Department of Nuclear Medicine, Technische Universitaet Muenchen, Munich, Germany.
J Nucl Med. 2011 May;52(5):690-6. doi: 10.2967/jnumed.110.084566. Epub 2011 Apr 15.
R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone)-like chemotherapy is the standard therapy in aggressive B-cell lymphoma. (18)F-FDG PET has high prognostic implications at treatment completion but is limited as an early predictor. Here, we present the results of a prospective study correlating the initial uptake of the in vivo proliferation marker 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) with the clinical outcome of patients with aggressive non-Hodgkin lymphoma treated with R-CHOP.
Sixty-six eligible patients were evaluated prospectively with (18)F-FLT PET before R-CHOP. PET was performed 45 min after injection of 300-370 MBq of (18)F-FLT. Mean and maximum standardized uptake values (SUVs) were calculated on a lesion-by-lesion basis. Response was assessed at the end of therapy. International Prognostic Index (IPI) scores and clinical parameters (Ann Arbor stage, lactate dehydrogenase, performance status, extranodal disease) were determined in all patients. Response was assessed according to revised response criteria after the end of therapy. After treatment, patients were followed in intervals from 4 wk to 6 mo (mean follow-up, 23.1 mo [range, 1-63 mo]), and progression-free and overall survival were determined.
All lymphoma lesions identified by a reference method ((18)F-FDG PET/CT or multislice CT of the trunk) showed increased focal tracer uptake (mean (18)F-FLT SUV, 7.3 ± 2.5). Response assessment revealed progressive disease in 4, partial response in 3, and complete response (CR) in the remaining 55 patients. The IPI score was predictive for achieving CR (P = 0.034). Importantly, initial mean SUV was also significantly higher in patients who showed progressive disease and partial response than in patients who achieved CR (P = 0.049). In addition, we found a significant correlation between IPI score and initial (18)F-FLT uptake.
Taken together, high (18)F-FLT uptake is a negative predictor of response to R-CHOP treatment in aggressive B-cell non-Hodgkin lymphoma and correlates with the IPI score. Thus, (18)F-FLT PET may represent a useful tool for implementing risk-adapted treatment in these patients.
在接受 R-CHOP 治疗的侵袭性非霍奇金淋巴瘤患者中，我们通过前瞻性研究，将体内增殖标志物 3'-脱氧-3'-(18)F-氟代胸苷（(18)F-FLT）的初始摄取与患者的临床转归相关联。
66 例符合条件的患者前瞻性接受 R-CHOP 治疗前的 (18)F-FLT PET 检查。在注射 300-370MBq (18)F-FLT 后 45 分钟进行 PET。对每个病灶进行病变层面的平均和最大标准化摄取值（SUV）的计算。在治疗结束时评估反应。所有患者均确定国际预后指数（IPI）评分和临床参数（Ann Arbor 分期、乳酸脱氢酶、表现状态、结外疾病）。根据治疗结束后的修订反应标准评估反应。治疗后，患者以 4 周至 6 个月的间隔进行随访（平均随访时间为 23.1 个月[范围，1-63 个月]），并确定无进展生存期和总生存期。
所有经参考方法（(18)F-FDG PET/CT 或躯干多层 CT）识别的淋巴瘤病灶均显示出病灶摄取增加（平均（18)F-FLT SUV，7.3±2.5）。反应评估显示，4 例为进行性疾病，3 例为部分缓解，其余 55 例为完全缓解（CR）。IPI 评分可预测 CR 的发生（P=0.034）。重要的是，在显示进行性疾病和部分缓解的患者中，初始平均 SUV 也明显高于达到 CR 的患者（P=0.049）。此外，我们还发现 IPI 评分与初始 (18)F-FLT 摄取之间存在显著相关性。
综上所述，高 (18)F-FLT 摄取是非霍奇金淋巴瘤侵袭性 B 细胞患者对 R-CHOP 治疗反应的负预测因子，与 IPI 评分相关。因此，(18)F-FLT PET 可能成为这些患者实施风险适应治疗的有用工具。
