Response assessment after an inductive CHOP or CHOP-like regimen with or without rituximab in 103 patients with diffuse large B-cell lymphoma: integrating 18fluorodeoxyglucose positron emission tomography to the International Workshop Criteria

• Published in: Annals of oncology Vol. 20; no. 3; pp. 503 - 507
• Main Authors: Dupuis, J., Itti, E., Rahmouni, A., Hemery, F., Gisselbrecht, C., Lin, C., Copie-Bergman, C., Belhadj, K., El Gnaoui, T., Gaillard, I., Kuhnowski, F., Meignan, M., Haioun, C.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.03.2009; Oxford Publishing Limited (England)
• Subjects: 18fluorodeoxyglucose PET scan; Adult; Aged; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Murine-Derived; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Cyclophosphamide - administration & dosage; Cyclophosphamide - therapeutic use; diffuse large B-cell lymphoma; Disease-Free Survival; Doxorubicin - administration & dosage; Doxorubicin - therapeutic use; Female; Fluorodeoxyglucose F18; Hematologic and hematopoietic diseases; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma, Large B-Cell, Diffuse - diagnostic imaging; Lymphoma, Large B-Cell, Diffuse - drug therapy; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Positron-Emission Tomography; Prednisone - administration & dosage; Prednisone - therapeutic use; Prospective Studies; response Criteria; Rituximab; Treatment Outcome; Vincristine - administration & dosage; Vincristine - therapeutic use; fluorodeoxyglucose PET scan; response Criteria; diffuse large B-cell lymphoma; rituximab; Radionuclide study; Antineoplastic agent; Human; Evaluation; Drug combination; Rituximab; Patient; B cell neoplasm; Malignant hemopathy; Monoclonal antibody; CHOP protocol; Treatment; 18fluorodeoxyglucose PET scan; Lymphoproliferative syndrome; Immunotherapy; Diffuse large B cell lymphoma; Workshop; Positron emission tomography; Cancer; International; Emission tomography
• DOI: 10.1093/annonc/mdn671
• ISSN: 0923-7534

Background: Revised response criteria for aggressive lymphomas have been proposed (Cheson, J Clin Oncol, 2007) stressing the role of 18fluorodeoxyglucose–positron emission tomography (PET) in posttreatment evaluation. The value of PET after four cycles compared with the International Workshop Criteria (IWC) remains to be established. Patients and methods: In all, 103 patients with untreated diffuse large B-cell lymphoma were prospectively enrolled to evaluate the prognostic impact of PET after two and four cycles. Results: Median age was 53 years (19–79), 68% male. The International Prognostic Index was low = 22%, low-intermediate = 19%, intermediate-high = 33% and high risk = 26%. Treatment consisted of cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) (30%) or dose-intensified CHOP (70%), with rituximab (49%) or without (51%). Ninety-nine patients were evaluated by PET and IWC at four cycles: 77 (78%) had a negative PET, while 22 (22%) remained positive. The 5-year event-free survival (EFS) was 36% for patients with a positive PET versus 80% with a negative examination, whatever the response [complete response (CR) versus partial response (PR)] according to IWC (P < 0.0001). Positive PET patients had a 5-year EFS of 58% if in CR/CR unconfirmed by IWC and 0% if not (P < 0.0001). The same observations could be made in patients treated with and without rituximab. Conclusion: The integration of PET in treatment evaluation offers a powerful tool to predict outcome.