Risk-Adapted Dose-Dense Immunochemotherapy Determined by Interim FDG-PET in Advanced-Stage Diffuse Large B-Cell Lymphoma

• Published in: Journal of clinical oncology Vol. 28; no. 11; pp. 1896 - 1903
• Main Authors: MOSKOWITZ, Craig H, SCHÖDER, Heiko, HORWITZ, Steven, WEAVER, Sarah A, MEIKLE, Jessica L, FILIPPA, Daniel A, CARAVELLI, James F, HAMLIN, Paul A, ZELENETZ, Andrew D, TERUYA-FELDSTEIN, Julie, SIMA, Camelia, IASONOS, Alexia, PORTLOCK, Carol S, STRAUS, David, NOY, Ariela, PALOMBA, Maria L, O'CONNOR, Owen A
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Society of Clinical Oncology 10.04.2010
• Subjects: Adolescent; Adult; Aged; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Cyclophosphamide - administration & dosage; Dose-Response Relationship, Drug; Doxorubicin - administration & dosage; 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; Lymphoma, Large B-Cell, Diffuse - immunology; Male; Medical sciences; Middle Aged; Neoplasm Staging; Original Reports; Positron-Emission Tomography; Prednisone - administration & dosage; Prospective Studies; Radiopharmaceuticals; Risk Factors; Rituximab; Survival Rate; Treatment Outcome; Tumors; Vincristine - administration & dosage; Young Adult; Radionuclide study; 2-deoxy-2-fluoroglucose; Immunochemotherapy; B cell neoplasm; Malignant hemopathy; Non Hodgkin lymphoma; Chemotherapy; Cancerology; Treatment; Lymphoproliferative syndrome; Risk factor; Diffuse large B cell lymphoma; Advanced stage; High dose; Positron emission tomography; Cancer
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2009.26.5942

PURPOSE In studies of diffuse large B-cell lymphoma, positron emission tomography with [(18)F]fluorodeoxyglucose (FDG-PET) performed after two to four cycles of chemotherapy has demonstrated prognostic significance. However, some patients treated with immunochemotherapy experience a favorable long-term outcome despite a positive interim FDG-PET scan. To clarify the significance of interim FDG-PET scans, we prospectively studied interim FDG-positive disease within a risk-adapted sequential immunochemotherapy program. PATIENTS AND METHODS From March 2002 to November 2006, 98 patients at Memorial Sloan-Kettering Cancer Center received induction therapy with four cycles of accelerated R-CHOP (rituximab + cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by an interim FDG-PET scan. If the FDG-PET scan was negative, patients received three cycles of ICE (ifosfamide, carboplatin, and etoposide) consolidation therapy. If residual FDG-positive disease was seen, patients underwent biopsy; if the biopsy was negative, they also received three cycles of ICE. Patients with a positive biopsy received ICE followed by autologous stem-cell transplantation. RESULTS At a median follow-up of 44 months, overall and progression-free survival were 90% and 79%, respectively. Ninety-seven patients underwent interim FDG-PET scans; 59 had a negative scan, 51 of whom are progression free. Thirty-eight patients with FDG-PET-positive disease underwent repeat biopsy; 33 were negative, and 26 remain progression free after ICE consolidation therapy. Progression-free survival of interim FDG-PET-positive/biopsy-negative patients was identical to that in patients with a negative interim FDG-PET scan (P = .27). CONCLUSION Interim or post-treatment FDG-PET evaluation did not predict outcome with this dose-dense, sequential immunochemotherapy program. Outside of a clinical trial, we recommend biopsy confirmation of an abnormal interim FDG-PET scan before changing therapy.