Prognostic significance of interim 18F-FDG PET/CT after three or four cycles of R-CHOP chemotherapy in the treatment of diffuse large B-cell lymphoma

Yang, Deok‐Hwan; Min, Jung‐Joon; Song, Ho‐Chun; Jeong, Yong Yeon; Chung, Woong‐Ki; Bae, Sung-Jin; Ahn, Jae‐Sook; Kim, Yeo-Kyeoung; Bom, Hee‐Seung; Chung, Ik‐Joo; Kim, Hyeoung-Joon; Lee, Je‐Jung

doi:10.1016/j.ejca.2010.12.027

Cited by 82 publications

(68 citation statements)

References 26 publications

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“…Historically, the expected 2-year PFS rate for iPET-4-positive patients treated with R-CHOP is approximately 40%. 11,12,15,17,21 The aim of this study was to determine if patients with poor prognosis DLBCL who are iPET-positive after 4 cycles of R-CHOP-14 and receive treatment intensification with R-ICE followed by Z-BEAM ASCT could obtain 2-year PFS of more than 65%. Not only was this achieved, but we show that this high-risk group of patients had survival outcomes similar to those for iPETnegative patients who receive standard R-CHOP.…”

Section: Discussionmentioning

confidence: 99%

“…The expected 2-year PFS rate for iPET-4-positive patients treated with R-CHOP based on historical data was considered to be 40% (range 36%-47%). 11,12,15,17,21 By switching these patients to early treatment intensification, the aim was to increase the 2-year PFS to 65%. A one-stage design with 33 iPET-positive patients provided a probability of at least 90% to detect a difference in 2-year PFS of 40% versus 65%, with a twosided alpha of 0.05.…”

Section: Discussionmentioning

confidence: 99%

“…In a post-hoc exploratory analysis iPET-positive scans were scored by 2 blinded readers with a visual interpretation using the Deauville 5-PS, 15,[29][30][31][32] and survival outcomes were evaluated accordingly. Of the entire 42 iPET-positive patients, 27 were Deauville score 4 and 15 were score 5.…”

Section: And B)mentioning

confidence: 99%

“…[8][9][10][11][12] More recent reports have called this into question, perhaps due to the diversity of imaging and interpretative methodologies that has led to wide variations in reported negative and positive predictive values for interim PET (iPET) scans. [13][14][15][16][17] One confounding factor is that iPET is typically performed after 2 cycles of Rchemotherapy when FDG-avidity likely reflects a mix of residual cancer cells and inflammation. [18][19][20] In contrast, iPET assessment after cycle 4 R-chemotherapy may more specifically identify resistant lymphoma 15,21 and thereby enable more accurate identification of high-risk patients on the basis of therapeutic response who may benefit most from early treatment intensification.…”

Section: Introductionmentioning

confidence: 99%

“…[13][14][15][16][17] One confounding factor is that iPET is typically performed after 2 cycles of Rchemotherapy when FDG-avidity likely reflects a mix of residual cancer cells and inflammation. [18][19][20] In contrast, iPET assessment after cycle 4 R-chemotherapy may more specifically identify resistant lymphoma 15,21 and thereby enable more accurate identification of high-risk patients on the basis of therapeutic response who may benefit most from early treatment intensification. Therefore, in this study we scheduled the iPET in the week following completion of cycle 4 R-CHOP (iPET-4), delaying cycle 5 by seven days to reduce any confounding inflammatory effects within the tumor bed of immuno-chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Early treatment intensification with R-ICE and 90Y-ibritumomab tiuxetan (Zevalin)-BEAM stem cell transplantation in patients with high-risk diffuse large B-cell lymphoma patients and positive interim PET after 4 cycles of R-CHOP-14

et al. 2016

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I n the treatment of diffuse large B-cell lymphoma, a persistently positive [ 18 F]fluorodeoxyglucose positron emission tomography (PET) scan typically carries a poor prognosis. In this prospective multi-center phase II study, we sought to establish whether treatment intensification with R-ICE (rituximab, ifosfamide, carboplatin, and etoposide) chemotherapy followed by 90Y-ibritumomab tiuxetan-BEAM (BCNU, etoposide, cytarabine, and melphalan) for high-risk diffuse large B-cell lymphoma patients who are positive on interim PET scan after 4 cycles of R-CHOP-14 (rituximab, cyclophosphamide, doxorubicin, and prednisone) can improve 2-year progression-free survival from a historically unfavorable rate of 40% to a rate of 65%. Patients received 4 cycles of R-CHOP-14, followed by a centrally-reviewed PET performed at day 17-20 of cycle 4 and assessed according to International Harmonisation Project criteria. Median age of the 151 evaluable patients was 57 years, with 79% stages 3-4, 54% bulk, and 54% International Prognostic Index 3-5. Among the 143 patients undergoing interim PET, 101 (71%) were PET-negative (96 of whom completed R-CHOP), 42 (29%) were PETpositive (32 of whom completed R-ICE and 90Y-ibritumomab tiuxetan-BEAM). At a median follow up of 35 months, the 2-year progressionfree survival for PET-positive patients was 67%, a rate similar to that for

