Imaging of Early Response to Predict Prognosis in the First-Line Management of Follicular Non-Hodgkin Lymphoma with Iodine-131-Rituximab Radioimmunotherapy.

Murali Kesavan,Jan Boucek,William Macdonald,J Turner,Andrew Mcquillan

doi:10.3390/diagnostics7020026

Abstract

The purpose of this study was to evaluate prediction of prognosis after first-line radioimmunotherapy (RIT) of advanced follicular non-Hodgkin lymphoma (FL), by imaging with fluorine-18-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG-PET/CT) three months after induction treatment by Iodine-131-rituximab (131I-rituximab). Objective response was determined using the Deauville 5-point scale in 68 prospective clinical trial patients. Baseline 18F-FDG-PET/CT studies were used to calculate total-metabolic-tumor-volume (TMTV). Non-imaging studies included the Follicular lymphoma international prognostic index (FLIPI) and absolute baseline monocyte and lymphocyte counts. Patients were monitored for over ten years (median follow-up 59 months), and no patient was lost to follow-up. Complete response (CR) of 88% predicted excellent prognosis with median time-to-next-treatment (TTNT) not yet reached. Those patients (12%) who failed to achieve CR (Deauville ≤ 3) on 18F-FDG-PET/CT at three months had significantly poorer outcomes (p < 0.0001) with a median TTNT of 41 months. Requirement for re-treatment was predicted by FLIPI and absolute baseline monocyte count but not lymphocyte count. The TTNT was accurately predicted by 18F-FDG-PET/CT Deauville response at three months following first-line therapy of FL with RIT. Early response demonstrated by imaging does, therefore, foretell prognosis in the individual FL patients.

Highlights

IntroductionWhen treated with rituximab alone, only 12% of patients required a new treatment within three years, compared with over half of the patients left untreated on a watch-and-wait protocol [2]
Follicular lymphoma (FL) constitutes over 20% of all non-Hodgkin lymphoma (NHL) [1].When treated with rituximab alone, only 12% of patients required a new treatment within three years, compared with over half of the patients left untreated on a watch-and-wait protocol [2].Combination of chemotherapy with rituximab has led to a remarkable prolongation of remission over the past decade; 20% of FL patients treated with immunochemotherapy have disease progression within two years and a five-year overall survival (OS) of only 50% [3]
We reviewed the 68 patients who received first line 131 I-rituximab RIT for newly diagnosed grade 1 or 2 CD20-positive follicular lymphoma as part of the original prospective phase II

Summary

Introduction

When treated with rituximab alone, only 12% of patients required a new treatment within three years, compared with over half of the patients left untreated on a watch-and-wait protocol [2]. Combination of chemotherapy with rituximab has led to a remarkable prolongation of remission over the past decade; 20% of FL patients treated with immunochemotherapy have disease progression within two years and a five-year overall survival (OS) of only 50% [3]. Existing prognostic indices at the time of induction therapy do not reliably identify these patients who are destined to relapse. The wide spectrum of clinical, biological and genetic heterogeneity of FL has confounded accurate prediction of the quality, degree, and duration of response to first-line treatment in any given individual patient in routine haemato-oncologic practice.

Results

Discussion

Conclusion