Abstract
PurposeStandardized uptake values (SUV), total metabolic tumor volumes (TMTV), and total lesion glycolysis (TLG) based on positron emission tomography with 2-deoxy-2-[18F]fluoro-d-glucose ([18F]FDG/positron emission tomography (PET) are established outcome predictors in FDG-avid lymphomas. We therefore investigated whether these biomarkers also have prognostic value in extranodal marginal zone B cell lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma), with a focus on patients treated with anti-CD20 antibody-based immunotherapy.ProceduresPre-therapeutic [18F]FDG/PET scans of 61 treatment-naïve MALT lymphoma patients, including 35 scheduled for anti-CD20 antibody-based immunotherapy, were included in this retrospective study. SUVmean, SUVmax, TMTV, and TLG were measured and tested for 2-year progression-free survival (PFS) prognostication, using Cox regression analyses. Receiver operating characteristic curves were used to determine optimal cutoffs for prognostic [18F]FDG/PET parameters, and Kaplan–Meier estimates with log rank tests were performed.ResultsAfter 2 years, progression had occurred in 12/61 patients (CD20-anitbody group 6/35). TLG emerged as the only significant prognostic factor for 2-year PFS in the multivariate analyses with forward selection, both in entire cohort (hazard ratio HR, 1.001; 95 % CI, 1.001–1.002; P < 0.0001) and in the CD20-antibody group (HR, 1.001; 95 % CI, 1.001–1.002; P = 0.001). However, in the entire population, where 8/26 patients with a TLG > 90 (30.8 %) vs. 4/35 patients with a TLG ≤ 90 (11.4 %) showed progression within the 2-year observation period, TLG-based separation of risk groups failed (HR, 0.35; 95 % CI, 0.10–1.15; P = 0.069); whereas in the CD20-antibody group, where 6/16 patients with a TLG > 90 (37.5 %) vs. 0/19 patients with a TLG ≤ 90 (0.0 %) showed progression, risk group separation was successful (HR, 0.010; 95 % CI, 0.0001–8.068; P = 0.003).ConclusionsTLG may improve early risk stratification of MALT lymphoma patients treated with CD20-antibody-based immunotherapy.
Highlights
Outcome prognostication and identification of risk groups play an important role in the management of patients with malignant lymphoma
An increasing number of recent studies suggest that, for patients with classical Hodgkin, diffuse large B cell (DLBCL), follicular, as well as T cell lymphomas, quantitative parameters derived from pretherapeutic positron emission tomography with 2-deoxy-2[18F]fluoro-D-glucose ([18F]FDG)/positron emission tomography (PET)—such as maximum standardized uptake value (SUVmax), total metabolic tumor volume (TMTV), or total lesion glycolysis (TLG)—are prognostic for clinical outcomes, and may improve risk stratification [1,2,3,4,5]
For extranodal marginal zone B cell lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma), only three studies have, so far, evaluated quantitative pretherapeutic [18F]FDG/PET-derived parameters for outcome prognostication [6,7,8], probably because of the variable FDG avidity of this lymphoma subtype, due to which [18F]FDG/ PET is not recommended for imaging of MALT lymphomas by the International Conference on Malignant Lymphoma (ICML) [9]
Summary
Outcome prognostication and identification of risk groups play an important role in the management of patients with malignant lymphoma. An increasing number of recent studies suggest that, for patients with classical Hodgkin, diffuse large B cell (DLBCL), follicular, as well as T cell lymphomas, quantitative parameters derived from pretherapeutic positron emission tomography with 2-deoxy-2[18F]fluoro-D-glucose ([18F]FDG)/positron emission tomography (PET)—such as maximum standardized uptake value (SUVmax), total metabolic tumor volume (TMTV), or total lesion glycolysis (TLG)—are prognostic for clinical outcomes, and may improve risk stratification [1,2,3,4,5]. None of the these studies—including the single, very recently published study that included an evaluation of TMTV and TLG, and was unable to establish either parameter as a prognostic factor for overall survival (OS) or progression-free survival (PFS) [6]—focused on a specific treatment group, contrary to studies in other lymphoma subtypes. Apart from antibiotics, CD20-antibody-based immunotherapy is the most commonly used systemic treatment for MALT lymphoma, and has been shown to carry significant anti-tumor activity in untreated as well as relapsed MALT lymphoma [10]
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