Abstract
Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) after one cycle of standard chemotherapy in patients with diffuse large B cell lymphoma (DLBCL) was assessed. Prospectively enrolled 51 patients had four PET/CT studies using the same protocol and system: at baseline and after one, three, and six cycles of chemotherapy (PET0, PET1, PET3, PET6). The PET1 and PET6 Deauville five-point score (D5PS) agreed in 60.8%, while PET3 and PET6 D5PS agreed in 90.2%. The absolute and percent changes of peak standard uptake value corrected for lean body mass (SULpeak) compared to baseline were significantly different between PET1 and PET3 (p = 0.001, p < 0.001) and PET1 and PET6 (p = 0.002, p = 0.001), but not between PET3 and PET6 (p = 0.276, p = 0.181). The absolute SULpeak from PET1 predicted treatment failure with accuracy of 78.4% (area under the curve 0.73, p = 0.023). D5PS, SULpeak, and metabolic tumor volume (MTV) were not statistically different between responders versus non-responders, or the one year disease-free versus relapse groups. D5PS and PERCIST responses showed 100% agreement at end-of-therapy. In conclusion, the responses after three and six cycles of therapy showed high degree of agreement. D5PS or MTV after one cycle of chemotherapy could not predict response or one-year disease-free status, but the SULpeak from PET1 was associated with response to first line therapy in DLBCL. Deauville and PERCIST criteria show high concordance.
Highlights
Diffuse large B cell lymphoma (DLBCL) is the most common non-Hodgkin’s lymphoma (NHL), approximately over 30% of all lymphoma cases, and shows aggressive clinical course
In FDG-avid lymphomas, visual analysis using D5PS is recommended in the Lugano response criteria and NCCN guidelines [4,7]
For stages I and II, FDG positron emission tomography (PET)/CT is recommended for planning the radiation treatment field [7]
Summary
Diffuse large B cell lymphoma (DLBCL) is the most common non-Hodgkin’s lymphoma (NHL), approximately over 30% of all lymphoma cases, and shows aggressive clinical course. In Korea, incidence of DLBCL was 29.8% among all lymphoid malignancy from 1999 to 2012 [1]. Initial treatment of choice for DLBCL is rituximab, cyclophosphamide, hydroxydaunomycin, vincristine (Oncovin®), prednisone (R-CHOP) regimen. Remission following first line chemotherapy using 6–8 cycles of R-CHOP is expected in 50–70% of patients [2]. Over one-third of patients need salvage treatment for refractory disease [3]. These non-responders suffer the toxic side effects of chemotherapy without clinical benefit, whereas an early change in treatment strategy may have been more helpful
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