo or transformed from a previous indolent CD20 + B-cell lymphoma. Patients were eligible if they failed to achieve at least a partial response after front-line immunochemotherapy (induction failure), and were further unresponsive (i.e. failed to attain a partial response) to salvage immunochemotherapy. Patients with a relapse who failed to achieve a partial response to salvage immunochemotherapy were also eligible. Other eligibility criteria included age between 18 and 70 years old, a performance status of 0-1, and standard transplantation criteria (i.e. adequate cardiac, renal, and respiratory function). All patients had measurable disease by fluorine-18 fluorodeoxyglucose positron emission tomography combined with computed tomography (PET-CT). Patients were excluded if they had central nervous system lymphoma at the time of enrollment, a history of human immunodeficiency virus infection, or had previously undergone ASCT. Study design and treatmentThis was a phase II study conducted at 17 centers within Spain, approved by the Ethics Committee of each center, and conducted in accordance with the Declaration of Helsinki. Patients were recruited from January 2008 to February 2010. Signed informed consent was obtained from all patients prior to any study-related procedure. The study was registered under European Union Drug Regulating Authorities Clinical Trials (EudraCT) N. 2007-003198-22.On day -21, patients were given rituximab 250 mg/m 2 ; on day -14, patients received 250 mg/m 2 rituximab followed by 90 Y-ibritumomab tiuxetan at a fixed dose of 0.4 mCi/kg (with a maximum total dose of 32 mCi) in an outpatient setting, with no dose adjustments for neutropenia or thrombocytopenia. One week later, patients were given high-dose BEAM chemotherapy (carmustine 300 mg/m 2 on day -6, etoposide 200 mg/m 2 on days -5 to -2, cytarabine 200 mg/m 2 twice a day on days -5 to -2, and melphalan 140 mg/m 2 on day -1). Autologous stem cells were reinfused on day 0. Granulocyte colony-stimulating factor 5 μg/kg/day was started on day +7 after ASCT and continued until neutrophil recovery. Acyclovir and trimethoprim sulfamethoxazole were used as prophylaxis 1 and 3 months after ASCT, respectively. Adverse events were assessed and graded according to the National Cancer Institute Common Toxicity Criteria for Adverse Events, version 3.0. Response evaluation and follow-upAll patients were required to have a complete baseline evaluation before the treatment, including a physical examination, blood count and serum biochemistry determinations, bone marrow biopsy and a whole body evaluation with PET-CT. Response was evaluated 3 months after ASCT, according to the 2007 C...

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“…In most of the studies, a negative FDG-PET after salvage chemotherapy has been reported as a predictor for better PFS (66-96%) as compared with a positive FDG-PET scan (23-35% PFS) and in some studies, even for OS (77-100 vs 39-61%, respectively). 3,4,7,9,13,15 Recently, there have been some reports of FDG-PET in reduced intensity or full allogeneic transplant. Four of these studies failed to show any impact of FDG-PET results [21][22][23][24] while only one showed a negative effect of FDG-PET positivity in this setting.…”

Section: Patients' Characteristicsmentioning

confidence: 99%

“…This scorebased analysis indicates increasing risk of treatment failure for higher scores. [3][4][5][7][8][9]12,13,15 Most commonly reported adverse factors are short duration of CR, elevated lactic dehydrogenase, extranodal disease, mediastinal mass, poor response to salvage chemotherapy, presence of B symptoms, poor performance status, bulky disease and primary induction failure.…”

Section: Patients' Characteristicsmentioning

confidence: 99%

“…Patients with FDG-PET positive disease after salvage chemotherapy/before HDC auto-SCT are reported to have inferior outcome. [3][4][5][6][7][8][9][10][11][12][13][14][15] Currently, there is no comprehensive predictive model integrating FDG-PET with other clinical risk factors in this group. We are reporting our experience of pre-transplant FDG-PET results along with other prognostic factors and constructed a predictive model and its impact on outcome.…”

Section: Introductionmentioning

confidence: 99%

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

Akhtar

Al-Sugair

Abouzied

et al. 2012

Bone Marrow Transplant

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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.

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Pretransplantation positron emission tomography scan is the main predictor of autologous stem cell transplantation outcome in aggressive B‐cell non‐Hodgkin lymphoma

Cited by 69 publications

References 22 publications

Role of 18FDG-PET/CT in detecting relapse during follow-up of patients with Hodgkin’s lymphoma

Role of 18FDG-PET/CT in detecting relapse during follow-up of patients with Hodgkin’s lymphoma

Post-thrombotic syndrome is an independent determinant of health-related quality of life following both first proximal and distal deep vein thrombosis

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

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