The impact of pre‐ and post‐transplantation positron emission tomography using 18‐fluorodeoxyglucose on poor‐prognosis lymphoma patients undergoing autologous stem cell transplantation

Abstract

BACKGROUND. In patients with lymphoma who had a poor prognosis, pretransplantation 18‐fluorodeoxyglucose (FDG)‐positron‐emission tomography (PET) was important for the evaluation of response and outcome. However, little is known about the correlation of FDG‐PET with post‐transplantation PET. The current study was designed to ascertain whether positive pretransplantation PET images are modified by the conditioning regimen. METHODS. Sixty consecutive patients who had achieved remission and underwent consolidation by autologous stem cell transplantation (ASCT) had PET images obtained before ASCT (after 3 or 4 chemotherapy cycles) and 100 days after ASCT. The correlation was explored between the presence of abnormal 18‐FDG uptake (PET positive) or its absence (PET negative) and patient outcomes. RESULTS. Before ASCT, 31 patients achieved complete remission (CR), and 23 patients achieved uncertain CR. Before ASCT, 44 patients (75%) were had negative PET images; and, after ASCT, 48 patients (80%) had negative PET images. One year after ASCT, the estimated event‐free survival (EFS) rate was 80% in patients who had negative pre‐ASCT PET images compared with 43% in patients who had positive pre‐ASCT PET images (P = .0002). The EFS rate was 81% in patients who had negative post‐ASCT PET images compared with 25% in patients who had negative post‐ASCT PET images (P < .0001). In multivariate analysis, only the results for pre‐ and post‐ASCT PET images retained prognostic value, with relative risks of failure estimated at 4.9 and 11.9, respectively. CONCLUSIONS. A positive pre‐ASCT PET image indicated a high risk of ASCT failure, which was increased by a positive post‐ASCT PET image. For patients with lymphoma who have positive pre‐ASCT PET images, more investigations using new treatment approaches will be required. For patients who have negative pre‐ASCT PET images, obtaining post‐ASCT PET images does not seem to be mandatory. Cancer 2007. © 2007 American Cancer Society.

Survival impact of rituximab combined with ACVBP and upfront consolidation autotransplantation in high-risk diffuse large B-cell lymphoma for GELA

“…26,27 Significant benefit was reported in patients who achieved a true complete remission after chemotherapy and before ASCT compared with those who experienced a less satisfactory response, thus showing the importance of the quality of response after induction treatment for long-term prognosis. 28 However, neither the present study nor previous control trials used PET imaging, making it extremely difficult to generalize results.…”

Positron emission tomography using F-18 fluorodeoxyglucose pre- and post-autologous stem cell transplant in non-Hodgkin's lymphoma

“…Of note in this study, patients who had chemotherapy-resistant disease by CT criteria, but were FDG PET negative, had comparable outcomes to patients with chemotherapy-sensitive disease and were FDG PET negative. Filmont et al 13 recently investigated the use of FDG PET scans pre-SCT for poor prognosis lymphoma patients undergoing ASCT. A total of 60 consecutive patients medical records were reviewed, including 50 patients with NHL and 10 with Hodgkin's lymphoma.…”

High-dose melphalan with autologous stem cell support in refractory Hodgkin lymphoma patients as a bridge to second transplant

“…At our Institution, tandem HDC or tandem auto-allo-SCT are preferred therapeutic options in lymphoma patients not reaching CR after salvage chemotherapy, based on the poor outcome reported with the use of single HDC; [18][19][20] indeed, disease status before transplantation is a well-known, independent prognostic factor in lymphoma patients. 18,[21][22][23] From present results it emerges that HD-PAM as a bridge therapy may be a challenging option in this setting of poor-prognosis patients. Interestingly, in our hands HD-PAM converted 77% of refractory patients (17 out of 22 patient in SD or PD before HD-PAM) into PR, or even CR (Figure 1), thus enabling them to proceed to further therapy.…”

“…PET images were acquired 60 min after i.v. injection of 250-450 MBq of 18 F-FDG, depending on the patient's weight. All patients fasted for at least 6 h before FDG injection.…”