FDG-PET/CT after two cycles of R-CHOP in DLBCL predicts complete remission but has limited value in identifying patients with poor outcome - final result of a UK National Cancer Research Institute prospective study
Mikhaeel, N. G. Cunningham, D. Counsell, N. McMillan, A. Radford, John A Ardeshna, K. M. Lawrie, A. Smith, P. Clifton-Hadley, L. O'Doherty, M. J.
Mikhaeel, N. G.
Cunningham, D.
Counsell, N.
McMillan, A.
Radford, John A
Ardeshna, K. M.
Lawrie, A.
Smith, P.
Clifton-Hadley, L.
O'Doherty, M. J.
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Abstract
The UK National Cancer Research Institute initiated a prospective study (UKCRN-ID 1760) to assess the prognostic value of early fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in diffuse large B-cell lymphoma (DLBCL). In total, 189 patients with DLBCL treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) had baseline and post-cycle-2 PET (PET2) within a quality assurance framework. Treatment decisions were based on CT; PET2 was archived for central blinded reporting after treatment completion. The association of PET2 response with end-of-treatment CT, progression-free (PFS) and overall survival (OS) was explored. The end-of-treatment complete response rate on CT was 83·9%, 75·0%, 70·5%, 40·4% and 36·4% for Deauville score (DS) 1 (n = 34), 2 (n = 39), 3 (n = 46), 4 (n = 56) and 5 (n = 14) (P < 0·001); and 64·1% and 50·0% for the maximum standardised uptake value (?SUVmax ) of ?66% (n = 168) and <66% (n = 21), respectively (P = 0·25). After a median 5·4 years of follow-up, the 5-year PFS was 69·4%, 72·8%, 76·7%, 71·2% and 47·6% by DS 1-5 (P = 0·01); and 72·6% and 57·1% by ?SUVmax of ?66% and <66% (P = 0·03), respectively. The association with DS remained in multivariable analyses, and was consistent for OS. Early complete metabolic response (DS 1-3) at interim PET/CT after two cycles of R-CHOP in DLBCL was associated with a higher end-of-treatment complete and overall response rate; however, only DS-5 patients had inferior PFS and OS.
Keywords: R-CHOP chemotherapy; diffuse large B-cell lymphoma (DLBCL); positron emission tomography (PET).
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Date
2020
Publisher
Collections
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Type
Article
Citation
Mikhaeel NG, Cunningham D, Counsell N, McMillan A, Radford JA, Ardeshna KM, et al. FDG-PET/CT after two cycles of R-CHOP in DLBCL predicts complete remission but has limited value in identifying patients with poor outcome - final result of a UK National Cancer Research Institute prospective study. Br J Haematol. 2020.