Predicting primary treatment failure using interim FDG‐PET scanning in diffuse large B‐cell lymphoma

Interim FDG‐PET (iPET) in diffuse large B‐cell lymphoma (DLBCL) is increasingly practised and used in clinical trials to adapt further therapy. However, the optimum timing and methodology of iPET remains controversial. We retrospectively analysed the iPET results and outcomes of 200 DLBCL patients w...

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Bibliographic Details
Published in:European journal of haematology 2021-10, Vol.107 (4), p.475-483
Main Authors: Wight, Joel, Wai, Shin Hnin, Shen, Edward, Lee, Sze‐Ting, Berlangieri, Salvatore, Fancourt, Tineke, Hawkes, Eliza, Hannah, Anthony, Leung, Teresa, Chong, Geoffrey
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
B-cell lymphoma
Clinical trials
Cyclophosphamide - therapeutic use
Doxorubicin - therapeutic use
Etoposide - therapeutic use
Fluorodeoxyglucose F18 - administration & dosage
Glycolysis
Humans
interim PET
Lymphoma
Lymphoma, Large B-Cell, Diffuse - diagnostic imaging
Lymphoma, Large B-Cell, Diffuse - drug therapy
Lymphoma, Large B-Cell, Diffuse - mortality
Lymphoma, Large B-Cell, Diffuse - pathology
Male
Middle Aged
Patients
Positron emission tomography
Positron Emission Tomography Computed Tomography
Prednisone - therapeutic use
Prognosis
refractory
Retrospective Studies
Rituximab - therapeutic use
ROC Curve
Time Factors
Tumor Burden - drug effects
Tumors
Vincristine - therapeutic use
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Summary:Interim FDG‐PET (iPET) in diffuse large B‐cell lymphoma (DLBCL) is increasingly practised and used in clinical trials to adapt further therapy. However, the optimum timing and methodology of iPET remains controversial. We retrospectively analysed the iPET results and outcomes of 200 DLBCL patients where FDG‐PET was routinely performed at baseline, after 2 cycles (iPET2) and at completion of chemoimmunotherapy. iPET was also performed after 4 cycles (iPET4) where at iPET2, Deauville score (DS) was ≥4. Scans were assessed by blinded expert lymphoma PET physicians for DS, maximum standard uptake value (SUVmax), total metabolic tumour volume (TMTV) and total lesion glycolysis (TLG). Treatment failure was defined as death, progression or refractory disease. 95.5% of patients received R‐CHOP. No baseline PET parameter was predicted for EFS or OS independent of the NCCN‐IPI. The multivariable analysis at iPET2 showed DS5 (19.5% of cases) predicted treatment failure (HR 6.29, 95% CI 3.01‐13.17, P 
ISSN:0902-4441
1600-0609
DOI:10.1111/ejh.13684