Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

The prognostic value of PET/CT evaluation with Deauville score on the recurrence and survival in diffuse large B-cell lymphoma: a multi-institutional study of KROG 17-02

Abstract

The Korean Radiation Oncology Group (KROG) assessed the value of Deauville score (DS) on 18F-fluorodeoxyglucose Positron emission tomography-computed tomography (FDG PET/CT) as a predictor of recurrence and survival after rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy in diffuse large B-cell lymphoma (DLBCL). A total of 512 patients with stage I–III DLBCL who received six cycles of R-CHOP with or without radiation therapy (RT) and obtained treatment responses according to PET-CT imagings after R-CHOP ± RT were included. Patients were sorted into two arms; DS 4–5 arm (n = 24) was matched at a 1:2 ratio with DS 1–3 arm (n = 48) using propensity score matching method. After a median follow-up time of 37.2 months, the recurrence-free survival rate (86.6% vs. 66.8%, P = 0.041) and overall survival rate (86.9% vs. 62.2%, P = 0.009) at 5 years were significantly different between the DS 1–3 and DS 4–5 arms. DS 4–5 arm showed higher 5-years locoregional recurrence-free survival (88.8% vs. 74.3%, P = 0.155) and distant failure-free survival (91.1% vs. 84.3%, P = 0.333) than DS 1–3 arm. In the multivariate analysis, DS was still a significant factor for recurrence-free survival [hazard ratio (HR), 3.840 and confidence interval (CI), 1.068–13.806; P = 0.039] and overall survival rates (HR 4.453 and CI 1.274–15.562; P = 0.019). This study showed and validated that Deauville score of 4–5 of PET-CT imaging taken after full-course of R-CHOP chemotherapy with or without RT could predict recurrence-free survival and overall survival in DLBCL patients.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

Abbreviations

CI:

Confidence interval

DLBCL:

Diffuse large B-cell lymphoma

DS:

Deauville score

ECOG:

Eastern Cooperative Oncology Group

EOT:

End-of-treatment

FDG:

18F-fluorodeoxyglucose

HR:

Hazard ratio

IPI:

International prognostic index

LRR:

Locoregional recurrence

PET/CT:

Positron emission tomography-computed tomography

R-CHOP:

Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone

RT:

Radiotherapy

RFS:

Recurrence-free survival

OS:

Overall survival

References

  1. 1.

    Feugier P, Van Hoof A, Sebban C et al (2005) Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d'Etude des Lymphomes de l'Adulte. J Clin Oncol 23:4117–4126

  2. 2.

    International Non-Hodgkin's Lymphoma Prognostic Factors Project (1993) A predictive model for aggressive non-Hodgkin's lymphoma. N Engl J Med 329:987–994

  3. 3.

    Kong Y, Qu L, Li Y et al (2016) Predictive significance of a new prognostic score for patients with diffuse large B-cell lymphoma in the interim-positron emission tomography findings. Medicine (Baltimore) 95:e2808

  4. 4.

    Mamot C, Klingbiel D, Hitz F et al (2015) Final results of a prospective evaluation of the predictive value of interim positron emission tomography in patients with diffuse large B-cell lymphoma treated with R-CHOP-14 (SAKK 38/07). J Clin Oncol 33:2523–2529

  5. 5.

    Juweid ME, Stroobants S, Hoekstra OS et al (2007) Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J Clin Oncol 25:571–578

  6. 6.

    Tilly H, Dreyling M (2009) Diffuse large B-cell non-Hodgkin's lymphoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 20(Suppl 4):110–112

  7. 7.

    Cheson BD, Fisher RI, Barrington SF et al (2014) Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol 32:3059–3068

  8. 8.

    National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: b-cell lymphomas [Internet]. Fort Washington, PA: National Comprehensive Cancer Network; c2018 [cited 2018 Oct 2]. Available from: https://www.nccn.org/professionals/physician_gls/pdf/b-cell.pdf

  9. 9.

    Meignan M, Gallamini A, Haioun C et al (2010) Report on the Second International Workshop on interim positron emission tomography in lymphoma held in Menton, France, 8–9 April 2010. Leuk Lymphoma 51:2171–2180

  10. 10.

    Mikhaeel NG, Hutchings M, Fields PA et al (2005) FDG-PET after two to three cycles of chemotherapy predicts progression-free and overall survival in high-grade non-Hodgkin lymphoma. Ann Oncol 16:1514–1523

  11. 11.

    Zhu Y, Lu J, Wei X et al (2013) The predictive value of interim and final [18F] fluorodeoxyglucose positron emission tomography after rituximab-chemotherapy in the treatment of non-Hodgkin's lymphoma: a meta-analysis. Biomed Res Int 2013:275805

  12. 12.

    Spaepen K, Stroobants S, Dupont P et al (2001) Prognostic value of positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose ([18F]FDG) after first-line chemotherapy in non-Hodgkin's lymphoma: is [18F]FDG-PET a valid alternative to conventional diagnostic methods? J Clin Oncol 19:414–419

  13. 13.

