Deauville Criteria Research Articles

Reactive axillary lymph nodes after COVID-19 mRNA vaccination: comparison of mRNA vs. attenuated whole-virus vaccines.

To compare the incidence and natural course of reactive axillary lymph nodes (RAL) between mRNA and attenuated whole-virus vaccines using Deauville criteria. In this multi-institutional PET-CT study comprising multiple vaccine types (Pfizer-BioNTech/Comirnaty, Moderna/Spikevax, Sinovac/CoronaVac and Janssen vaccines), we evaluated the incidence and natural course of RAL in a large cohort of oncological patients utilizing a standardized Deauville scaling system (n=522; 293 Female, Deauville 3-5 positive for RAL). Univariate and multivariate analyses were conducted to evaluate the predictive value of clinical parameters (absolute neutrophil count [ANC], platelets, age, sex, tumor type, and vaccine-to-PET interval) for PET positivity. Pfizer-BioNTech/Comirnaty and Moderna vaccines revealed similar RAL incidences for the first 20 days after the second dose of vaccine administration (44% for the first 10 days for both groups, 26% vs. 20% for 10-20 days, respectively for Moderna and Pfizer). However, Moderna recipients revealed significantly higher incidences of RAL after 20 days compared to Pfizer-BioNTech/Comirnaty, with nodal reactivity spanning up to the 9th week post-vaccination (15% vs. 4%, respectively P < 0.001). No RAL was observed in patients who received either a single dose of J&J vaccine or two doses of CroronaVac. Younger patients showed increased likelihood of RAL, otherwise, clinical/demographic parameters were not predictive of RAL ( P = 0.014 for age, P > 0.05 for additional clinical/demographic parameters). RAL based on strict PET criteria was observed with mRNA but not with attenuated whole-virus vaccines, in line with higher immunogenicity and stronger protection offered by mRNA vaccines.

Prognostic Significance Of Sequential 18f-fdg Pet/Ct During Frontline Treatment Of Peripheral T Cell Lymphomas.

The prognostic significance of 18F-fluorodeoxyglucose (FDG)-positron emission tomography-computed tomography (PET/CT) in peripheral T-cell lymphomas (PTCLs) are controversial. We explored the prognostic impact of sequential 18F-FDG PET/CT during frontline chemotherapy of patients with PTCLs. In total, 143 patients with newly diagnosed PTCLs were included. Sequential 18F-FDG PET/CTs were performed at the time of diagnosis, during chemotherapy, and at the end of chemotherapy. The baseline total metabolic tumor volume (TMTV) was calculated using the the standard uptake value with a threshold method of 2.5. A baseline TMTV of 457.0 cm3 was used to categorize patients into high and low TMTV groups. Patients with a requirehigh TMTV had shorter progression-free survival (PFS) and overall survival (OS) than those with a low TMTV (PFS, 9.8 vs. 26.5 mo, p = 0.043; OS, 18.9 vs. 71.2 mo, p = 0.004). The interim 18F-FDG PET/CT response score was recorded as 1, 2-3, and 4-5 according to the Deauville criteria. The PFS and OS showed significant differences according to the interim 18F-FDG PET/CT response score (PFS, 120.7 vs. 34.1 vs. 5.1 mo, p < 0.001; OS, not reached vs. 61.1 mo vs. 12.1 mo, p < 0.001). The interim PET/CT response based on visual assessment predicts disease progression and survival outcome in PTCLs. A high baseline TMTV is associated with a poor response to anthracycline-based chemotherapy in PTCLs. However, TMTV was not an independent predictor for PFS in the multivariate analysis.

Appropriate timing to perform an interim 18F-FDG PET/CT in patients with nasal-type extranodal natural killer/T cell lymphoma.

Interim 18F-FDG PET/CT (I-PET) has a role in response evaluation and treatment guidance in patients with nasal-type extranodal natural killer/T cell lymphoma (ENKTL). However, there was no agreement on the timing of I-PET performed, after chemotherapy or after chemoradiotherapy. We aimed to find the appropriate timing for I-PET by assessing the prognostic value of I-PET in response evaluation in ENKTL patients. Two hundred and twenty-seven ENKTL patients who had undergone I-PET were retrospectively included. All patients were grouped based on their therapeutic strategy received, chemotherapy or chemoradiotherapy. The Deauville 5-point score (DS) was used to interpret the I-PET images. The hazard ratio (HR) and C-index were used to measure the discriminatory and prognostic capacities of I-PET performed at different times. One hundred and six patients underwent the I-PET after chemotherapy (chemotherapy group), while I-PET was performed after chemoradiotherapy in 121 patients (chemoradiotherapy group). Eighty-seven patients were classified as metabolic remission (DS score of 1-3), while the other 140 were classified as non-metabolic remission (DS score of 4-5) according to the Deauville criteria. There were no significant survival differences between patients in metabolic remission and in non-metabolic remission in either progression-free survival (PFS, p = 0.406) or overall survival (OS, p = 0.350). In the chemotherapy group, patients in metabolic remission had significantly superior PFS than patients in non-metabolic remission (p = 0.012). For OS, a discriminative trend was also found on the survival curve between patients in metabolic remission and in non-metabolic remission (p = 0.082). In the chemoradiotherapy group, there was no significant difference in PFS (P = 0.185) or OS (P = 0.627) between patients in metabolic remission and in non-metabolic remission. I-PET after chemotherapy yields higher discriminative power and has the ability for prognostic prediction in nasal-type ENKTL patients. I-PET after radiochemotherapy has no prognostic value. Thus, the appropriate timing for I-PET is after chemotherapy but before radiotherapy for response evaluation in nasal-type ENKTL patients.