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: And B)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early treatment intensification with R-ICE and 90Y-ibritumomab tiuxetan (Zevalin)-BEAM stem cell transplantation in patients with high-risk diffuse large B-cell lymphoma patients and positive interim PET after 4 cycles of R-CHOP-14

et al. 2016

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The impact of baseline and interim PET/CT parameters on clinical outcome in patients with diffuse large B cell lymphoma

et al. 2012

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mg administered during two or three annual cycles (12 mg or 24 mg, 3 times a week). The shorter time to ITP development observed in our study may be related to the different cumulative dose and to the different schedule of drug administration.It has been previously suggested that ITP secondary to lymphoproliferative disorders could be ascribed to autoreactive non-malignant B-cell clones, favored by the loss of immune tolerance due to T-cell dysfunction and/or inappropriate pathological (auto)antigen presentation by CLL cells [16,17]. During alemtuzumab treatment, immune-dysregulation of T lymphocytes may further favor autoimmunity.In conclusion, while reporting for the first time the association between lowdose alemtuzumab treatment and ITP in a cohort of CLL patients, we would also suggest to maintain a high level of vigilance and to strongly consider routine monitoring for ITP in patients treated with this agent for any pathologic condition. MethodsWe retrospectively analyzed a cohort of 64 patients affected by CLL, diagnosed according to NCIWG-CLL criteria and referred to the Hematology-BMT Unit of the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan between 2003 and. Median age of patients was 68 years (range: 40-83 years).Patients had been treated with low-dose Alemtuzumab, defined as a total weekly dose lower than 45 mg and a cumulative dose inferior to 600 mg, administered for up to 18 weeks [18,19,20].The diagnosis of ITP was based on (1) an otherwise unexplained, rapid (<2 weeks) and severe fall (at least half of the initial level and below 100 3 10 9 /L) of the platelet counts; (2) a normal or augmented number of megakaryocytes in the bone marrow; (3) no or limited (not palpable) splenomegaly, and (4) no cytotoxic treatment in the last month except for alemtuzumab. We also evaluated assays for antibodies to specific platelet glycoproteins, even if they are not routinely recommended, as platelet-associated IgG is elevated in both immune and non-immune thrombocytopenia [21]. Conflict of interest: Nothing to report. A.C., G.R., C.V., and F.R. designed the research study; F.M., G.G., G.R., A.G., F.B., and F.G. performed the research; F.M., G.G., A.G., and A.P. analyzed the data; A.C., G.R., F.M., G.G., C.V. wrote the paper. The impact of baseline and interim PET/CT parameters on clinical outcome in patients with diffuse large B cell lymphoma F-FDG PET/CT as a tool for guidance in risk stratification in patients with aggressive non-Hodgkin's lymphoma (NHL). Here, we analyzed the predictive value of various PET/CT parameters in patients with DLBCL. Particularly, we were interested in patients with an IPI score of 1, 2, or 3, whose prognosis are confusing. Between Jul 2008 and Feb 2010, a total of 100 patients (including 57 patients with an IPI score of 1-3) who were treated with R-CHOP for DLBCL, and had assessable PET/CT parameters were analyzed in this study. Absolute value of SUV max , SUV sum (sum of SUV max ) and TLG sum (SUV mean x Volume meta ) from baseline and interim PET/CT, and DS...

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Utility of interim and end‐of‐treatment PET/CT in peripheral T‐cell lymphomas: A review of 124 patients

et al. 2015

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According to the updated guidelines for imaging in lymphoma, 18F-FDG positron emission tomography/ computed tomography (PET/CT) is recommended for staging and evaluation of treatment response in FDGavid lymphomas. The purpose of the study was to evaluate the utility of PET/CT in nodal peripheral T-cell lymphomas (PTCL). Patients with newly diagnosed nodal PTCL (peripheral T-cell lymphoma NOS, anaplastic large-cell lymphoma, or angioimmunoblastic T-cell lymphoma) seen at five Danish hematology centers during the period 2006 to 2012 were included, if they had been pretherapeutically staged with PET/CT. Medical records were reviewed for baseline clinical and follow-up information. Staging, interim (I-PET), and end-of-treatment PET/CT (E-PET) studies were centrally reviewed, and reported using the Deauville 5-point score (DS). A total of 124 patients fulfilled the inclusion criteria. The median age was 58 years, and 88% received CHOP/CHOP-like therapy. Five years PFS and OS of the study population was 36.8% (95% CI 27.3-46.4) and 49.7% (95% CI 38.9-59.6), respectively. The presence of PET/CT-ascertained lung and/or liver involvement was associated with a worse outcome. The sensitivity of PET/CT for detecting biopsy-defined bone marrow involvement was only 18% (95% CI 4-43). An interim DS >3 was not prognostic for worse OS and PFS among CHOP/CHOP-like treated patients in uni-or multivariate analyses. A DS >3 after treatment predicted a worse prognosis. In conclusion, I-PET was not predictive of outcome in CHOP/CHOP-like treated PTCL patients when using the DS. Prospective studies are needed to determine the optimal use of PET/CT in PTCL including the role of quantitative PET/CT analysis.

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Prognostic significance of interim 18F-FDG PET/CT after three or four cycles of R-CHOP chemotherapy in the treatment of diffuse large B-cell lymphoma

Cited by 82 publications

References 26 publications

Early treatment intensification with R-ICE and 90Y-ibritumomab tiuxetan (Zevalin)-BEAM stem cell transplantation in patients with high-risk diffuse large B-cell lymphoma patients and positive interim PET after 4 cycles of R-CHOP-14

Early treatment intensification with R-ICE and 90Y-ibritumomab tiuxetan (Zevalin)-BEAM stem cell transplantation in patients with high-risk diffuse large B-cell lymphoma patients and positive interim PET after 4 cycles of R-CHOP-14

The impact of baseline and interim PET/CT parameters on clinical outcome in patients with diffuse large B cell lymphoma

Utility of interim and end‐of‐treatment PET/CT in peripheral T‐cell lymphomas: A review of 124 patients

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