Risk stratification in diffuse large B-cell lymphoma using lesion dissemination and metabolic tumor burden calculated from baseline PET/CT†

Cottereau, Anne‐Ségolène; Meignan, Michel; Nioche, Christophe; Capobianco, Nicolò; Clerc, Jérôme; Chartier, Loïc; Vercellino, Laëtitia; Casasnovas, Olivier; Thiéblemont, Catherine; Buvat, Irène

doi:10.1016/j.annonc.2020.11.019

Cited by 99 publications

(97 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Beyond Total Metabolic Tumor Volume, recent data suggest that lesion dissemination assessed on PET/CT by means of the largest distance between two lesions (normalized with the body surface area), contributes to assess the spread of the disease, and has a prognostic value, independently of Total Metabolic Tumor Volume in a cohort of first-line chemotherapy diffuse large B-cell lymphoma (39). Radiomics could further contribute to extract clinically meaningful data from medical images.…”

Section: Challenges and Perspectivesmentioning

confidence: 99%

Current and Future Role of Medical Imaging in Guiding the Management of Patients With Relapsed and Refractory Non-Hodgkin Lymphoma Treated With CAR T-Cell Therapy

et al. 2021

View full text Add to dashboard Cite

Chimeric antigen receptor (CAR) T-cells are a novel immunotherapy available for patients with refractory/relapsed non-Hodgkin lymphoma. In this indication, clinical trials have demonstrated that CAR T-cells achieve high rates of response, complete response, and long-term response (up to 80%, 60%, and 40%, respectively). Nonetheless, the majority of patients ultimately relapsed. This review provides an overview about the current and future role of medical imaging in guiding the management of non-Hodgkin lymphoma patients treated with CAR T-cells. It discusses the value of predictive and prognostic biomarkers to better stratify the risk of relapse, and provide a patient-tailored therapeutic strategy. At baseline, high tumor volume (assessed on CT-scan or on [18F]-FDG PET/CT) is a prognostic factor associated with treatment failure. Response assessment has not been studied extensively yet. Available data suggests that current response assessment developed on CT-scan or on [18F]-FDG PET/CT for cytotoxic systemic therapies remains relevant to estimate lymphoma response to CAR T-cell therapy. Nonetheless, atypical patterns of response and progression have been observed and should be further analyzed. The potential advantages as well as limitations of artificial intelligence and radiomics as tools providing high throughput quantitative imaging features is described.

show abstract

Section: Challenges and Perspectivesmentioning

confidence: 99%

Current and Future Role of Medical Imaging in Guiding the Management of Patients With Relapsed and Refractory Non-Hodgkin Lymphoma Treated With CAR T-Cell Therapy

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Patients from an ancillary study of the REMARC trial (NCT01122472) [13] who had a baseline PET/CT available for retrospective review were analyzed. A total of 290 patients were selected, with Body Surface Area (BSA) data and with at least 2 detectable lesions allowing distance measurement [11]. The REMARC study design and details have been reported elsewhere [5].…”

Section: Patientsmentioning

confidence: 99%

“…The 290 patients baseline characteristics were previously reported [11]. Briefly, half of them (52%, n = 150) belonged to the Lenalidomide arm, 91% (n = 264) had an advanced stage, 71% (n = 205) had an IPI ≥ 3, 16% (n = 47) ECOG ≥ 2, 60% elevated LDH upper than normal (n = 175), 51% (n = 147) extranodal sites ≥ 2, and 55% (n = 158) had an MTV ≥ 220 cm 3 .…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…The centroid of each lesion, i.e., each volume of interest (VOI) was considered as the lesion location and Euclidean distance was used. The largest distance between lymphoma sites, called Dmax, was found to have a high prognostic impact on DLBCL outcome [10,11]. Until now TMTV was obtained by summing each individual lesion delineated with a semi-automated image analysis software, allowing the location of each individual lesion and subsequent calculation of distance between lesions.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

New Approaches in Characterization of Lesions Dissemination in DLBCL Patients on Baseline PET/CT