Lymphoid Malignancies in Shwachman-Diamond Syndrome: Incidence, Clinical Features, and Outcomes from the North American SDS Registry

Introduction: Many marrow failure conditions are associated with myeloid malignancy predisposition and a subset carry an increased risk of both myeloid and lymphoid malignancies. The increased risk of myeloid malignancy is known in Shwachman-Diamond syndrome (SDS), however, the risk of lymphoid malignancy in SDS has not been previously reported. Through the North American SDS Registry (SDSR), we identified patients with SDS diagnosed with lymphoma. We report the clinical features and outcomes in these patients as well as the incidence rates of lymphoma, MDS, and AML in this cohort. Methods: Patients with biallelic SBDS mutations enrolled on the SDSR were included for analysis. Age- and sex-specific incidence rates from the SEER Program (2016-2020) were multiplied by person-years of observation to obtain expected numbers of events. The crude rate per 100,000 (100,000*observed number of malignancies/person-years of follow-up) and the standardized incidence ratio (SIR) were calculated. Results: Out of a total of 217 patients with SDS with biallelic SBDS mutations in the SDSR, we identified 3 subjects who developed lymphoma. Case 1: A male patient with biallelic SBDS mutations (c.258 + 2T&amp;gt;C; c.653G&amp;gt;A, p.Arg218Gln) presented with dyspnea and was diagnosed with primary mediastinal B-cell lymphoma at age 16 years. Bone marrow exam was negative for lymphoma but revealed a new del20q clone. He received 6 cycles of R-CHOP. His course was complicated by febrile neutropenia, pleural effusion, deep vein thrombosis, and decreased cardiac ejection fraction requiring subsequent omission of doxorubicin and carvedilol initiation. He is in remission &amp;gt;3 years from diagnosis. Case 2: A male patient with biallelic SBDS mutations (c.258 + 2T&amp;gt;C; c.183_184TA&amp;gt;CT, p.Lys62*) was diagnosed at age 23 years with diffuse large B-cell lymphoma (DLBCL) of the distal stomach and duodenal bulb. Bone marrow exam was negative for malignancy but demonstrated an abnormal karyotype: 46,XY,t(11;16)(q23;q24), del(20)(q11.2q13.3)[9]/46,XY[11]. He received 5 cycles of R-CHOP therapy, which was complicated by febrile neutropenia and S. aureus sepsis. Four years later, he was diagnosed with relapsed DLBCL of the distal ileum and concurrent AML with 5q deletion. He achieved complete remission of both malignancies after 2 cycles of cyclophosphamide, vincristine, prednisone, obinutuzumab, azacitidine, and venetoclax. Therapy was complicated by B. cereus bacteremia with brain abscesses and endocarditis and C. difficile infection. He underwent a matched unrelated donor hematopoietic stem cell transplant and is in remission &amp;gt;180 days from transplant. Case 3: A male patient with biallelic SBDS mutations (c.258 + 2T&amp;gt;C; c.183_184TA&amp;gt;CT, p.Lys62*) was diagnosed with Stage IVB classical Hodgkin lymphoma at age 12 years after presenting with mediastinal syndrome. Bone marrow biopsy was negative for findings suggestive of MDS or malignancy, however, the initial PET-CT was consistent with medullary involvement. He initiated therapy with steroids, doxorubicin, vinblastine, dacarbazine, and brentuximab vedotin and received focal radiation. His course was complicated by recurrent febrile neutropenia, C. difficile colitis, and cellulitis. Due to infectious complications and delayed count recovery after 2 cycles, despite chemotherapy dose reductions, he was transitioned to brentuximab and nivolumab. He demonstrated complete response by Deauville criteria prior to cycle 5 of brentuximab and nivolumab. Among 217 patients with biallelic SBDS mutations in the SDSR, the median age was 12.8 years (range: 0.3 - 52.8). The observed number, rates, and SIR for lymphoma, MDS, and AML are given in Table 1. A high SIR indicates a higher incidence in the SDSR relative to the SEER population in 2016-2020. The observed rate of lymphoma was 28.5 times higher in SDS than the expected rate in the general population. Conclusions: The incidence of lymphoma among patients with SDS is increased relative to the general population but is lower than the incidence of MDS or AML. Increased toxicity with standard therapies was observed in these patients. Given the increased risk of MDS/AML in SDS, which may be further increased by antecedent chemotherapy, non-genotoxic therapies should be investigated for lymphoma in SDS. Our results show that SDS should be added to the list of marrow failure conditions predisposing to both myeloid and lymphoid malignancies.

A Prospective Ukrainian Multicentre Cohort Study of Pet Value Prognostic Role in Primary Patients with Hodgkin Lymphoma (HL): Six-Year a Brief Review

