Abstract
PurposeThe purpose of this study was to determine the prognostic significance of metabolic parameters on pre-treatment 18F-fluorodeoxyglucose positron emission tomography/ computed tomography (FDG PET/CT), in patients with diffuse large B-cell lymphoma (DLBCL) receiving rituximab-containing therapy.Materials and MethodsFrom September 2009 to December 2014, DLBCL patients who had received FDG PET/CT scans for staging were enrolled. The maximal standardized uptake value of tumor (SUVt) was recorded. The metabolic tumor volume (MTV) was the volume of lesion with an elevated SUV greater than 2.5. The total lesion glycolysis (TLG) was the sum of the products of MTV and mean SUV in all measured lesions. Univariate and multivariate analyses were used to assess the prognostic significance of maximal SUVt, total MTV, TLG and other clinical parameters.ResultsThere were 118 patients enrolled in this study. The median follow-up time was 28.7 months. The 5-year progression-free survival (PFS) for patients with higher and lower total MTV was 32.3% and 66.0% respectively (p = 0.0001). The 5-year overall survival (OS) for patients with higher and lower total MTV was 34.3% and 69.9% respectively (p < 0.0001). Multivariate analysis revealed, besides IPI, that total MTV was independently predictive for PFS (HR: 2.31, 95% CI: 1.16 – 4.60, p = 0.0180) and OS (HR: 2.38, 95% CI: 1.12 – 5.04, p = 0.024). TLG and maximal SUV of tumor were not independent prognostic factors.ConclusionsAn elevated total MTV was a predictor for shorter PFS and OS in patients with DLBCL receiving rituximab-containing therapy, independent of IPI.
Highlights
Diffuse large B-cell lymphoma (DLBCL), accounting for about one-third of all non-Hodgkin’s lymphoma (NHL), is the most common type of NHL [1]
Multivariate analysis revealed, besides international prognostic index (IPI), that total metabolic tumor volume (MTV) was independently predictive for progression-free survival (PFS) (HR: 2.31, 95% confidence interval (CI): 1.16 – 4.60, p = 0.0180) and overall survival (OS) (HR: 2.38, 95% CI: 1.12 – 5.04, p = 0.024)
An elevated total MTV was a predictor for shorter PFS and OS in patients with DLBCL receiving rituximab-containing therapy, independent of IPI
Summary
Diffuse large B-cell lymphoma (DLBCL), accounting for about one-third of all non-Hodgkin’s lymphoma (NHL), is the most common type of NHL [1]. The immuno-chemotherapy combining rituximab and cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) has resulted in a significant improvement of survival [1]. Efforts have been made to improve the risk stratification model, including regrouping the IPI score (revised IPI) [3], initial hematological index [4], type of bone marrow involvement [5] and tumor bulk [6]. These efforts have only resulted in an incremental improvement.
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