Prognostic value of [18F]FDG PET/CT in patients with CNS lymphoma receiving ibrutinib-based therapies

Purpose Current clinical and imaging tools remain suboptimal for predicting treatment response and prognosis in CNS lymphomas. We investigated the prognostic value of baseline [ 18 F]FDG PET in patients with CNS lymphoma receiving ibrutinib-based treatments. Methods Fifty-three patients enrolled in a prospective clinical trial and underwent brain PET before receiving single-agent ibrutinib or ibrutinib in combination with methotrexate with or without rituximab. [ 18 F]FDG uptake in these lesions was quantified by drawing PET volumes of interest around up to five [ 18 F]FDG-avid lesions per patient (with uptake greater than surrounding brain). We measured standardized uptake values (SUV max ), metabolic tumor volumes, total lesion glycolysis (TLG), and the sum thereof in these lesions. We analyzed the relationship between PET parameters and mutation status, overall response rates, and progression-free survival (PFS). Results Thirty-eight patients underwent single-agent therapy and 15 received combination therapy. On PET, 15/53 patients had no measurable disease. In the other 38 patients, a total of 71 lesions were identified on PET. High-intensity [ 18 F]FDG uptake and a larger volume of [ 18 F]FDG-avid disease were inversely related to treatment outcome ( p ≤ 0.005). In univariable analysis, PFS was linearly correlated with all PET parameters, with stronger association when sum-values were used. A multivariable model showed that risk of progression increased by 9% for every 5-unit increase in sumSUV max (hazard ratio = 1.09 [95% CI: 1.04 to 1.14]). Conclusion Higher lesional metabolic parameters are inversely related to outcome in patients undergoing ibrutinib-based therapies, and sumSUV max emerged as a strong independent prognostic factor. Trial registration NCT02315326; https://clinicaltrials.gov/ct2/show/NCT02315326?term=NCT02315326&draw=2&rank=1