Six versus eight doses of rituximab in patients with aggressive B cell lymphoma receiving six cycles of CHOP: results from the “Positron Emission Tomography-Guided Therapy of Aggressive Non-Hodgkin Lymphomas” (PETAL) trial

Hüttmann, Andreas; Rekowski, Jan; Hertenstein, Bernd; Franzius, Christiane; Mesters, Rolf M.; Weckesser, Matthias; Kroschinsky, Frank; Kotzerke, Jörg; Ganser, Arnold; Bengel, Frank M.; Rosée, Paul La; Freesmeyer, Martin; Höffkes, Heinz-Gert; Hertel, A.; Behringer, Dirk; Prange‐Krex, Gabriele; Grießhammer, Martin; Holzinger, Jens; Wilop, Stefan; Krohn, Thomas; Raghavachar, Aruna; Maschmeyer, Georg; Brink, Ingo; Schroers, Roland; Gaska, Tobias; Bernhard, Helga; Giagounidis, Aristoteles; Schütte, J.; Dienst, Ariane; Hautzel, Hubertus; Naumann, Ralph; Klein, Alfred; Hahn, D; Pöpperl, Gabriele; Grube, Matthias; Marienhagen, Jörg; Schwarzer, Andreas; Kurch, Lars; Hawranek, Thomas; Steiniger, Heike; Nückel, Holger; Südhoff, Thomas; Römer, Wolfgang; Brinkmann, Marcus; Ose, Claudia; Alashkar, Ferras; Schmitz, Christine; Dürig, Jan; Hoelzer, Dieter; Jöckel, Karl‐Heinz; Klapper, Wolfram

doi:10.1007/s00277-018-3578-0

Cited by 25 publications

(13 citation statements)

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“…Patients were treated with R-CHOP-14 but with three weeks between cycles two and three to prevent false-positive results in iPET staging that uniformly took place after the second cycle (16). Patients with favorable iPET response (ΔSUV max >66%) either received four more cycles of R-CHOP or the same treatment plus two extra doses of rituximab.…”

Section: Methodsmentioning

confidence: 99%

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Interim PET Evaluation in Diffuse Large B-Cell Lymphoma Using Published Recommendations: Comparison of the Deauville 5-Point Scale and the ΔSUV_max Method

et al. 2020

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The value of interim 18F-fluorodeoxyglucose positron emission tomography (iPET) guided treatment decisions in patients with diffuse large B-cell lymphoma (DLBCL) has been the subject of much debate. This investigation focuses on a comparison of the Deauville score and the deltaSUVmax (ΔSUV max) approachtwo methods to assess early metabolic response to standard chemotherapy in DLBCL. Methods: Of 609 DLBCL patients participating in the Positron Emission Tomography-guided Therapy of Aggressive non-Hodgkin Lymphomas (PETAL) trial, iPET scans of 596 patients originally evaluated using the ΔSUV max method were available for post-hoc assessment of the Deauville score. A commonly used definition of an unfavorable iPET result according to the Deauville score is an uptake greater than that of the liver, whereas an unfavorable iPET scan with regard to the ΔSUV max approach is characterized as a relative reduction of the maximum standardized uptake value between baseline and iPET staging of less than or equal to 66%. We investigated the two methods' correlation and concordance by Spearman's rank correlation coefficient and the agreement in classification, respectively. We further used Kaplan-Meier curves and Cox regression to assess differences in survival between patient subgroups defined by the pre-specified cutoffs. Timedependent receiver operating curve analysis provided information on the methods' respective discrimination performance. Results: Deauville score and ΔSUV max approach differed in their iPET-based prognosis. The ΔSUV max approach outperformed the Deauville score in terms of discrimination performance-most likely due to a high number of false-positive decisions by the Deauville score. Cut-offindependent discrimination performance remained low for both methods, but cutoff related analyses showed promising results. Both favored the ΔSUV max approach, e.g. for the segregation by iPET response, where the event-free survival hazard ratio was 3.14 (95% confidence interval (CI): 2.22-4.46) for ΔSUV max and 1.70 (95% CI: 1.29-2.24) for the Deauville score. Conclusion: When considering treatment intensification, the currently used Deauville score cutoff of an uptake above that of the liver seems to be inappropriate and associated with potential harm for DLBCL patients. The ΔSUV max criterion of a relative

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Section: Methodsmentioning

confidence: 99%

“…and Hüttmann et al(16)). With regard to eventfree survival, for 207 patients an event terminated their follow-up time -for 164 of them before the ROC analysis time point of interest at two years after iPET staging.…”

