Maurizio Martelli and Erica Finolezzi, Sapienza University, Rome; Pier Luigi Zinzani and Stefano A. Pileri, Policlinico S. Orsola-Malpighi, Bologna; Andrés J.M. Ferreri, San Raffaele Scientific Institute, Milan; Umberto Vitolo, Azienda Ospedaliera S. Giovanni Battista, Torino; Caterina Stelitano, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Ercole Brusamolino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Maria Giuseppina Cabras, Ospedale Businco, Cagliari; Luigi Rigacci, Policlinico Careggi, Florence; Monica Balzarotti, IRCCS Humanitas, Rozzano; Flavia Salvi, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Luca Ceriani, Emanuele Zucca, Franco Cavalli, and Luca Giovanella, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Silvia Montoto, Barts Cancer Institute, London; Andrew Davies and Peter W.M. Johnson, University of Southampton, Southampton, United Kingdom; and Armando Lopez-Guillermo, Hospital Clinic, Barcelona, Spain.
J Clin Oncol. 2014 Jun 10;32(17):1769-75. doi: 10.1200/JCO.2013.51.7524. Epub 2014 May 5.
To assess the role of [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) after rituximab and anthracycline-containing chemoimmunotherapy in patients with primary mediastinal large B-cell lymphoma (PMLBCL).
Among 125 patients prospectively enrolled, 115 were eligible for central review of PET/CT scans at the completion of standard chemoimmunotherapy, by using a five-point scale. Consolidation radiotherapy (RT) was permitted and given to 102 patients.
Fifty-four patients (47%) achieved a complete metabolic response (CMR), defined as a completely negative scan or with residual [18F]FDG activity below the mediastinal blood pool (MBP) uptake. In the remaining 61 patients (53%), the residual uptake was higher than MBP uptake but below the liver uptake in 27 (23%), slightly higher than the liver uptake in 24 (21%), and markedly higher in 10 (9%). CMR after chemoimmunotherapy predicted higher 5-year progression-free survival (PFS; 98% v 82%; P=.0044) and overall survival (OS; 100% v 91%; P=.0298). Patients with residual uptake higher than MBP uptake but below liver uptake had equally good outcomes without any recurrence. Using the liver uptake as cutoff for PET positivity (boundary of score, 3 to 4) discriminated most effectively between high or low risk of failure, with 5-year PFS of 99% versus 68% (P<.001) and 5-year OS of 100% versus 83% (P<.001).
More than 90% of patients are projected to be alive and progression-free at 5 years, despite a low CMR rate (47%) after chemoimmunotherapy. This study provides a basis for using PET/CT to define the role of RT in PMLBCL.
评估利妥昔单抗和含蒽环类药物化疗免疫治疗后[18F]氟脱氧葡萄糖([18F]FDG)正电子发射断层扫描/计算机断层扫描(PET/CT)在原发性纵隔大 B 细胞淋巴瘤(PMLBCL)患者中的作用。
在 125 例前瞻性入组患者中，115 例患者在标准化疗免疫治疗结束时进行了中央 PET/CT 扫描评估，采用五分制。允许并对 102 例患者进行巩固放疗(RT)。
54 例患者(47%)达到完全代谢缓解(CMR)，定义为完全阴性扫描或残留[18F]FDG 活性低于纵隔血池(MBP)摄取。在其余 61 例患者(53%)中，残留摄取高于 MBP 摄取，但低于肝脏摄取 27 例(23%)，稍高于肝脏摄取 24 例(21%)，明显高于肝脏摄取 10 例(9%)。化疗免疫治疗后的 CMR 预测更高的 5 年无进展生存率(PFS；98%比 82%；P=.0044)和总生存率(OS；100%比 91%；P=.0298)。残留摄取高于 MBP 摄取但低于肝脏摄取的患者没有任何复发，结果同样良好。使用肝脏摄取作为 PET 阳性的截止值(评分边界，3 至 4)最有效地区分了失败风险的高低，5 年 PFS 为 99%比 68%(P<.001)，5 年 OS 为 100%比 83%(P<.001)。
尽管化疗免疫治疗后的 CMR 率(47%)较低，但超过 90%的患者预计在 5 年内仍能存活且无进展。这项研究为使用 PET/CT 来确定 RT 在 PMLBCL 中的作用提供了依据。