Introduction : The PET-adapted approach for the treatment of patients with Hodgkin's lymphoma has long been used around the world. In Ukraine, this method has recently become actively used at all stages of treatment, which allows it to meet modern standards. Airms. The primary endpoint was to assess the effectiveness of individualized approaches as a correlation between PET findings and response to therapy, type of regimen and clinical outcome (Event free (EFS) and overall survival (OS)). The second endpoint was to evaluate the impact of risk factors on the survival. Methods. Of 278 evaluable patients, 64% were female; median age 43 years (range, 17-69 years). Patients received a treatment with ABVD or ABVD/AVD (more than 50% pts); BEACOPP-14/esc or “switched-regimens” (ABVD+BEACOPP-esc/14, BEACOPP-esc/14+ABVD). Metabolic PET imaging was performed to routine protocols using Deauville criteria for response assessment. Results. Bulky disease (&amp;gt;10 cm in any dimension) were presented in 74/278 (26.6%) of pts, B symptoms - in 126/278 (45.3%) and extranodal disease had 57/278 (20.5%). 93.8% of patients achieved remission (CR/PR) during the follow-up period (median timeline: 27 months). The ORR for patients with stage I-II was 87.2% (137/157) vs 80.1% (97/121) for patients with stage III-IV. We recorded a disease progression in 44 (15.8%) patients during and after the 1st line therapy, (median time to relapse - 8 months). Only 6 pts died due to HL. In the study group, PET was performed at the beginning of treatment in 150 pts, interim in 248 and at the end of treatment in 190 pts. We found a trend in improved outcome after treatment in patients with at least two follow-up PETs (interim and EOT), indicating the effectiveness of individualized PET-adapted therapy. Interim PET-CT was assessed as DS 1-2 in 127 patients (48.4%), DS 3 in 88 (33.6%), DS 4-5 in 47 pts (17.9%). In total, the disease progression occurred in 48.3% (15/31) of interim PET-positive (PET2+) patients and 11.5% (20/174) of interim PET-negative (PET2-) patients (p&amp;lt;0.05). After 6 year of follow-up EFS decreased in patients with PET2+ by 10% than the previously reported (PET2- pts 85% and vs 44% PET2+ pts, p=0.0001). Perhaps, despite the achievement of a partial metabolic response (DS-4), patients in this group still require intensification of treatment. Intermediate-risk group cohort (2B stage) to improve the EFS levels when the regimens was given BEACOPP-esc/14+ABVD vs ABVD+BEACOPP-esc/14 vs ABVD (80% vs 60% vs 55% respectively, p=0.03) and was independent of PET2 status. Also, a more intensified treatment for patients with stage III-IV of HL showed a significantly better level of EFS compared to the ABVD regimen, and it did not depend on PET2 status (Log-rank test, p=0.0003). OS is the most patient-relevant outcome in oncology; large sample sizes and extended follow-up durations are needed to detect statistically significant differences in OS. After a median follow up of 70 months, the study met its primary endpoint in the PET-2 negative cohort, with 6-year OS of 97% versus 60% (p=0.004). Interestingly, we did not find any correlation between EFS between risk groups 2B+bulky vs 2B without bulky (p=0.9) and also 2A+ (vs) - bulky (p=0.2). But we confirmed OS higher in pts with stage 2A vs 2B (98% vs 75%, respectively, p=0.03). Conclusions . The results of the use of PET in patients with primary HL showed a high predictive value of PET, which affects event-free and overall survival.

Outcomes of Patients with Transformed Diffuse Large B-Cell Lymphoma (DLBCL).

There is limited data regarding the results of treating transformed Diffuse Large B-Cell Lymphoma, including the influence of radiation therapy on their overall prognosis. Thus, we aimed to investigate the clinical outcomes of transformed DLBCL patients treated at a single institution. We reviewed clinical features and outcomes of 27 patients with biopsy confirmed transformed Diffuse Large B-cell Lymphoma (DLBCL) treated at a single institution from 2005 and 2014. Response to therapy was based on the Deauville criteria. Kaplan-Meier method was used to estimate time to event outcomes and compared using log-rank tests. Associations between local recurrence and relevant clinical variables were analyzed using logistic regression. The median age of patients was 63 (43-84). Eleven patients (40.7%) presented with bulky disease. The majority of patients (n = 16, 59.3%) had the activated B-cell (ABC) subtype, while 11 (40.7%) patients had germinal center B-cell (GCB) subtype. Most of the patients had early-stage disease 19 (70.4%). Double- and triple-hit expression was noted in 6 (22.2%) and 3 (11.1%) patients, respectively. The median international prognostic index (IPI) was 2. Median follow up was 37 months (range 2-168). Twelve (44.4%) patients received consolidative RT after systemic therapy with a median dose of 36 Gy (30-45). At 72 months, our RT cohort had an overall survival (OS), relapse-free survival (RFS) and local control (LC) rates of 63%, 64% and 81%, respectively. The OS did not differ between patients that received RT compared to those who did not (p = 0.124), although RT conferred statistically significant improvement in OS on MVA (HR 0.07; 95% CI, 0.007 to 0.718; p = 0.025). In the group that received RT, local control was worse among patients with double or triple-hit disease (p = 0.034). Patients with transformed Diffuse Large B-cell Lymphoma treated with RT may have better outcomes than patients who did not receive RT. Presence of translocation (double-hit and/or triple-hit lymphomas) was significantly associated with worse local control in our RT cohort.

PROGNOSTIC SIGNIFICANCE OF SEQUENTIAL 18F‐FDG PET/CT DURING THE TREATMENT OF ANTHRACYCLINE‐CONTAINING FRONTLINE CHEMOTHERAPY IN PERIPHERAL T CELL LYMPHOMAS

