Predictive value of pre-treatment FDG PET in patients with non-Hodgkin lymphoma treated with radioimmunotherapy: a systematic review

Abstract

We aimed to systematically review studies addressing the value of baseline FDG PET as predictive biomarker for response to RIT in patients with NHL. We searched (last update: March 2019) the databases PubMed, PMC, Google Scholar and Medline using both as text and as MeSH (Medical Subject Headings) terms the following: “positron emission tomography—PET”, “PET/CT”, “FDG”, “18F-fluorodeoxyglucose”, and “radioimmunotherapy”, ‘90Y-ibritumomab tiuxetan” and “non-Hodgkin lymphoma” and “follicular lymphoma”. Among all the retrieved articles, we selected only those specifically analyzing role, predictive and overall value of pretreatment FDG PET in patients with NHL submitted to RIT. The initial search retrieved seventy articles, however, only eight specifically analyzed the predictive value of pretreatment FDG PET in patients with NHL submitted to RIT and were thus discussed. Eight studies in 254 patients evaluated the role of FDG PET as a predictor of response prior to RIT. Despite several methodological issues, patients- and lesion-based analyses carried out to-date seem to suggest a relevant prognostic role of both morphological computed tomography and metabolic imaging. Although it is still not possible to specifically define the best PET-based predictor (i.e. SUVmax, TLG, MTV), FDG-PET is a promising tool for a more accurate and individualized selection of NHL patients candidates to RIT. The availability of FDG PET examinations in homogenous group of patients included in already completed clinical trials might be used in the next future also to specifically assess the prognostic value of baseline FDG PET in patients treated with RIT based on the study design.