Prognostic value of PET-CT after first-line therapy in patients with follicular lymphoma: a pooled analysis of central scan review in three multicentre studies

The Lancet Haematology, Volume 1, Issue 1, Pages e17 - e27, October 2014

doi:10.1016/S2352-3026(14)70008-0

This article can be found in the following collections: Oncology (Haematological cancer, Oncology-other)

Published Online: 18 September 2014

Copyright © 2014 Elsevier Ltd All rights reserved.

Dr Judith Trotman FRACP a Corresponding AuthorEmail Address, Stefano Luminari MD b, Sami Boussetta MS c, Annibale Versari MD d, Jehan Dupuis MD e, Christelle Tychyj MD f, Luigi Marcheselli MS b, Alina Berriolo-Riedinger MD g, Antonella Franceschetto MD b, Anne Julian MD h, Fabien Ricard MD i, Luca Guerra MD k, Prof Corinne Haioun MD l, Irene Biasoli MD n, Prof Hervé Tilly MD o, Prof Massimo Federico MD b, Prof Gilles Salles MD j, Prof Michel Meignan MD m

Summary

Background

The value of 18F-fluorodeoxyglucose (FDG) PET-CT (PET) imaging in response assessment after first-line rituximab chemotherapy for follicular lymphoma has been documented. We analysed the application of the five-point Deauville scale (5PS; used to score FDG uptake on PET images) in a large cohort derived from three studies, to assess the correlation between post-induction PET status and survival in patients with follicular lymphoma.

Methods

In this pooled analysis, we used data from three multicentre prospective studies of first-line rituximab chemotherapy for patients with high-tumour-burden follicular lymphoma (the PRIMA study, the PET-Folliculaire study, and the Fondazione Italiana Linfomi FOLL05 study). Patients included in this analysis received at least six cycles of rituximab and chemotherapy before response assessment with conventional contrast-enhanced CT and PET low-dose CT (PET). We included only patients who had a PET scan within 3 months of the last dose of induction rituximab. Patient data, including conventional CT-based response assessment, were recorded for all patients undergoing PET review. Scans undergoing central PET review were scored independently by three reviewers according to the 5PS. The primary endpoints were progression-free survival and overall survival according to the 5PS score of post-induction PET scan (ie, positive [≥4 points] or negative [<4 analysed="" central="" in="" p="" points="" population.="" review="" the="">

Findings

Between Dec 24, 2004, and Sept 22, 2010, 439 of the patients enrolled in the three studies underwent local PET assessment, 246 of whom had centrally reviewed post-induction scans. 41 (17%) of 246 patients had a positive post-induction PET scan according to a cutoff of 4 or higher on the 5PS, with substantial reporter concordance. With a median follow-up of 54·8 months (IQR 39·7—68·5; range 7·7—90·1), the hazard ratio (HR) for progression-free survival for patients with a positive PET scan versus those with a negative PET scan was 3·9 (95% CI 2·5—5·9; p<0 11="" 1="" 23="" 4-year="" 4="" 63="" 6="" 71="" 87="" 97="" a="" and="" at="" ci="" compared="" complete="" conventional="" ct-based="" for="" free="" had="" ie="" negative="" of="" or="" overall="" p="0·017).</p" partial="" patients="" pet="" positive="" predictive="" progression-free="" progression="" respectively="" response="" scan="" survival="" those="" unconfirmed="" versus="" vs="" was="" weakly="" were="" who="" with="" years="">

Interpretation

PET-CT rather than contrast-enhanced CT scanning should be considered as a new standard for response assessment of follicular lymphoma in clinical practice, and could help guide response-adapted therapy.

Funding

Groupe d'Etude des Lymphomes de l'Adulte (Paris, France), now LYSA (Lymphoma Study Association), Direction de la Recherche Clinique de l'Assistance Publique—Hôpitaux de Paris, Fondazione Italiana Linfomi, and the Italian Ministry of Health.

Link original: http://www.thelancet.com/journals/lanhae/article/PIIS2352-3026%2814%2970008-0/fulltext