Meignan

Nioche

Clerc

et al. 2021

Cancers

View full text Add to dashboard Cite

Dissemination, expressed recently by the largest Euclidian distance between lymphoma sites (SDmax), appeared a promising risk factor in DLBCL patients. We investigated alternative distance metrics to characterize the robustness of the dissemination information. In 290 patients from the REMARC trial (NCT01122472), the Euclidean (Euc), Manhattan (Man), and Tchebychev (Tch) distances between the furthest lesions, firstly based on the centroid of each lesion and then directly from the two most distant tumor voxels and the Travelling Salesman Problem distance (TSP) were calculated. For PFS, the areas under the ROC curves were between 0.63 and 0.64, and between 0.62 and 0.65 for OS. Patients with high SDmax whatever the method of calculation or high SD_TSP had a significantly poorer outcome than patients with low SDmax or SD_TSP (p < 0.001 for both PFS and OS), with significance maintained in Ann Arbor advanced-stage patients. In multivariate analysis with total metabolic tumor volume and ECOG, each distance feature had an independent prognostic value for PFS. For OS, only SDmax_Tch, SDmax_Euc _Vox, and SDmax_Man _Vox reached significance. The spread of DLBCL lesions measured by the largest distance between lymphoma sites is a strong independent prognostic factor and could be measured directly from tumor voxels, allowing its development in the area of the deep learning segmentation methods.

show abstract

“…There is evidence that the baseline metabolic tumor volume (MTV) is an important prognostic factor, e.g. in NHL, NSCLC and multiple myeloma, as well as in prostate cancer patients treated with the bone-seeking agent radium-223 (173)(174)(175)(176). Furthermore, MTV can be combined with metrics of tumor distance within a patient to not only represent volume, but also dissemination for better reflecting prognosis, as shown in NHL (175).…”

Section: Beyond Recist and Percistmentioning

confidence: 99%

Bone Metastases Are Measurable: The Role of Whole-Body MRI and Positron Emission Tomography

et al. 2021

View full text Add to dashboard Cite

Metastatic tumor deposits in bone marrow elicit differential bone responses that vary with the type of malignancy. This results in either sclerotic, lytic, or mixed bone lesions, which can change in morphology due to treatment effects and/or secondary bone remodeling. Hence, morphological imaging is regarded unsuitable for response assessment of bone metastases and in the current Response Evaluation Criteria In Solid Tumors 1.1 (RECIST1.1) guideline bone metastases are deemed unmeasurable. Nevertheless, the advent of functional and molecular imaging modalities such as whole-body magnetic resonance imaging (WB-MRI) and positron emission tomography (PET) has improved the ability for follow-up of bone metastases, regardless of their morphology. Both these modalities not only have improved sensitivity for visual detection of bone lesions, but also allow for objective measurements of bone lesion characteristics. WB-MRI provides a global assessment of skeletal metastases and for a one-step “all-organ” approach of metastatic disease. Novel MRI techniques include diffusion-weighted imaging (DWI) targeting highly cellular lesions, dynamic contrast-enhanced MRI (DCE-MRI) for quantitative assessment of bone lesion vascularization, and multiparametric MRI (mpMRI) combining anatomical and functional sequences. Recommendations for a homogenization of MRI image acquisitions and generalizable response criteria have been developed. For PET, many metabolic and molecular radiotracers are available, some targeting tumor characteristics not confined to cancer type (e.g. 18F-FDG) while other targeted radiotracers target specific molecular characteristics, such as prostate specific membrane antigen (PSMA) ligands for prostate cancer. Supporting data on quantitative PET analysis regarding repeatability, reproducibility, and harmonization of PET/CT system performance is available. Bone metastases detected on PET and MRI can be quantitatively assessed using validated methodologies, both on a whole-body and individual lesion basis. Both have the advantage of covering not only bone lesions but visceral and nodal lesions as well. Hybrid imaging, combining PET with MRI, may provide complementary parameters on the morphologic, functional, metabolic and molecular level of bone metastases in one examination. For clinical implementation of measuring bone metastases in response assessment using WB-MRI and PET, current RECIST1.1 guidelines need to be adapted. This review summarizes available data and insights into imaging of bone metastases using MRI and PET.

show abstract

Risk stratification in diffuse large B-cell lymphoma using lesion dissemination and metabolic tumor burden calculated from baseline PET/CT†

Cited by 99 publications

References 27 publications

Current and Future Role of Medical Imaging in Guiding the Management of Patients With Relapsed and Refractory Non-Hodgkin Lymphoma Treated With CAR T-Cell Therapy

Current and Future Role of Medical Imaging in Guiding the Management of Patients With Relapsed and Refractory Non-Hodgkin Lymphoma Treated With CAR T-Cell Therapy

New Approaches in Characterization of Lesions Dissemination in DLBCL Patients on Baseline PET/CT

Bone Metastases Are Measurable: The Role of Whole-Body MRI and Positron Emission Tomography

Contact Info

Product

Resources

About