Positron emission tomography with [18F]2-fluoro-D-2-deoxyglucose (FDG-PET) predicts relapse of malignant lymphoma after high-dose therapy with stem cell transplantation

• Published in: Leukemia Vol. 16; no. 2; pp. 260 - 267
• Main Authors: Becherer, A, Mitterbauer, M, Jaeger, U, Kalhs, P, Greinix, HT, Karanikas, G, Pötzi, C, Raderer, M, Dudczak, R, Kletter, K
• Format: Journal Article
• Language: English
• Published: London Nature Publishing 01.02.2002; Nature Publishing Group
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Carmustine - administration & dosage; Chemotherapy; Chronic toxicity; Combined Modality Therapy; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Complications; Cyclophosphamide - administration & dosage; Cytarabine - administration & dosage; Deoxyglucose; Disease-Free Survival; Drug dosages; Etoposide - administration & dosage; Female; Fluorine isotopes; Fluorodeoxyglucose F18 - pharmacokinetics; Follow-Up Studies; Hematopoietic Stem Cell Transplantation - mortality; Hodgkin Disease - diagnosis; Hodgkin Disease - diagnostic imaging; Hodgkin Disease - mortality; Hodgkin Disease - therapy; Humans; Internal medicine; Leukemia; Lymphoma; Lymphoma - diagnostic imaging; Lymphoma - drug therapy; Lymphoma - mortality; Lymphoma - therapy; Lymphoma, Non-Hodgkin - diagnosis; Lymphoma, Non-Hodgkin - diagnostic imaging; Lymphoma, Non-Hodgkin - mortality; Lymphoma, Non-Hodgkin - therapy; Male; Medical prognosis; Medical schools; Medical sciences; Melphalan - administration & dosage; Middle Aged; Neoplasm Recurrence, Local; Non-Hodgkin's lymphoma; Nuclear medicine; Patients; Pharmacology. Drug treatments; Podophyllotoxin - administration & dosage; Positron emission; Positron emission tomography; Prognosis; Radiopharmaceuticals - pharmacokinetics; Remission; Remission (Medicine); Stem cell transplantation; Stem cells; Survival Analysis; Survival Rate; Tomography; Tomography, Emission-Computed; Toxicity; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Conditioning - mortality; Treatment Outcome; Whole-Body Irradiation; Austria; Radionuclide study; Antineoplastic agent; Human; Relapse; Stem cell; Treatment efficiency; Hematopoietic cell; Homograft; Exploration; Hodgkin disease; Malignant hemopathy; Non Hodgkin lymphoma; Lymphoma; Chemotherapy; Treatment; Lymphoproliferative syndrome; Graft; Combined treatment; Predictive factor; High dose; Positron; Emission tomography
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/sj.leu.2402342

We have determined the predictive value of [18F]2-fluoro-2-deoxy-glucose (FDG-PET) in patients with Hodgkin's disease (HD) and aggressive non-Hodgkin's lymphoma (NHL) scheduled for high-dose therapy with stem cell transplantation (HDT/SCT). Inclusion criteria were the presence of an FDG-PET scan after chemotherapy (ChT) within 8 weeks prior to HDT/SCT and available follow-up data. Sixteen patients (10 NHL and six HD) were observed during a follow-up period of 4 to 28 months (median 13 months). Before SCT, five patients had a negative PET, three were weakly positive, two moderately positive, and six strongly positive. None of the five patients with a negative PET before HDT/SCT relapsed and two of three patients with a weakly positive scan are still in remission after HDT/SCT. Of eight patients with a moderate or high positive PET before HDT/SCT, seven relapsed and one died of early HDT/SCT related complications (P< 0.01). Three of eight relapsing patients died of lymphoma 5 to 10 months after SCT and in one additional patient not responding to HDT/SCT, the main cause of death was chronic toxicity 4 months after transplantation. After 12 months, in PET-negative patients the overall and relapse-free survival was 100%, in PET-positive patients 55% and 18%, respectively. In NHL, two patients with negative PET, but with an age-adjusted international prognostic index (AaIPI) of 2 and one with AaIPI = 1 are still in remission. In the seven PET-positive subjects, one patient with AaIPI = 0, three with AaIPI = 1, and two with AaIPI = 2 relapsed. We conclude that FDG-PET is accurate in the prediction of relapse prior to HDT/SCT in patients with lymphoma. It provides additional information when compared with the AaIPI.