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confidence: 96%

Interim PET Evaluation in Diffuse Large B-Cell Lymphoma Using Published Recommendations: Comparison of the Deauville 5-Point Scale and the ΔSUV_max Method

et al. 2020

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“…Individuals with positive PET results received a fourth chemoimmunotherapy cycle instead of standard irradiation and were observed to have a superior 3-year PFS of 92% versus 60% when using radiotherapy alone. The German PETAL trial calculated the percentage change in maximum standardized uptake value (SUV max ) between baseline and follow-up (∆SUV max ) for response stratification after two courses of R-CHOP and demonstrated semi-quantitative interpretation to be superior as compared with visual assessment [17,18]. Most of the 812 non-Hodgkin lymphoma patients recruited had DLBCL.…”

Section: Dlbclmentioning

confidence: 99%

“…Treatment is selected depending on individual factors and consists of chemotherapy alone or chemotherapy followed by irradiation [2]. Over the years, 18 F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) in combination with computed tomography (CT) has proved a valuable tool for detecting manifestations of lymphoma at diagnosis, and is nowadays considered state-of-the-art. On the basis of stage and other clinical risk indicators, Hodgkin lymphoma can be divided into three different risk-groups, these being early-favorable, early-unfavorable, and advanced disease.…”

Section: Introductionmentioning

confidence: 99%

“…Due to its superior sensitivity in the detection of nodal and extra-nodal lymphoma manifestations, FDG-PET is strongly recommended for staging patients with DLBCL [13]. Moreover, several international trials have examined whether PET imaging may be used early during treatment to separate individuals needing therapy intensification from good responders, that is, candidates for de-escalation [14][15][16][17][18]. As standard treatment, patients receive six chemotherapy cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone alongside the monoclonal antibody rituximab (R-CHOP).…”

Section: Introductionmentioning

confidence: 99%

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FDG-PET Imaging for Hodgkin and Diffuse Large B-Cell Lymphoma—An Updated Overview

Voltin

Mettler

Grosse

et al. 2020

Cancers

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Since the mid-1990s, 18F-fluorodeoxglucose (FDG)-positron emission tomography (PET) in combination with computed tomography has come to play a prominent role in the management of malignant lymphomas. One of the first PET applications in oncology was the detection of lymphoma manifestations at staging, where it has shown high sensitivity. Nowadays, this imaging modality is also used during treatment to evaluate the individual chemosensitivity and adapt further therapy accordingly. If the end-of-treatment PET is negative, irradiation in advanced-stage Hodgkin lymphoma patients can be safely omitted after highly effective chemotherapy. Thus far, lymphoma response assessment has mainly been performed using visual criteria, such as the Deauville five-point scale, which became the international standard in 2014. However, novel measures such as metabolic tumor volume or total lesion glycolysis have recently been recognized by several working groups and may further increase the diagnostic and prognostic value of FDG-PET in the future.

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Baseline and interim PET‐based outcome prediction in peripheral T‐cell lymphoma: A subgroup analysis of the PETAL trial

Schmitz

Rekowski

Hertenstein

et al. 2020

Hematological Oncology

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Six versus eight doses of rituximab in patients with aggressive B cell lymphoma receiving six cycles of CHOP: results from the “Positron Emission Tomography-Guided Therapy of Aggressive Non-Hodgkin Lymphomas” (PETAL) trial

Cited by 25 publications

References 25 publications

Interim PET Evaluation in Diffuse Large B-Cell Lymphoma Using Published Recommendations: Comparison of the Deauville 5-Point Scale and the ΔSUV_max Method

Interim PET Evaluation in Diffuse Large B-Cell Lymphoma Using Published Recommendations: Comparison of the Deauville 5-Point Scale and the ΔSUV_max Method

FDG-PET Imaging for Hodgkin and Diffuse Large B-Cell Lymphoma—An Updated Overview

Baseline and interim PET‐based outcome prediction in peripheral T‐cell lymphoma: A subgroup analysis of the PETAL trial

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Six versus eight doses of rituximab in patients with aggressive B cell lymphoma receiving six cycles of CHOP: results from the “Positron Emission Tomography-Guided Therapy of Aggressive Non-Hodgkin Lymphomas” (PETAL) trial

Cited by 25 publications

References 25 publications

Interim PET Evaluation in Diffuse Large B-Cell Lymphoma Using Published Recommendations: Comparison of the Deauville 5-Point Scale and the ΔSUVmax Method

Interim PET Evaluation in Diffuse Large B-Cell Lymphoma Using Published Recommendations: Comparison of the Deauville 5-Point Scale and the ΔSUVmax Method

FDG-PET Imaging for Hodgkin and Diffuse Large B-Cell Lymphoma—An Updated Overview

Baseline and interim PET‐based outcome prediction in peripheral T‐cell lymphoma: A subgroup analysis of the PETAL trial

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Interim PET Evaluation in Diffuse Large B-Cell Lymphoma Using Published Recommendations: Comparison of the Deauville 5-Point Scale and the ΔSUV_max Method

Interim PET Evaluation in Diffuse Large B-Cell Lymphoma Using Published Recommendations: Comparison of the Deauville 5-Point Scale and the ΔSUV_max Method