Abstract
ObjectiveHigh-dose chemotherapy (HDC) followed by autologous hematopoietic stem cell transplantation (auto-HSCT) plays an important role in improving outcomes of diffuse large B cell lymphoma (DLBCL) patients. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) has been widely accepted in response assessment and prediction of prognosis in DLBCL. Here, we report the value of 18F-FDG PET/CT pre- and post-HSCT in predicting outcomes of patients with DLBCL. MethodsDLBCL patients who had PET/CT scan before and after HSCT were included. PET results were interpreted based upon Deauville criteria. The prognostic value of 18F-FDG PET/CT in auto-HSCT was evaluated. ResultsEighty-four patients were enrolled. In univariate analysis, pre- and post-HSCT PET findings were correlated with 3-year progression-free survival (PFS) [hazard ratio (HR)=4.391, P=0.001; HR=7.607, P<0.001] and overall survival (OS) (HR=4.792, P=0.008; HR=26.138, P<0.001). Patients receiving upfront auto-HSCT after first-line treatment had better outcomes than relapsed/refractory DLBCL patients (3-year PFS, P<0.001; 3-year OS, P<0.001). In the relapsed/refractory patients, pre- and post-HSCT PET findings were also associated with 3-year PFS (P=0.003vs. P<0.001) and OS (P=0.027vs. P<0.001). A significant correlation was observed between clinical response to chemotherapy before auto-HSCT and outcomes of patients in the entire cohort (3-year PFS, P<0.001; 3-year OS, P<0.001) and in the subgroup of 21 patients with positive pre-HSCT PET (3-year PFS, P=0.084; 3-year OS, P=0.240). A significant association between survival and post-HSCT PET findings was observed in multivariate analysis (HR=5.168, P<0.001). ConclusionsPET results before and after HSCT are useful prognostic factors for DLBCL patients receiving HSCT. Patients who responded to chemotherapy, even those with positive pre-HSCT PET, are appropriate candidates for auto-HSCT.
Highlights
Diffuse large B cell lymphoma (DLBCL) is the most common lymphoid neoplasm in adults, accounting for approximately 32.5% of non-Hodgkin’s lymphomas diagnosed annually in America [1]
PFS, progression-free survival; OS, overall survival; GCB, germinal center B cell; ECOG PS, Eastern Cooperative Oncology Group performance status; sAAIPI, secondary age-adjusted International Prognostic Index; BM, bone marrow; LDH, lactate dehydrogenase; CBV, cyclophosphamide, carmustine, etoposide; BEAM, carmustine, etoposide, cytarabine, melphalan; BEAC, carmustine, etoposide, cytarabine, cyclophosphamide; CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease; HSCT, hematopoietic stem cell transplantation; PET, positron emission tomography; HR, hazard ratio; 95% CI, 95% confidence interval
Patients who responded to chemotherapy before auto-HSCT had significantly better 3-year PFS and OS in the entire cohort and in the subgroup of patients with positive pre-HSCT PET
Summary
Diffuse large B cell lymphoma (DLBCL) is the most common lymphoid neoplasm in adults, accounting for approximately 32.5% of non-Hodgkin’s lymphomas diagnosed annually in America [1]. Approximately 40% of DLBCL patients are refractory to or relapse after standard first-line treatment [2,3]. High-dose chemotherapy (HDC) followed by autologous hematopoietic stem cell transplantation (auto-HSCT) has been proven to be an important strategy for improving outcomes of DLBCL patients [4,5]. The prognostic value of 18F-FDG PET/CT in patients with DLBCL receiving HDC followed by auto-HSCT is still controversial [7]. Our previous studies showed that post-HSCT PET/CT assessment was the main predictor of outcomes in DLBCL patients [8,9]. We report an updated analysis of the study on the value of 18F-FDG PET/CT pre- and postHSCT in predicting outcomes of patients with DLBCL
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