Introduction: Despite the prognostic significance of 18F-fluorodeoxyglucose (FDG)-positron emission tomography-computed tomography (PET/CT) assessment has important implications on determining the response-adapted therapy in patients with peripheral T-cell lymphomas (PTCLs), an optimal timing of the use and clinical application of PET/CT-based response are still up in the air. The aim of this study was to explore the prognostic impact of sequential 18F-FDG PET/CT analysis in patients with newly diagnosed PTCLs who treated with frontline anthracycline-based chemotherapy. Methods: Between February 2006 and September 2022, 143 patients with newly diagnosed PTCLs were included. All patients were treated with 6 cycles of anthracycline-containing chemotherapy. Sequential 18F-FDG PET/CT were obtained at the time of diagnosis, after three cycles of chemotherapy and finally at the end of chemotherapy. Baseline total metabolic tumor volume (TMTV) was computed with the sum of SUV2.5 threshold method, and the PET/CT response were assessed using the five-point scale (5-PS) of Deauville criteria. Results: Baseline MTV could be calculated in 126 patients, and the cut-off value of TMTV according to ROC analysis was 457.0 cm3 (Sensitivity 45.0%, specificity 74.0%). With a median follow-up of 52.0 months (range 3.8–153.9 months), patients with high TMTV more than cut-off value had inferior PFS and OS than those with low TMTV (PFS, 9.8 months vs. 26.5 months, HR 1.600, 95% CI 1.010–2.671, p = 0.043; OS, 18.9 months vs. 71.2 months, HR 2.135, 95% CI 1.261–3.615, p = 0.004, Figure 1A, B). Interim 18F-FDG PET/CT assessment was available in all 143 patients. When patients were categorized with three subgroups as response with grade 1, grade 2 and 3, and grade 4–5, PFS and OS showed significant difference according to interim visual assessment (PFS, 120.7 months vs. 34.1 months vs. 5.1 months, p < 0.001; OS, not reached vs. 61.1 months vs. 12.1 months, p < 0.001, Figure 1C, D), respectively. Among 77 patients who were assessed as grade 2 or 3 in interim PET/CT analysis, 19 patients (26.3%) turned over a remnant tumor metabolism or progressed at final PET response assessment. Moreover, the outcome of patients with interim grade 2 or 3 showed the significant differences based on the final achievement of complete metabolic response or not in PFS and OS (PFS, 59.9 months vs. 7.2 months, HR 4.754, 95% CI 2.267–9.971, p < 0.001; OS, not reached vs. 24.0 months, HR 3.706, 95% CI 1.592–8.630, p = 0.001), respectively. Keywords: aggressive T-cell non-Hodgkin lymphoma, diagnostic and prognostic biomarkers No conflicts of interests pertinent to the abstract.

Semiquantitative measurements of standardized uptake value in assessment of response and outcomes in patients with lymphoma

Abstract Objectives To evaluate the accuracy of semiquantitative measurements of standardized uptake value (ΔSUVmax) in the assessment of response to treatment in patients with lymphoma. Background Positron emission tomography (PET) with 2-[18 F]-fluoro-2-deoxy-D-glucose is an essential tool for accurate staging and early and late therapy response assessments in all 2-[18 F]-fluoro-2-deoxy-D-glucose -avid histologies. Patients and methods The study included 73 patients diagnosed as having diffuse large B-cell lymphoma or Hodgkin’s disease. PET/CT examinations were performed at baseline (PET0), then after 2 cycles of chemotherapy (PET 2), and after 4 cycles of chemotherapy (PET4). PET scans were analyzed according to Deauville five-point scale, and cutoff values for changes in the maximum standardized uptake value (SUVmax). The change in activity (ΔSUV) from initial (SUVmax1) to later scans (SUVmax2) was calculated. Biopsy was also taken when PET4 was visually positive but delta SUVmax was negative or in case of new lesions if other sites have improved. Results In comparison with the results of biopsy, ΔSUV0-2 had 80% sensitivity, 94.1% specificity, and 90.91% accuracy, with significant P value of 0.001. Moreover, ΔSUV0–4 had sensitivity of 80%, specificity of 100%, and accuracy of 95.45%, with high agreement k(P) 0.861 with significant P value less than 0.001. On the contrary, the visual five-point scale analysis specificity was 17.65% and accuracy was 36.36%, with insignificant P value less than 0.321. Neither the Deauville criteria nor ΔSUVmax was significantly associated with time to progression and overall survival. Conclusion ΔSUVmax is comparable to biopsy and significantly more accurate than Deauville criteria in response assessment to chemotherapy.

Outcomes of Patients with Positive Interim Positron Emission Tomography (PET) Continuing ABVD in the Clinical Setting

Recent prospective clinical trial data suggest that patients with Hodgkin's lymphoma who continue treatment with ABVD, despite failing to attain a complete metabolic response on interim PET (PET2+), may fare better than previously published. We describe the outcomes of PET2+ patients who continued ABVD and compare the performance of a quantitative measure based on the lesion-to-liver SUV ratio (LLS qPET2+) to that of the subjective Deauville criteria (dvPET2+). We analyzed all patients with newly diagnosed advanced-stage Hodgkin lymphoma treated with frontline ABVD at the Memorial Sloan Kettering Cancer Center between 2008 and 2017. Eligibility was set to correspond with the RATHL inclusion criteria. Images were reviewed by two nuclear medicine physicians and discordant cases were resolved with a third expert in consensus. qPET2+ was defined as LLS ≥ 1.3. We identified 227 patients of whom 25% (57) were qPET2+, but only 14% (31) were dvPET2+. Forty-eight patients (84%) continued ABVD with a 3-year PFS of 70% for qPET2+ and 64% for dvPET2+. In conclusion, interim PET interpretation in clinical practice may be associated with a higher rate of scans deemed positive. Irrespective of the criteria for PET2 positivity, a subset of patients may continue ABVD without a dismal outcome.

