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Combination of baseline FDG PET/CT total metabolic tumour volume and gene expression profile have a robust predictive value in patients with diffuse large B-cell lymphoma

  • Mathieu Nessim Toledano
  • P. Desbordes
  • A. Banjar
  • I. Gardin
  • P. Vera
  • P. Ruminy
  • F. Jardin
  • H. Tilly
  • S. Becker
Original Article

Abstract

Purpose

This study evaluated the predictive significance of total metabolic tumour volume (TMTV) measured on baseline FDG PET/CT and its value in addition to gene expression profiling using a new method of gene analysis (rapid reverse transcriptase multiplex ligation-dependent probe amplification assay, RT-MLPA) in patients with diffuse large B-cell lymphoma treated with R-CHOP or R-CHOP-like chemotherapies.

Methods

The analysis included 114 patients. TMTV was measured using a 41% SUVmax threshold and tumours were classified into GCB or ABC subtypes according to the RT-MLPA assay.

Results

The median follow-up was 40 months. the 5-year progression-free survival (PFS) was 54% and the 5-year overall survival (OS) was 62%. The optimal TMTV cut-off value was 261 cm3. In 59 patients with a high TMTV the 5-year PFS and OS were 37% and 39%, respectively, in comparison with 72% and 83%, respectively, in 55 patients with a low TMTV (p = 0.0002 for PFS, p < 0.0001 for OS). ABC status was significantly associated with a worse prognosis. TMTV combined with molecular data identified three groups with very different outcomes: (1) patients with a low TMTV whatever their phenotype (n = 55), (2) patients with a high TMTV and GCB phenotype (n = 33), and (3) patients with a high TMTV and ABC phenotype (n = 26). In the three groups, 5-year PFS rates were 72%, 51% and 17% (p < 0.0001), and 5-year OS rates were 83%, 55% and 17% (p < 0.0001), respectively. In multivariate analysis, TMTV, ABC/GCB phenotype and International Prognostic Index were independent predictive factors for both PFS and OS (p < 0.05 for both).

Conclusions

This integrated risk model could lead to more accurate selection of patients that would allow better individualization of therapy.

Keywords

DLBCL FDG PET/CT Metabolic tumour volume ABC/GCB RT-MLPA 

Notes

Funding

No funding was received for this study.

Compliance with ethical standards

Conflicts of interest

None.

Ethical approval

This study was performed in accordance with the principles of the Declaration of Helsinki and local laws, and the protocol was approved by the Institutional Review Board of Henri Becquerel Centre.

Informed consent

All patients participating in this study provided written informed consent.

Supplementary material

259_2017_3907_Fig4_ESM.gif (32 kb)
Supplementary Fig. 1

Box-and-whisker diagram of TMTV in the whole population. (GIF 31.5 kb)

259_2017_3907_MOESM1_ESM.tif (76 kb)
High resolution image (TIFF 75.9 kb)
259_2017_3907_Fig5_ESM.gif (166 kb)
Supplementary Fig. 2

Kaplan–Meier curves of progression-free survival (PFS) and overall survival (OS) in relation to a baseline total metabolic tumour volume (TMTV) cut-off value of 261 cm3 in patients with unclassifiable phenotype. (GIF 165 kb)

259_2017_3907_MOESM2_ESM.tif (100 kb)
High resolution image (TIFF 100 kb)
259_2017_3907_MOESM3_ESM.png (67 kb)
ESM 1 (PNG 67 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Nuclear Medicine DepartmentHenri Becquerel Cancer Centre and Rouen University HospitalRouenFrance
  2. 2.QuantIF-LITIS (EA 4108-FR CNRS 3638), Faculty of MedicineUniversity of RouenRouenFrance
  3. 3.INSERM U918Centre Henri BecquerelRouenFrance
  4. 4.Hematology DepartmentCentre Henri BecquerelRouenFrance

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