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Predictive value of interim 18F-FDG-PET/CT for event-free survival in patients with diffuse large B-cell lymphoma homogenously treated in a phase II trial with six cycles of R-CHOP-14 plus pegfilgrastim as first-line treatment

González-Barca, Evaa; Canales, Miguele; Cortés, Montseb; Vidal, M. Jesusg; Salar, Antonioc; Oriol, Albertd; Bargay, Joanh; Bello, José L.i; Sánchez, José J.j; Tomás, José F.f; Donato, Evak; Ferrer, Secundinol; Caballero, Doloresmon behalf of the GELTAMO (Grupo Español de Linfoma y Trasplante de Médula Ósea)

Nuclear Medicine Communications: October 2013 - Volume 34 - Issue 10 - p 946–952
doi: 10.1097/MNM.0b013e328363c695
Original Articles

Objective The predictive value of interim PET/computed tomography (I-PET/CT) in diffuse large B-cell lymphoma (DLBCL) is controversial. Our aim was to evaluate the predictive value of I-PET/CT for an event-free survival.

Patients and methods We analyzed patients with DLBCL included in a prospective clinical trial who were treated with six cycles of dose-dense R-CHOP followed by pegfilgrastim and who had undergone an I-PET/CT (after two cycles) and a final PET [F-PET/CT (60 days after the sixth cycle)]. Event was defined as nonresponse, relapse, or death.

Results A total of 69 patients were included. Their median age was 60 years; 54% were male, 25% had bulky disease, and 67% had an International Prognostic Index of 0–2. The median follow-up duration was 28.8 months. I-PET/CT was positive in 34 (49%) patients and F-PET/CT was positive in 12 (17.4%). The 3-year event-free survival was 86% for patients who were I-PET/CT negative as against 64% for those who were I-PET/CT positive (P=0.036). The negative and positive predictive values, sensitivity, and specificity of I-PET/CT for an event were 83, 32, 65, and 56%, respectively. In a multivariate analysis including baseline characteristics, I-PET/CT, and F-PET/CT, F-PET/CT was the only significant predictor (P<0.0005).

Conclusion In patients with DLBCL treated with dose-dense R-CHOP plus pegfilgrastim, a negative I-PET/CT is highly predictive of a favorable outcome and a positive I-PET/CT is of limited clinical value. These results do not support treatment intensification after a short course of chemotherapy based solely on a positive I-PET/CT.

aLymphoma Unit, Department of Hematology, Institut Català d’Oncologia, Hospital Duran i Reynals, IDIBELL

bPET Unit, Institut of Diagnosis by Image (IDI)

cDepartment of Hematology, Hospital del Mar

dDepartment of Hematology, Institut Català d’Oncologia-Hospital, Hospital Germans Trias i Pujol, Barcelona

eDepartment of Hematology, University Hospital La Paz

fDepartment of Hematology, MD Anderson Hospital, Madrid

gDepartment of Hematology, University Hospital Donostia, Donostia

hDepartment of Hematology, Hospital Sont Llatzer, Palma de Mallorca

iDepartment of Hematology, University Hospital Santiago, Santiago de Compostela

jDepartment of Hematology, University General Hospital Morales Meseguer, Murcia

kDepartment of Hematology, General Hospital of Castellón, Castellón

lDepartment of Hematology, University Hospital Dr. Peset, Valencia

mDepartment of Hematology, University Hospital Clínico of Salamanca, Salamanca, Spain

Correspondence to Eva González-Barca, MD, PhD, Lymphoma Unit, Department of Hematology, Institut Catalá d’Oncología, Hospital Duran i Reynals, IDIBELL, Av. Gran Vía 199-203, 08908-L’Hospitalet de LLobregat, Barcelona, Spain Tel: +34 93 2607353; fax: +34 93 2607797; e-mail: e.gonzalez@iconcologia.net

Received February 22, 2013

Accepted May 31, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins