Predictive Value of Interim and End-of-Therapy 18F-FDG PET/CT in Patients with Follicular Lymphoma
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18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is the standard imaging modality for response evaluation in FDG-avid lymphoma, but the prognostic value is not established in follicular lymphoma (FL). This study investigated the prognostic value of Deauville 5-point scale (D5PS) from paired interim PET/CT (PETInterim) and end-of-induction therapy PET/CT (PETEOI) in patients with FL.
FL staging and response assessment PET/CT images from 2013 to 2015 were retrospectively reviewed. PETInterim was performed 3 or 4 cycles after chemotherapy and PETEOI after 6 or 8 cycles. D5PS scores of 1, 2, and 3 were considered as negative (−), and scores 4 and 5 were considered as positive (+). Statistical analysis was done using Cox regression analysis, Kaplan–Meier survival analysis, and the log-rank test.
Thirty-three patients with set of baseline, interim, and end-of-induction therapy PET/CT studies were included. Ten patients (30.3%) had progression. The median progression-free survival (PFS) was 38.8 months (range 3.5–72.7 months). On PETInterim, 23 patients were negative and 10 were positive. On PETEOI scans, 29 patients were negative, and 4 were positive. On multivariate analysis, PETEOI(−) was associated with longer PFS. PETInterim(+) and PETEOI(+) patients had a significantly shorter PFS than PETInterim(−) patients (39.9 months, 95% confidence interval [CI] 23.0–56.9, versus 55.5 months, 95% CI 49.7–61.2, p = 0.005) and PETEOI(−) patients (14.2 months, 95% CI 8.5–19.8, versus 60.5 months, 95% CI 52.1–69.0, p < 0.001).
For patients with FL, PETInterim and PETEOI response is predictive of PFS, and PETEOI(+) is an independent prognostic factor for progression of FL.
KeywordsFollicular lymphoma 18F-fluorodeoxyglucose Positron emission tomography Lugano classification Progression-free survival
The authors thank Martin Mawhinney for his assistance in data acquisition.
Compliance with Ethical Standards
Conflict of Interest
Sun Ha Boo, Joo Hyun O, Soo Jin Kwon, Ie Ryung Yoo, Sung Hoon Kim, Gyeongsin Park, Byung Ock Choi, Seung Eun Jung, Seok-Goo Cho declare that they have no conflict of interest. There is no source of funding.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
The Institutional Review Board of our institute approved this retrospective study, and the requirement to obtain informed consent was waived.
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