Prognostic value of the completeness of the metabolic response in patients with diffused large B-cell lymphoma

The currently used prognostic factors for long-term results of standard treatment of diffuse large B-cell lymphoma (DLBCL) are not clear enough to predict outcomes. The prognostic significance of interim PET/CT in DLBCL remains controversial. The aim of this study is to determine the predictive value of interim 18 F-FDG PET/CT after first-line treatment in patients with DLBCL. One hundred-eighty patients with DLBCL underwent baseline and interim 18 F-FDG PET/CT scans after 4 cycles of R-CHOP during the period of 2015–2020 at the N. N. Alexandrov National Cancer Centre of Belarus. Interim 18 F-FDG PET/ CT findings were retrospectively correlated to the progression-free survival (PFS) using the Kaplan–Meier analysis. The metabolic response was assessed according Deauville criteria: PET-negative – Deauville 1–2, PET-positive – Deauville 3–5. The International prognostic index (IPI) was used for risk stratification. After 4 cycles of chemotherapy, PET-positive lesions were found in 76 patients and negative scans – in 104 patients. Survival analyses showed highly significant relationships between early interim 18 F-FDG PET/CT imaging and PFS (p &lt; 0.001). For PET-negative patients, the 7-year PFS rate was 91.1 %, for PET-positive patients it is 41.2 %. 5-year PFS rates for PET-negative patients with IPI scores 0–1, 2–3 and 4–5 were 97.5, 93.4 and 66.7 %, respectively. For PET-positive patients, 5-year PFS rates in the same subgroups were 55.6, 50.6 and 23.1 %, respectively. Early interim 18 F-FDG PET/CT imaging is a predictor of PFS in DLBCL. An early assessment of chemotherapy response with 18 F-FDG PET/CT scans may provide useful information on selection of patients for escalated therapeutic strategies.

18F]FDG PET/CT in head and neck squamous cell carcinoma: a head-to-head between visual point-scales and the added value of multi-modality imaging

BackgroundHead and neck squamous cell carcinoma (HNSCC) represents the 6th leading cancer worldwide. In most cases, patients present a locally advanced disease at diagnosis and non-surgical curative treatment is considered the standard of care. Nowadays, [18F]FDG PET/CT is a validated tool in post-treatment evaluation, with a high level of evidence. However, to standardize imaging response, several visual scales have been proposed with none of them approved yet. The study’s aim is a head-to-head comparison between the diagnostic performance of the Hopkins criteria, the Deauville score, and the new proposed Cuneo score, to establish their prognostic role. Secondly, we investigate the possible value of semiquantitative analysis, evaluating SUVmax and ΔSUVmax of the lymph node with the highest uptake on the restaging PET scan. Moreover, we also considered morphological features using the product of diameters measured on the co-registered CT images to assess the added value of hybrid imaging.MethodsWe performed a retrospective analysis on histologically proven HNSCC patients who underwent baseline and response assessment [18F]FDG PET/CT. Post-treatment scans were reviewed according to Hopkins, Deauville, and Cuneo criteria, assigning a score to the primary tumor site and lymph nodes. A per-patient final score for each scale was chosen, corresponding to the highest score between the two sites. Diagnostic performance was then calculated for each score considering any evidence of locoregional progression in the first 3 months as the gold standard. Survival analysis was performed using the Kaplan–Meier method. SUVmax and its delta, as well as the product of diameters of the lymph node with the highest uptake at post-treatment scan, if present, were calculated.ResultsA total of 43 patients were finally included in the study. Sensitivity, specificity, PPV, NPV, and accuracy were 87%, 86%, 76%, 92%, and 86% for the Hopkins score, whereas 93%, 79%, 70%, 96%, and 84% for the Deauville score, respectively. Conversely, the Cuneo score reached the highest specificity and PPV (93% and 78%, respectively) but the lowest sensitivity (47%), NPV (76%), and accuracy (77%). Each scale significantly correlated with PFS and OS. The ROC analysis of the combination of SUVmax and the product of diameters of the highest lymph node on the restaging PET scan reached an AUC of 0.822. The multivariate analysis revealed the Cuneo criteria and the product of diameters as prognostic factors for PFS.ConclusionsEach visual score statistically correlated with prognosis thus demonstrating the reliability of point-scale criteria in HNSCC. The novel Cuneo score showed the highest specificity, but the lowest sensibility compared to Hopkins and Deauville criteria. Furthermore, the combination of PET data with morphological features could support the evaluation of equivocal cases.

Predicting the pathological invasiveness of early lung adenocarcinoma prior to surgery using Deauville criteria: reliability and validity

PurposeThis retrospective study aimed to investigate the validity and reliability of FDG-PET/CT visual assessment using Deauville criteria to predict pathological invasiveness of early lung adenocarcinoma prior to surgery.Materials and methodsBetween April 2020 and January 2022, 51 patients who underwent surgery for pathological stage 0/I lung adenocarcinoma were enrolled. The pulmonary lesions were divided into two groups according to pathological invasiveness: less invasive (including adenocarcinoma in situ and minimally invasive adenocarcinoma and invasive adenocarcinoma. We compared CT size (total and solid size), SUVmax, and Deauville score between the two groups. Furthermore, we investigated inter-rater and intra-rater agreements regarding the Deauville score. Receiver operating characteristic (ROC) curve analysis was performed to identify the diagnostic performance of each method.ResultsBased on pathologic diagnoses, 51 lesions in the 51 patients were divided into 6 less invasive and 45 invasive adenocarcinoma lesions. According to quadratic-weighted Kappa statistics, inter-rater (k = 0.93) and intra-rater (k = 0.97) agreements among all five components of the Deauville score indicated high agreement. There was a statistically significant difference in CT solid size, SUVmax, and Deauville score between the two groups. There were no significant differences between CT solid size and FDG-PET/CT assessments (AUC = 0.93 for Deauville score and SUVmax, AUC = 0.84 for CT solid size).ConclusionFDG-PET/CT visual assessment using the Deauville score could assist in deciding upon minimally invasive surgery for early lung adenocarcinoma.

Performance of Deauville Criteria in [18F]FDG-PET/CT Diagnostics of Giant Cell Arteritis.

