Interim PET/CT in diffuse large B-cell lymphoma may facilitate identification of good-prognosis patients among IPI-stratified patients
Treating patients with DLBCL remains a challenge, as the response to first-line immunochemotherapy is somewhat unpredictable. The International Prognostic Index (IPI) is one of the most widely used methods for assessing prognosis. Interim PET/CT (iPET/CT) can play an important role in the early identification of ‘non-responder’ patients before the end of treatment examination. In this study, we retrospectively analyzed 104 newly diagnosed DLBCL patients treated with R-CHOP-like regimens who underwent iPET/CT imaging during therapy. There was a significant difference in 2-year OS between patients with negative iPET/CT and those with positive iPET/CT. Patients who had positive iPET/CT showed inferior 2-year PFS compared to those with negative iPET/CT. According to IPI, there was a statistically significant difference in 2-year OS and PFS between patients in the lower and higher risk groups. However, these patients can be further subdivided according to iPET/CT. The iPET/CT results in the present study clearly separate good- and poor-prognosis patients according to differences in 2-year OS, both in the lower and higher IPI risk groups. These results are in agreement with those of previous studies that demonstrated that iPET/CT has high negative predictive value, clearly identifying good-prognosis patients even within the poor-prognosis IPI group.
KeywordsDiffuse large B-cell lymphoma DLBCL Response PET/CT Interim PET/CT
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Sabattini E, Bacci F, Sagramoso C, Pileri SA. WHO classification of tumours of haematopoietic and lymphoid tissues in 2008: an overview. Pathologica. 2010;102:83–7.Google Scholar
- 2.Coiffier B, Thieblemont C, Van Den Neste E, Lepeu G, Plantier I, Castaigne S, et al. Long-term outcome of patients in the LNH-98.5 trial, the first randomized study comparing rituximab-CHOP to standard CHOP chemotherapy in DLBCL patients: a study by the Groupe d’Etudes des Lymphomes de l’Adulte. Blood. 2010;116:2040–5.CrossRefGoogle Scholar
- 13.Vitolo U, Chiappella A, Bellò M, Passera R, Botto B, Castellano G, et al. The outcome of patients with diffuse large B-Cell lymphoma (DLBCL) treated with Rituximab-CHOP (R-CHOP) is not predicted by 18-FDG-Positron Emission Tomography/Computerized Tomography (PET) performed at intermediate in-course evaluation, but only by PET assessed at the end of therapy. Blood. 2010;116:2819.Google Scholar
- 16.Nols N, Mounier N, Bouazza S, Lhommel R, Costantini S, Vander Borght T, et al. Quantitative and qualitative analysis of metabolic response at interim positron emission tomography scan combined with International Prognostic Index is highly predictive of outcome in diffuse large B-cell lymphoma. Leuk Lymph. 2013;55:773–80.CrossRefGoogle Scholar
- 17.Jiang M, Chen P, Ruan X, Ye X, Pan Y, Zhang J, et al. Interim 18F-FDG PET/CT improves the prognostic value of S-IPI, R-IPI and NCCN-IPI in patients with diffuse large B-cell lymphoma. Oncol Lett. 2017;14:6715–23.Google Scholar
- 24.de Oliveira Costa R, Neto HA, Siqueira S, de Lage LAPC, de Paula HM, Coutinhoet AM, et al. Interim fluorine-18 fluorodeoxyglucose PET-computed tomography and cell of origin by immunohistochemistry predicts progression-free and overall survival in diffuse large B-cell lymphoma patients in the rituximab era. Nucl Med Commun. 2016;37:1095–101.CrossRefGoogle Scholar
- 26.Jiang M, Chen P, Ruan X, Xu W, Li T, Wu L, et al. Interim 18F-FDG PET/CT and BCL2 for predicting the prognosis of patients with diffuse large B-cell lymphoma in the rituximab era. Nucl Med Commun. 2018;39:147–53.Google Scholar
- 28.Kasamon YL, Jones RJ, Wahl RL. Integrating PET and PET/CT into the risk-adapted therapy of lymphoma. J Nucl Med. 2007;48:19S–27S.Google Scholar