Optimal timing and criteria of interim PET in DLBCL: a comparative study of 1692 patients

Jakoba J. Eertink*, Coreline N. Burggraaff, M.W. Heymans, U Duhrsen, A Huttmann, C Schmitz, S Muller, Elly Lugtenburg, S. F. Barrington, N. G. Mikhaeel, R. Carr, S. Czibor, T. Györke, Luca Ceriani, E Zucca, M Hutchings, L. Kostakoglu, A. Loft, S. Fanti, Sanne E. WiegersSimone Pieplenbosch, R Boellaard, O.S. Hoekstra, J. M. Zijlstra, H.C.W. de Vet*

*Corresponding author for this work

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Abstract

Interim 18F-fluorodeoxyglucose positron emission tomography (Interim- 18F-FDG-PET,
hereafter I-PET) has the potential to guide treatment of patients with diffuse large B-cell
lymphoma (DLBCL) if the prognostic value is known. The aim of this study was to determine
the optimal timing and response criteria for evaluating prognosis with I-PET in DLBCL.
Individual patient data from 1692 patients with de novo DLBCL were combined and scans were harmonized. I-PET was performed at various time points during treatment with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. Scans were interpreted using the Deauville score (DS) and change in maximum standardized uptake value (DSUVmax ). Multilevel Cox proportional hazards models corrected for International Prognostic Index (IPI) score were used to study the effects of
timing and response criteria on 2-year progression-free survival (PFS). I-PET after 2 cycles (I-PET2) and I-PET4 significantly discriminated good responders from poor responders, with the highest hazard ratios (HRs) for I-PET4. Multivariable HRs for a PET-positive result at I-PET2 and I-PET4 were 1.71 and 2.95 using DS4-5, 4.91 and 6.20 using DS5, and 2.93 and 4.65 using DSUVmax , respectively. DSUVmax identified a larger proportion of poor responders
than DS5 did. For all criteria, the negative predictive value was >80%, and positive
predictive values ranged from 30% to 70% at I-PET2 and I-PET4. Unlike I-PET1, I-PET3
discriminated good responders from poor responders using DS4-5 and DS5 thresholds (HRs,
2.94 and 4.67, respectively). I-PET2 and I-PET4 predict good response equally during R-CHOP
therapy in DLBCL. Optimal timing and response criteria depend on the clinical context. Good
response at I-PET2 is suggested for de-escalation trials, and poor response using DSUVmax at
I-PET4 is suggested for randomized trials that are evaluating new therapies
Original languageEnglish
Pages (from-to)2375-2384
JournalBlood advances
Volume5
Issue number9
Early online date4 May 2021
DOIs
Publication statusPublished - 11 May 2021

Bibliographical note

Presented at the 61st annual meeting of the American Society of Hematology, Orlando,
FL, 7-10 December 2019

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