In this retrospective study, PET/CT data from 59 patients with suspected giant cell arteritis (GCA) were reviewed using the Deauville criteria to determine an optimal cut-off between PET positivity and negativity. Seventeen standardised vascular regions were analysed per patient by three investigators blinded to clinical information. Statistical analysis included ROC curves with areas under the curve (AUC), Cohen's and Fleiss' kappa (κ) to calculate sensitivity, specificity, accuracy, and agreement. According to final clinician's diagnosis and the revised 2017 ACR criteria GCA was confirmed in 29 of 59 (49.2 %) patients. With a diagnostic cut-off ≥ 4 (highest tracer uptake of a vessel wall exceeds liver uptake) for PET positivity, all investigators achieved high accuracy (range, 89.8-93.2%) and AUC (range, 0.94-0.97). Sensitivity and specificity ranged from 89.7-96.6% and 83.3-96.7%, respectively. Agreement between the three investigators suggested 'almost perfect agreement' (Fleiss' κ = 0.84) A Deauville score of ≥4 as threshold for PET positivity yielded excellent results with high accuracy and almost perfect inter-rater agreement, suggesting a standardized, reproducible, and reliable score in diagnosing GCA. However, the small sample size and reference standard could lead to biases. Therefore, verification in a multicentre study with a larger patient cohort and prospective setting is needed.

Role of Circulating Myeloid-Derived Suppressor Cell (MDSC) in Hodgkin Lymphoma (HL) Progression: Highlighting Clinical Relevance

Introduction. About 15-25% of patients with HL have primary refractory disease or relapse after the first line of therapy and about half of them diagnosed chemosensitivity after transplantation. In the attempt to find a peripheral blood biological marker that could mirror the dysregulated microenvironment of HL, we analyzed the number of myeloid-derived suppressor cells (MDSC) and its correlation with clinical variables and response to therapy. Methods. 52 primary HL patients, (median age: 40, range: 19-61 years; male: 21, female: 31), were included in the study since April, 2018. 63.5% and 36.5% of patients have been diagnosed with early and advanced stages of HL, respectively, and received the ABVD or BEACOPP (14/esc) as a 1st-line treatment regimen. We have also used a routine protocol of metabolic PET assessment according to Deauville criteria of treatment response. Results. 82.6% (43/52) of patients achieved remission (CR/PR) during the follow-up period (median timeline: 25 months). We recorded a disease progression in 6/52 (11.5%) patients during and after the 1st line therapy, (median time to relapse - 8 months). We observed that the level of E-MDSC in patients with HL before treatment is twelve times higher than in healthy control group (24% vs 2 % respectively, p=0.02). Also, the E-MDSC count increases significantly with age of HL patient (with the highest levels in patients over 40 y.o., p=0.008) and with the stage of the disease. Thus patients with advanced stages (III-IV) of HL have increased % of circulating E-MDSC compared to early stages (1A-2B) of disease (p=0.07) . We also found the significant correlation between increased level of MDSC during the treatment and the presence of 4 or more risk factors by IPS (p=0.03). Patients with negative PET results (interim and EOT) had a significantly lower percent of E-MDSC in peripheral blood during and in the end of treatment compare to positive PET patients (interim MDSC: 14% vs 36%, p=0.03; EOT MDSC: 12% vs 42%, p=0.0007, respectively). Patients with CR also had increased number of T and NK-T cells compared to pre-treatment numbers (p=0.05), which all together indicates the activation of anti-tumor immune response. Conclusion. Increased level of circulating E-MDSC is associated with age, advanced stage of HL, presence of 4 or more IPS risk factors and poor clinical outcome. Evaluation of MDSC levels in peripheral blood can be used as additional prognostic marker for early clinical outcome assessment. The discovery of new prognostic factors will improve the individualized approach to the treatment of patients and reduce the risk of disease recurrence.

ABCL-007 Semiquantitative Measurements of Standard-Uptake-Value (ΔSUV) in Assessment of Patients Response and Outcomes in Aggressive Lymphomas

Positron emission tomography (PET) with 18-fluoro-2-deoxy-D-glucose ([18 F] FDG) is an essential tool for accurate staging, early, and late therapy response assessment in all FDG-avid lymphomas. To evaluate the accuracy of ΔSUV max in assessment of response to treatment in patients with lymphoma. This study was conducted between October 2019 and October 2021. Seventy-three patients diagnosed as high-grade lymphoma or Hodgkin disease (HD) were enrolled in the study. PET/CT examinations were performed at baseline (PET0), after the second, the fourth cycle of chemotherapy and at the end of treatment. PET-CT scans were analyzed according to the Deauville 5-point scale (5-PS). According to SUV-based assessment, PET/CT was considered negative when ΔSUV max at 2nd cycle (PET0-2) is more than 66% and ΔSUV max at 4th cycle (PET0-4) is more than 70%, respectively. The change in activity (ΔSUV) from initial (SUVmax1) to later scans (SUVmax2) was calculated as: SUV (%) = 100 x ([SUVmax2/SUVmax1] -1). Biopsy was taken if PET 2 or 4 is visually positive with negative delta SUV max, or in case of new lesions if other sites have improved. SUV uptake values at baseline were 16.30 ± 9.36 in NHL versus 12.55 ± 6.78 in HL. After 2 cycles of chemotherapy, (78.1%) had negative PET based on ΔSUV max raised to (86.3%) by the end of 4th cycle and this was different from 5PS where only (60.5%) raised to (74.4%) after the 4th cycle. In comparison with results of biopsy, ΔSUV0-2 has sensitivity 80%, specificity 94.1%, accuracy 90.91 % with P value (0.001) also, ΔSUV0-4 has sensitivity 80%, specificity 100%, accuracy 95.45 % with high agreement with P value (<0.001). On the contrary, the visual 5-PS analysis 0-2 specificity 17.65%, accuracy 36.36 with P value (<0.321). Also, the visual 5-PS analysis 0-4 specificity 41.18 %, accuracy 54.55% with P value (<0.082). After 4 cycles 22 patients needed to undergo biopsy because inconclusive results of PET. Comparison reveled that using ΔSUV max demonstrated higher specificity. ΔSUV max is comparable to biopsy and significantly more accurate than Deauville criteria in assessment of response to treatment.

P1132: PET INTERIM RESULTS PREDICT PROGRESSION-FREE-SURVIVAL IN FOLLICULAR LYMPHOMA PATIENTS WITH ADVANCED STAGE

Background: Follicular lymphoma (FL) is the second most common NHL. It is generally associated with an indolent course, but a subgroup of patients has worse outcome, lower progression-free-survival (PFS) and higher risk of histological transformation (HT). Since Lugano classification, the Deauville criteria using the 5-point scale (D5PS) is validated as the interpretation method for response assessment PET scans in HL and NHL. Nevertheless, the prognostic value of D5PS in the interim evaluation in FL (PETINT) is not well stablished. Additionally, the quantitative value of SUVmax parameter in the response assessment is almost not studied. Aims: The aim of this study is to evaluate the prognostic value of PETINT evaluation and quantitative mid-induction SUVmax parameter in a cohort of FL patients followed and treated in a single, academic centre with chemo-immunotherapy. Methods: 179 consecutive FL patients were newly diagnosed between 2011 and 2020. 40 patients that did not require systemic treatment and 68 that did not have a PETINT evaluation were excluded. As well, patients with HT (9) and FL grade 3B (4) were excluded. From the 58 remaining patients, clinical, laboratory and PET examinations data was recorded. All patients were Ann-Arbor stage III-IV and were treated with chemo-immunotherapy. PET/CT examinations were acquired at baseline, mid-induction (after 4 cycles of treatment) and end of treatment (EOT). PET positive was considered when Deauville score (DS) was 4 or 5. Statistical analysis was performed with SPSS® using Cox regression, Kaplan-Meier survival curves and log-rank test. Results: The median age at diagnosis was 64 years (26-95) and 29 (50%) patients were female. 33/58 (57%) patients had a high risk FLIPI and 18/55 (33%) had a high risk PRIMA-PI. 37 (64%) patients were treated with R-CHOP and 21 with R-bendamustine. 44 (76%) patients received maintenance with rituximab. After a median follow-up of 43 months, 20 (34%) patients had progression. On PETINT, 19 (32%) patients were PET(+), and 10 of them remained PETEOT(+). Only one patient with PETINT(-), became PETEOT(+). PETINT(+) patients had a median PFS of 31 months compared with a median PFS of 88 months in PETINT(-) (p < 0.001), Figure 1. 38.2% PETINT(+) presented progression of disease in less than 24 months (POD24) vs 5.2% on those who were in PETINT(-), with a p<0.001. PETINT(-) presented a negative predictive value of 95%. No differences in OS was observed. 3/19 (16%) patients with PETINT(+) presented HT vs 1/39 (2%) with PETINT(-). Transformation-free survival was lower in patients with PETINT(+), with a trend towards significance (p= 0.057). Similar PFS results were obtained independently of prognostic index, treatment or maintenance received. Analysing the prognostic value of quantitative SUVmax, patients with SUVmax< 3,8 (28/58; 48%) presented better outcomes, with larger PFS (p < 0.001) and less HT (p= 0.004). Figure 2. Additionally, PET/CT findings at EOT were predictive of relapse, with a median PFS of 30 months in PETEOF (+) vs 88 months in PETEOT(-) (p = 0.005). PETEOT (+) presented a higher risk of HT (p= 0.004). Figure 3. Image:Summary/Conclusion: This study suggests that response assessment by PET at mid-induction is predictive of relapse in advanced stage FL patients treated with 1st line chemo-immunotherapy. With previous conflicting results, further studies are needed to confirm this preliminary data. Probably, new laboratory tests such as MRD monitored by liquid biopsy could improve the detection of this subgroup of high risk patients and help to develop a response-adapted precision therapy.

P1284: LIQUID BIOPSY BY ULTRA-DEEP SEQUENCING PLUS PET-TC MONITORING IN REAL-LIFE FOLLICULAR LYMPHOMA PATIENTS

Background: Follicular lymphoma (FL) is considered an indolent disorder with a relatively favorable course. With modern day treatments, long remissions are often achieved both in front-line and relapsed setting. However, a subset of patients has a more aggressive course and a poorer outcome. Although understanding prognosis is important, ultimately the goal in FL should be to guide therapy. Studies of risk-adapted therapy based on MRD remains investigational. Aims: To prospectively evaluate the predictive value of a liquid Biopsy MRD (LiqBio-MRD) SNV-NGS method in combination with the Deauville criteria using the 5-point scale (D5PS) in the evaluation of response in a cohort of 72 FL patients that require treatment from 2018-2021. Methods: 57 patients received first-line therapy (39 R-CHOP, 10 R-B, 5 Rituximab in monotherapy and 3 radiotherapy) and 15 patients salvage treatment. Genomic DNA from formalin-fixed paraffin embedded (FFPE) lymph node biopsies and/or cell-free DNA (cfDNA) was obtained before start treatment. These samples were sequenced with short length Ampliseq Custom Panel targeting 56 important genes in B-cell dyscrasias. Somatic mutations were selected as disease biomarkers, and cfDNA samples were analysed at mid-induction (n = 26) and at the end of treatment (n= 41). PET/CT examinations were usually performed after 4 cycles (n = 44) and at the end of treatment (n = 63). PET positive was considered when D5PS was 4 or 5. Statistical analysis was performed with SPSS® using Cox regression, Kaplan-Meier survival curves and log-rank test. Results: Median age at diagnosis was 66 years (35 – 90) and 58% were female. At diagnosis only the lymphocyte to monocyte ratio < 2.5 had prognostic value (p=0.04). Median PFS was 13 months for PETEOT (+) cases and 10 months for MRDEOT (+) ones. 71% of patients with PETEOT (+) presented POD24, in contrast to only 9% of patients with PETEOT (-), p < 0.001. Regarding MRD, 73% of patients with MRDEOT (+) presented POD24 vs 12% of patients with MRDEOT (-), (p < 0,001; HR 8.30, 95%CI 1.70–40.38). The sensitivity (SE) and specificity (SP) of both tests to predict POD24 were: PETEOT (SE77%, SP68%) and MRD (SE77%, SP86%). 40 patients had MRDEOT and PETEOT available and results were concordant in 80% of cases. In a stratified analysis combining the information on MRD and PET, the 2-yr PFS were; 96% for MRD/PET -/-, 71% for MRD/PET -/+, and 58% MRD/PET +/-. Strikingly, patients that were positive by both tests presented a 2-yr PFS of only 10%. Using only concordant results, SE91% and SP96% was achieved. Similar results in PFS and in predicting POD24 were obtained when including only patients with first line therapy. Figure 1. When interim results were analysed, also PETINT(+) and MRDINT(+) were associated with higher risk of relapse (p<0,001 and p=0.009, respectively). The negative predictive value of PETINT results was 96%. Concordance between both tests was clearly inferior (47%), although no patient with PETINT(-) and MRDINT(-) results relapsed. Image:Summary/Conclusion: Our results demonstrate for the first time that NGS based MRD quantification is feasible in Liquid Biopsies from FL. The achievement of negative MRD after treatment, but also in an interim analysis, enhances prognostic information on patient outcome. PET/CT and cfDNA are complementary increasing SE and SP to predict progression and POD 24 with a high accuracy. Although, more patients are necessary to draw meaningful conclusion, the combination of these techniques could aid to the develop clinical trials with a response-adapted precision therapy.

Does Metabolic liver steatosis has impact on Deauville criteria in Lymphoma patients in 18F-PET/CT.

Does Metabolic liver steatosis has impact on Deauville criteria in Lymphoma patients in 18F-PET/CT.

The Utility of Metabolic Parameters on Baseline F-18 FDG PET/CT in Predicting Treatment Response and Survival in Paediatric and Adolescent Hodgkin Lymphoma.

Lymphoma is the third most common paediatric cancer. Early detection of high-risk patients is necessary to anticipate those who require intensive therapy and follow-up. Current literature shows that residual tumor avidity on PET (Positron Emission Tomography) following chemotherapy corresponds with decreased survival. However, the value of metabolic parameters has not been adequately investigated. In this retrospective study, we aimed to evaluate the prognostic value of metabolic and other parameters in paediatric and adolescent Hodgkin lymphoma. We recorded tMTV (total Metabolic Tumor Volume), TLG (Total Lesion Glycolysis), and SUVmax (maximum Standard Uptake Value) on baseline PET, as well the presence of bone marrow or visceral involvement. HIV (human immunodeficiency virus) status and baseline biochemistry from clinical records were noted. All patients received stage-specific standard of care therapy. Response assessment on end-of-treatment PET was evaluated according to the Deauville criteria. We found that bone marrow involvement (p = 0.028), effusion (p < 0.001), and treatment response (p < 0.001) on baseline PET, as well as HIV status (p = 0.036) and baseline haemoglobin (p = 0.039), were significantly related to progression-free survival (PFS), whereas only effusion (p = 0.017) and treatment response (p = 0.050) were predictive of overall survival (OS). Only baseline tMTV predicted treatment response (p = 0.017). This confirms the value of F-18 FDG PET/CT (Fluoro-deoxy-glucose Positron Emission Tomography/Computed Tomography) in prognostication in paediatric and adolescent Hodgkin lymphoma; however, further studies are required to define the significance of metabolic parameters.

Role of 18F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography Imaging in the Prediction of Prognosis in Patients With Indolent Lymphoma: Prospective Study.

BackgroundThe role of fluorodeoxyglucose–positron emission tomography/computed tomography (FDG-PET/CT) in indolent lymphoma has been minimally studied.ObjectiveThis study aims to assess the value of FDG-PET/CT in predicting the prognosis of indolent lymphoma.MethodsWe prospectively recruited 42 patients with indolent lymphoma. A total of 2 patients were excluded, and 40 underwent baseline PET/CT and follow-up at various time points. A total of 9 patients were observed only, 7 received 4 doses of rituximab alone, and 24 received chemoimmunotherapy. Metabolic response on follow-up PET/CT was assessed using the maximum standardized uptake value (SUVmax) and Deauville criteria (DC). We aimed to obtain the best SUVmax and DC to predict optimal survival rates, risk stratification, and optimize therapeutic strategies. The mean follow-up from the initial diagnosis was 33.83 months.ResultsSUVmax <4.35 at interim PET/CT provided the best discrimination, with a progression-free survival (PFS) of 100% and a median survival time of 106.67 months compared with SUVmax ≥4.35 (P=.04), which had a PFS of 43.8% and a median survival time of 50.17 months. This cutoff was also valuable in predicting overall survival at baseline, that is, 100% overall survival with baseline SUVmax <4.35, versus 58.4% for SUVmax ≥4.35 (P=.13). The overall survival of patients with a baseline DC score <3.0 was 100%, with a median overall survival of 106.67 months.ConclusionsWe demonstrated the utility of PET/CT in indolent lymphomas. SUVmax (<4.35 vs ≥4.35) on interim PET/CT performed best in predicting PFS.