Schot Bart W, Pruim Jan, van Imhoff Gustaaf W, Sluiter Wim J, Vaalburg Willem, Vellenga Edo
Department of Hematology, University Medical Center Groningen, The Netherlands.
Haematologica. 2006 Apr;91(4):490-5. Epub 2006 Mar 1.
18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) appears to be an excellent tool for evaluating early response to chemotherapy in lymphoma patients. As only chemosensitive patients with relapsed lymphoma may benefit from ablative therapy and autologous stem cell transplantation (ASCT), PET may be used to select patients for ASCT. A prospective study was performed to investigate the optimal time point of pre-transplantation PET, using different PET-parameters.
Three serial whole-body attenuation-corrected FDG-PET scans were performed in 39 consecutive patients with relapsed lymphoma (28 with aggressive non-Hodgkin's lymphoma and 11 with Hodgkin's disease) eligible for second-line chemotherapy followed by ASCT: PET1 before treatment, PET2 after two cycles of induction chemotherapy and PET3 after a third cycle of chemotherapy just before ASCT in cases with an abnormal PET2. Visual analysis and standardized uptake value (SUV) parameters were obtained for each scan. The follow-up lasted a minimum of 6 months after ASCT.
PET2 normalized in 43% (17/39) of the patients, and PET3 normalized in 27% (6/22). Persistent abnormal FDG-uptake was observed in 41% of the patients: 15% showed partial remission and 26% stable or even progressive abnormalities. With a median follow-up of 22 months (range 6-55) 54% of all patients relapsed after ASCT. The results demonstrated that those patients who showed a complete response after the second and third cycles of chemotherapy had a 2-year progression-free survival of 71% and 58%, respectively, while those who showed no response, all relapsed shortly after ASCT. Analysis of the SUV parameters did not reveal additional information compared to that yielded by the visual assessment.
Two serial PET scans predict outcome after ASCT more precisely than one interim PET in patients with relapsed lymphoma.
18F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）似乎是评估淋巴瘤患者化疗早期反应的极佳工具。由于只有复发淋巴瘤的化疗敏感患者可能从消融治疗和自体干细胞移植（ASCT）中获益，PET可用于选择适合ASCT的患者。进行了一项前瞻性研究，使用不同的PET参数来研究移植前PET的最佳时间点。
对39例符合二线化疗后行ASCT的复发淋巴瘤患者（28例侵袭性非霍奇金淋巴瘤和11例霍奇金病）进行了三次连续的全身衰减校正FDG-PET扫描：治疗前的PET1、诱导化疗两个周期后的PET2以及PET2异常时在ASCT前第三个化疗周期后的PET3。对每次扫描获取视觉分析和标准化摄取值（SUV）参数。ASCT后随访至少6个月。
43%（17/39）的患者PET2恢复正常，27%（6/22）的患者PET3恢复正常。41%的患者观察到持续的异常FDG摄取：15%显示部分缓解，26%显示稳定甚至进展性异常。中位随访22个月（范围6 - 55个月），所有患者中有54%在ASCT后复发。结果表明，在化疗第二和第三个周期后显示完全缓解的患者，其2年无进展生存率分别为71%和58%，而那些无反应的患者，在ASCT后不久均复发。与视觉评估相比，SUV参数分析未揭示更多信息。
对于复发淋巴瘤患者，两次连续的PET扫描比一次中期PET更能准确预测ASCT后的结果。
