TY - JOUR
T1 - 18F-FDG PET improves baseline clinical predictors of response in diffuse large B-cell lymphoma
T2 - The HOVON-84 study
AU - Burggraaff, Coreline N.
AU - Eertink, Jakoba J.
AU - HOVON Imaging working group
AU - HOVON lymphoma working group
AU - Lugtenburg, Pieternella J.
AU - Hoekstra, Otto S.
AU - Arens, Anne I.J.
AU - De Keizer, Bart
AU - Heymans, Martijn W.
AU - Van Der Holt, Bronno
AU - Wiegers, Sanne E.
AU - Pieplenbosch, Simone
AU - Boellaard, Ronald
AU - De Vet, Henrica C.W.
AU - Zijlstra, Josée M.
N1 - Funding Information:
PJL reports research funding from Roche, Takeda, and Servier, and honoraria for advisory boards
Publisher Copyright:
© 2022 Society of Nuclear Medicine Inc.. All rights reserved.
PY - 2022/7/1
Y1 - 2022/7/1
N2 - We aimed to determine the added value of baseline metabolic tumor volume (MTV) and interim positron emission tomography (I-PET) to age-adjusted international prognostic index (aaIPI) to predict 2- year progression-free survival (PFS) in diffuse large B-cell lymphoma (DLBCL). Secondary objectives were to investigate optimal I-PET response criteria (using Deauville score (DS) - or quantitative change in maximum Standardized Uptake Value (ΔSUVmax) between baseline and I-PET). Methods: Observational I-PET scans were performed after four cycles R(R)-CHOP14 (I-PET4) in the HOVON-84 randomized clinical trial (EudraCT 2006-005174-42), and centrally reviewed using DS (cut-off 4-5). Additionally, ΔSUVmax (prespecified cut-off 70%) and baseline MTV were measured. Multivariable hazard ratios (HR), positive (PPV), and negative predictive values (NPV) were obtained for 2-year PFS. Results: 513 I-PET4 scans were reviewed according to DS, and ΔSUVmax and baseline MTV were available for 367 and 296 patients. NPV of I-PET ranged between 82% and 86% for all PET response criteria. Univariate HR and PPV were optimal for ΔSUVmax (4·8 and 53%, respectively) compared to DS (3·1 and 38%, respectively). AaIPI and ΔSUVmax independently predicted 2-year PFS (HRs 3·2 and 5·0, respectively); adding MTV slightly improved this. Low/low-intermediate aaIPI combined with ΔSUVmax >70% (37% of patients) yielded a NPV of 93%, and the combination of high-intermediate/high aaIPI and ΔSUVmax=70% a PPV of 65%. Conclusion: In this DLBCL study, I-PET after four cycles R(R)-CHOP14 added predictive value to aaIPI for 2-year PFS, and both were independent response biomarkers in a multivariable Cox model. We externally validated that ΔSUVmax outperformed Deauville score in 2-year PFS prediction.
AB - We aimed to determine the added value of baseline metabolic tumor volume (MTV) and interim positron emission tomography (I-PET) to age-adjusted international prognostic index (aaIPI) to predict 2- year progression-free survival (PFS) in diffuse large B-cell lymphoma (DLBCL). Secondary objectives were to investigate optimal I-PET response criteria (using Deauville score (DS) - or quantitative change in maximum Standardized Uptake Value (ΔSUVmax) between baseline and I-PET). Methods: Observational I-PET scans were performed after four cycles R(R)-CHOP14 (I-PET4) in the HOVON-84 randomized clinical trial (EudraCT 2006-005174-42), and centrally reviewed using DS (cut-off 4-5). Additionally, ΔSUVmax (prespecified cut-off 70%) and baseline MTV were measured. Multivariable hazard ratios (HR), positive (PPV), and negative predictive values (NPV) were obtained for 2-year PFS. Results: 513 I-PET4 scans were reviewed according to DS, and ΔSUVmax and baseline MTV were available for 367 and 296 patients. NPV of I-PET ranged between 82% and 86% for all PET response criteria. Univariate HR and PPV were optimal for ΔSUVmax (4·8 and 53%, respectively) compared to DS (3·1 and 38%, respectively). AaIPI and ΔSUVmax independently predicted 2-year PFS (HRs 3·2 and 5·0, respectively); adding MTV slightly improved this. Low/low-intermediate aaIPI combined with ΔSUVmax >70% (37% of patients) yielded a NPV of 93%, and the combination of high-intermediate/high aaIPI and ΔSUVmax=70% a PPV of 65%. Conclusion: In this DLBCL study, I-PET after four cycles R(R)-CHOP14 added predictive value to aaIPI for 2-year PFS, and both were independent response biomarkers in a multivariable Cox model. We externally validated that ΔSUVmax outperformed Deauville score in 2-year PFS prediction.
UR - http://www.scopus.com/inward/record.url?scp=85133276639&partnerID=8YFLogxK
U2 - 10.2967/jnumed.121.262205
DO - 10.2967/jnumed.121.262205
M3 - Review article
C2 - 34675112
AN - SCOPUS:85133276639
SN - 0161-5505
VL - 63
SP - 1001
EP - 1007
JO - Journal of Nuclear Medicine
JF - Journal of Nuclear Medicine
IS - 7
ER -