    Takasaki H, Yamamoto W, Ishii Y et al (2015) Post-treatment PET-CT findings may predict the prognosis of DLBCL with a Bulky Mass. Indian J Hematol Blood Transfus 31:346–351

  14. 14.

    Jerusalem G, Beguin Y, Fassotte MF et al (1999) Whole-body positron emission tomography using 18F-fluorodeoxyglucose for posttreatment evaluation in Hodgkin's disease and non-Hodgkin's lymphoma has higher diagnostic and prognostic value than classical computed tomography scan imaging. Blood 94:429–433

  15. 15.

    Yoo C, Lee DH, Kim JE et al (2011) Limited role of interim PET/CT in patients with diffuse large B-cell lymphoma treated with R-CHOP. Ann Hematol 90:797–802

  16. 16.

    Malek E, Sendilnathan A, Yellu M et al (2015) Metabolic tumor volume on interim PET is a better predictor of outcome in diffuse large B-cell lymphoma than semiquantitative methods. Blood Cancer J 5:e326

  17. 17.

    Kostakoglu L, Chauvie S (2018) Metabolic tumor volume metrics in lymphoma. Semin Nucl Med 48:50–66

  18. 18.

    Cheson BD, Pfistner B, Juweid ME et al (2007) Revised response criteria for malignant lymphoma. J Clin Oncol 25:579–586

  19. 19.

    Fallanca F, Alongi P, Incerti E et al (2016) Diagnostic accuracy of FDG PET/CT for clinical evaluation at the end of treatment of HL and NHL: a comparison of the Deauville Criteria (DC) and the International Harmonization Project Criteria (IHPC). Eur J Nucl Med Mol Imaging 43:1837–1848

  20. 20.

    Filippi AR, Piva C, Levis M et al (2016) Prognostic role of pre-radiation therapy (18)F-Fluorodeoxyglucose positron emission tomography for primary mediastinal B-cell lymphomas treated with R-CHOP or R-CHOP-like chemotherapy plus radiation. Int J Radiat Oncol Biol Phys 95:1239–1243

  21. 21.

    Ham JS, Kim SJ, Choi JY et al (2016) The prognostic value of interim and end-of-treatment PET/CT in patients with newly diagnosed peripheral T-cell lymphoma. Blood Cancer J 6:e395

  22. 22.

    Kostakoglu L, Goldsmith SJ, Leonard JP et al (2006) FDG-PET after 1 cycle of therapy predicts outcome in diffuse large cell lymphoma and classic Hodgkin disease. Cancer 107:2678–2687

  23. 23.

    Pinnix CC, Dabaja B, Ahmed MA et al (2015) Single-institution experience in the treatment of primary mediastinal B cell lymphoma treated with immunochemotherapy in the setting of response assessment by 18fluorodeoxyglucose positron emission tomography. Int J Radiat Oncol Biol Phys 92:113–121

  24. 24.

    Barrington SF, Qian W, Somer EJ et al (2010) Concordance between four European centres of PET reporting criteria designed for use in multicentre trials in Hodgkin lymphoma. Eur J Nucl Med Mol Imaging 37:1824–1833

  25. 25.

    Dann EJ (2012) PET/CT adapted therapy in Hodgkin disease: current state of the art and future directions. Curr Oncol Rep 14:403–410

  26. 26.

    Barrington SF, Mikhaeel NG, Kostakoglu L et al (2014) Role of imaging in the staging and response assessment of lymphoma: consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J Clin Oncol 32:3048–3058

  27. 27.

    Coiffier B (1999) How to interpret the radiological abnormalities that persist after treatment in non-Hodgkin's lymphoma patients? Ann Oncol 10:1141–1143

  28. 28.

    Juweid ME, Wiseman GA, Vose JM et al (2005) Response assessment of aggressive non-Hodgkin's lymphoma by integrated International Workshop Criteria and fluorine-18-fluorodeoxyglucose positron emission tomography. J Clin Oncol 23:4652–4661

  29. 29.

    Chung JH, Na K, Kim IH (2018) Benefit of volumetric-modulated arc therapy over three-dimensional conformal radiotherapy for stage I-II extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue in the stomach: a dosimetric comparison. Radiat Oncol J 36(4):332–340

Download references

Acknowledgements

The statistical analyses performed in this article were advised by Catholic Medical Center Clinical Research Coordinating Center.

Funding

There is no funding relevant to this work to be declared.

Author information

Correspondence to Jong Hoon Lee.

Ethics declarations

Conflicts of interest

The authors declare that they have no competing interests.

Ethical approval

This study was approved by the Institutional Review Board (VC17RESI0046).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lee, J.W., Oh, D., Eom, K. et al. The prognostic value of PET/CT evaluation with Deauville score on the recurrence and survival in diffuse large B-cell lymphoma: a multi-institutional study of KROG 17-02. Clin Exp Metastasis 37, 125–131 (2020). https://doi.org/10.1007/s10585-019-09992-z

Download citation

Keywords

  • Deauville score
  • Diffuse large B-cell lymphoma
  • Prognosis
  • Survival