Prognostic utility of pre‐transplantation [¹⁸F] fluorodeoxyglucose positron emission tomography/computed tomography in patients with diffuse large B‐cell lymphoma who underwent rituximab, dexamethasone, high‐dose cytarabine, carboplatin salvage chemotherapy

Abstract

We analysed the outcomes of 62 patients with refractory/relapsed diffuse large B-cell lymphoma (rrDLBCL) who had pre-transplantation fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) after R-DHAC (rituximab, dexamethasone, high-dose cytarabine, carboplatin) salvage chemotherapy, and were evaluated using Deauville criteria and total lesion glycolysis (TLG). A positive pretransplantation PET/CT with Deauville score of 5 was associated with shorter progression-free survival (PFS) (P = 0Á01), while a Deauville score of 4 was not predictive of outcome. Only pre-transplant TLG was significantly associated with both PFS (P = 0Á005) and overall survival (P = 0Á03). TLG deserves to be further investigated in prospective studies. , patients with rrDLBCL treated with R-DHAC salvage therapy and scheduled for HDT-ASCT after at least one course of chemotherapy at the Department of Haematology of the University Hospital of Bordeaux were retrospectively reviewed. Patients were eligible for ASCT if they exhibited chemosensitive disease after salvage chemotherapy. Patients with transformed B-cell non-Hodgkin lymphoma were excluded. Our Institutional Review Board (IRB) approved this retrospective study and waived the need for informed patient consent due to the retrospective nature of the work. The PET/CT data obtained at relapse and after salvage therapy were blindly and independently reviewed by two experienced nuclear medicine physicians using the Advantage Workstation (GE Healthcare, Milwaukee, WI, USA). The PET/CT results were classified using the Deauville 5-point scale: 1, no uptake; 2, uptake ≤ that of the mediastinal blood pool; 3, uptake > that of the pool but ≤ that of the liver; 4,

Value of total lesion glycolysis and cell-of-origin subtypes for prognostic stratification of diffuse large B-cell lymphoma patients

“…Our study demonstrated that participants with high TLG (≥1,852 cm 3 ) had inferior survival outcomes compared to those with low TLG and that 41.3% of patients with high TLG eventually experienced disease relapse, and 33.7% died. This finding is consistent with the results reported in previous studies (22,23). Although the SUVmax is an easy-to-calculate index of the 18 F-FDG metabolic rate, it represents an only 1-pixel point of the lesion and could not reflect the entire glucose metabolism condition lesion.…”

Are dynamic or fixed FDG‐PET measures of disease of greater prognostic value in patients with relapsed/refractory diffuse large B‐cell lymphoma undergoing autologous haematopoietic stem cell transplantation?

“…For patients with R/R DLBCL receiving salvage immunochemotherapy and ASCT, metabolic response on pre‐ASCT FDG‐PET is known to be a powerful predictor of outcome 10–12,20–25 . Approximately 50% of patients planned for ASCT fail to achieve CMR after salvage immunochemotherapy, 26 and for these patients, the optimal course of therapy is less clear.…”

“…A smaller retrospective series from CHU Bordeaux of 62 patients with R/R DLBCL had pre‐ASCT PET after receiving R‐DHAC (rituximab, dexamethasone, high‐dose cytarabine, carboplatin) salvage chemotherapy prior to ASCT, and were analysed by intention‐to‐treat 26 . In this study, SUVmax (HR 1.14 (95% CI 1.07–1.23), p < 0.001) and TLG (HR 1.007 (95% CI 1–1.011), p = 0.005) were found to be predictive of PFS, however, pre‐ASCT MTV was not found to be prognostic (HR not provided) 26 . The prognostic value of pre‐ASCT PET metrics specific to patients with incomplete responses was evaluated in a retrospective series from the MD Anderson Cancer Centre of 92 patients with PR or SD on pre‐ASCT PET following salvage chemotherapy for R/R large cell lymphoma (including DLBCL, primary mediastinal B‐cell lymphoma and transformed indolent B‐cell non‐Hodgkin lymphoma) 25 .…”

“…For patients with R/R DLBCL receiving salvage immunochemotherapy and ASCT, metabolic response on pre-ASCT FDG-PET is known to be a powerful predictor of outcome. [10][11][12][20][21][22][23][24][25] Approximately 50% of patients planned for ASCT fail to achieve CMR after salvage immunochemotherapy, 26 and for these patients, the optimal course of therapy is less clear. Yet, of this group with less than CMR who do proceed to ASCT, approximately half will remain alive and relapse free at 3 years, 10,25 suggesting that the Deauville score alone is insufficient to identify patients most likely to benefit from ASCT.…”

“…Other emerging data also confirm the prognostic value of pre‐ASCT PET‐based metrics in patients receiving salvage immunochemotherapy and ASCT for R/R DLBCL. A smaller retrospective series from CHU Bordeaux of 62 patients with R/R DLBCL had pre‐ASCT PET after receiving R‐DHAC (rituximab, dexamethasone, high‐dose cytarabine, carboplatin) salvage chemotherapy prior to ASCT, and were analysed by intention‐to‐treat 26 . In this study, SUVmax (HR 1.14 (95% CI 1.07–1.23), p < 0.001) and TLG (HR 1.007 (95% CI 1–1.011), p = 0.005) were found to be predictive of PFS, however, pre‐ASCT MTV was not found to be prognostic (HR not provided) 26 .…”