Abstract
Objectives: To examine the prognostic value of interim 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) findings after 2–4 cycles of rituximab, plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in patients with diffuse large B-cell lymphoma (DLBCL) receiving standardized treatment. Results: After a median 3.36 years (range 0.33 to 9.14 years), 24 of the 80 patients had documented relapse. In Interim-PET findings, 2-year PFS was significantly shorter for PET-positive as compared with PET-negative patients (50.0% vs. 86.4%; p = 0.0012). In End-PET findings, 2-year PFS was significantly shorter for PET-positive as compared with PET-negative patients (25.0% vs. 84.7%; p < 0.0001). The positive predictive value (PPV) and negative predictive value (NPV) of Interim-PET for predicting relapse or disease progression were 57.1% and 75.8%, respectively, while those for End-PET were 75.0% and 75.0%, respectively. Methods: Eighty DLBCL patients treated with first-line 6–8 R-CHOP courses regardless of interim imaging findings were enrolled. Each underwent FDG-PET/CT scanning at staging, and again during (Interim-PET) and at the end of (End-PET) therapy. PET positivity or negativity at Interim-PET and End-PET as related to progression-free survival (PFS) was examined using Kaplan–Meier analysis. Conclusion: Mid-treatment FDG-PET/CT findings may be useful for determining disease status in patients with DLBCL undergoing induction R-CHOP chemotherapy, though are not recommended for treatment decisions as part of routine clinical practice.
Highlights
Diffuse large B-cell lymphoma (DLBCL), the most common type of non-Hodgkin lymphoma worldwide, has been reported to be curable in about 60–70% of patients treated with standard rituximab, plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy [1]
Current salvage therapy strategies seem to be inadequate for nonresponding patients, with only 30% to 35% of resistant or relapsed patients in this rituximab era able to achieve prolonged progression-free survival (PFS) with highwww.oncotarget.com dose chemotherapy followed by autologous stem cell transplantation (ASCT)
We examined the predictive value of Interim-PET regarding PFS of DLBCL patients using visual dichotomous analysis
Summary
Diffuse large B-cell lymphoma (DLBCL), the most common type of non-Hodgkin lymphoma worldwide, has been reported to be curable in about 60–70% of patients treated with standard rituximab, plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy [1]. Current salvage therapy strategies seem to be inadequate for nonresponding patients, with only 30% to 35% of resistant or relapsed patients in this rituximab era able to achieve prolonged progression-free survival (PFS) with highwww.oncotarget.com dose chemotherapy followed by autologous stem cell transplantation (ASCT). FDG-PET/ CT is the standard recommended method for response assessment at the end of first-line treatment, with FDG positivity at that point considered predictive of survival in patients with malignant lymphoma [2, 3]. We examined the predictive value of Interim-PET regarding PFS of DLBCL patients using visual dichotomous analysis
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