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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| Veröffentlicht in: | European journal of haematology 2021-10, Vol.107 (4), p.475-483 |
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| creator | Wight, Joel Wai, Shin Hnin Shen, Edward Lee, Sze‐Ting Berlangieri, Salvatore Fancourt, Tineke Hawkes, Eliza Hannah, Anthony Leung, Teresa Chong, Geoffrey |
| description | 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 |
| doi_str_mv | 10.1111/ejh.13684 |
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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 < .001), but DS4 was equivalent to DS1‐3. At iPET4, ΔSUVmax < 66% predicted treatment failure (HR 5.49, 95% CI 3.03‐9.99, P < .001). By multivariable analysis of all time points, high NCCN‐IPI and DS5 at iPET2 were negative predictors of survival. These findings were independent of novel prognostic markers.</description><identifier>ISSN: 0902-4441</identifier><identifier>EISSN: 1600-0609</identifier><identifier>DOI: 10.1111/ejh.13684</identifier><identifier>PMID: 34240453</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>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</subject><ispartof>European journal of haematology, 2021-10, Vol.107 (4), p.475-483</ispartof><rights>2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd</rights><rights>2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3534-54815ef84082b2bc775040696208a80cb391b4bff42bf3fc18e2f20486356a063</citedby><cites>FETCH-LOGICAL-c3534-54815ef84082b2bc775040696208a80cb391b4bff42bf3fc18e2f20486356a063</cites><orcidid>0000-0002-3216-2392 ; 0000-0002-3925-4302</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fejh.13684$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fejh.13684$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34240453$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wight, Joel</creatorcontrib><creatorcontrib>Wai, Shin Hnin</creatorcontrib><creatorcontrib>Shen, Edward</creatorcontrib><creatorcontrib>Lee, Sze‐Ting</creatorcontrib><creatorcontrib>Berlangieri, Salvatore</creatorcontrib><creatorcontrib>Fancourt, Tineke</creatorcontrib><creatorcontrib>Hawkes, Eliza</creatorcontrib><creatorcontrib>Hannah, Anthony</creatorcontrib><creatorcontrib>Leung, Teresa</creatorcontrib><creatorcontrib>Chong, Geoffrey</creatorcontrib><title>Predicting primary treatment failure using interim FDG‐PET scanning in diffuse large B‐cell lymphoma</title><title>European journal of haematology</title><addtitle>Eur J Haematol</addtitle><description>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 < .001), but DS4 was equivalent to DS1‐3. At iPET4, ΔSUVmax < 66% predicted treatment failure (HR 5.49, 95% CI 3.03‐9.99, P < .001). By multivariable analysis of all time points, high NCCN‐IPI and DS5 at iPET2 were negative predictors of survival. These findings were independent of novel prognostic markers.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>B-cell lymphoma</subject><subject>Clinical trials</subject><subject>Cyclophosphamide - therapeutic use</subject><subject>Doxorubicin - therapeutic use</subject><subject>Etoposide - therapeutic use</subject><subject>Fluorodeoxyglucose F18 - administration & dosage</subject><subject>Glycolysis</subject><subject>Humans</subject><subject>interim PET</subject><subject>Lymphoma</subject><subject>Lymphoma, Large B-Cell, Diffuse - diagnostic imaging</subject><subject>Lymphoma, Large B-Cell, Diffuse - drug therapy</subject><subject>Lymphoma, Large B-Cell, Diffuse - mortality</subject><subject>Lymphoma, Large B-Cell, Diffuse - pathology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Positron emission tomography</subject><subject>Positron Emission Tomography Computed Tomography</subject><subject>Prednisone - therapeutic use</subject><subject>Prognosis</subject><subject>refractory</subject><subject>Retrospective Studies</subject><subject>Rituximab - therapeutic use</subject><subject>ROC Curve</subject><subject>Time Factors</subject><subject>Tumor Burden - drug effects</subject><subject>Tumors</subject><subject>Vincristine - therapeutic use</subject><issn>0902-4441</issn><issn>1600-0609</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kEtO5DAQQC3EaGhgFlwAWWIDi0D5E8de8mlgEBIsYB056TKdVj6NnQj1jiNwRk6Ce9IzC6SpTS3q6an0CDlgcMrinOFifsqE0nKLTJgCSECB2SYTMMATKSXbIbshLACAG5b9JDtCcgkyFRMyf_Q4q8q-al_o0leN9Svae7R9g21Pna3qwSMdwvpetT1GhF5f3Xy-fzxOn2gobduOJzqrnBsC0tr6F6QXkSixrmm9apbzrrH75IezdcBfm71Hnq-nT5e3yf3Dze_L8_ukFKmQSSo1S9FpCZoXvCizLAUJyigO2mooC2FYIQvnJC-ccCXTyB0HqZVIlQUl9sjx6F367nXA0OdNFdaf2Ba7IeQ8TYErI4yJ6NE3dNENvo3fRSoDbTLI1sKTkSp9F4JHl2865Qzydf485s__5I_s4cY4FA3O_pF_e0fgbATeqhpX_zfl07vbUfkF5ayO9w</recordid><startdate>202110</startdate><enddate>202110</enddate><creator>Wight, Joel</creator><creator>Wai, Shin Hnin</creator><creator>Shen, Edward</creator><creator>Lee, Sze‐Ting</creator><creator>Berlangieri, Salvatore</creator><creator>Fancourt, Tineke</creator><creator>Hawkes, Eliza</creator><creator>Hannah, Anthony</creator><creator>Leung, Teresa</creator><creator>Chong, Geoffrey</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QG</scope><scope>7T5</scope><scope>7TM</scope><scope>7TO</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3216-2392</orcidid><orcidid>https://orcid.org/0000-0002-3925-4302</orcidid></search><sort><creationdate>202110</creationdate><title>Predicting primary treatment failure using interim FDG‐PET scanning in diffuse large B‐cell lymphoma</title><author>Wight, Joel ; 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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 < .001), but DS4 was equivalent to DS1‐3. At iPET4, ΔSUVmax < 66% predicted treatment failure (HR 5.49, 95% CI 3.03‐9.99, P < .001). By multivariable analysis of all time points, high NCCN‐IPI and DS5 at iPET2 were negative predictors of survival. These findings were independent of novel prognostic markers.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>34240453</pmid><doi>10.1111/ejh.13684</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-3216-2392</orcidid><orcidid>https://orcid.org/0000-0002-3925-4302</orcidid></addata></record> |
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| 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 |
| title | Predicting primary treatment failure using interim FDG‐PET scanning in diffuse large B‐cell lymphoma |
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