Service d'Hématologie, Centre Henri Becquerel, Université de Rouen, rue d'Amiens, Rouen, Cedex 760381, France.
Eur J Nucl Med Mol Imaging. 2015 Feb;42(2):215-21. doi: 10.1007/s00259-014-2896-2. Epub 2014 Sep 20.
Salvage of young patients with follicular lymphoma (FL) after R-CHOP includes salvage immunochemotherapy followed by autologous stem cell transplantation (ASCT). Previous studies dealing with relapsed Hodgkin lymphoma have shown the prognostic value of PET/CT prior to ASCT.
We retrospectively analysed 59 patients with refractory/relapsed FL after first-line R-CHOP who were chemosensitive (as evaluated by CT) to the salvage treatment and who proceeded to ASCT. The role of PET/CT in this setting to define chemosensitivity is not definitely established. So we focused on the prognostic value of PET/CT performed after salvage treatment, before ASCT.
The estimated 3-year progression-free survival (PFS) and overall survival were 63.1% (50.9-78.3%) and 90.5% (82.8 - 98.8%), respectively, and did not differ significantly according to their Follicular Lymphoma International Prognostic Index at relapse, conditioning regimen, or type of salvage. PFS was significantly lower in PET/CT-positive patients, according to the International Harmonization Project revised response criteria, with a 3-year PFS of 45.5% (26.6 - 77.8%) versus 72.6% (58.5 - 90.0%; p = 0.039). To better refine prognosis, we applied two types of throsholds: a Deauville five-point scale positive threshold of ≥3 (3-year PFS of 74.9%, range 61.0 - 92.1% %, versus 42.8%, range 24.7 - 74.4%; p = 0.02), and a ≥70% ∆SUVmax threshold between presalvage and pre-ASCT PET/CT (3-year PFS of 72.4%, range 57.5 - 91.3% versus 13.3%, 2.2 - 81.7%; p < 10(-3)). The PET/CT findings before ASCT were independently correlated with PFS in our series.
PET/CT negativity before ASCT is a desirable and achievable goal in the management of chemosensitive FL relapsing after first-line R-CHOP.
挽救接受 R-CHOP 一线治疗后滤泡性淋巴瘤（FL）的年轻患者包括挽救性免疫化疗，随后进行自体干细胞移植（ASCT）。以前涉及复发霍奇金淋巴瘤的研究表明，ASCT 前 PET/CT 具有预后价值。
我们回顾性分析了 59 例接受一线 R-CHOP 治疗后复发/难治性 FL 的患者，这些患者对挽救治疗有化疗敏感性（根据 CT 评估），并进行了 ASCT。在这种情况下，PET/CT 确定化疗敏感性的作用尚未明确。因此，我们重点研究了挽救治疗后、ASCT 前进行的 PET/CT 的预后价值。
估计的 3 年无进展生存率（PFS）和总生存率分别为 63.1%（50.9-78.3%）和 90.5%（82.8-98.8%），根据复发时滤泡性淋巴瘤国际预后指数、预处理方案或挽救类型，差异无统计学意义。根据国际协调项目修订的反应标准，PET/CT 阳性患者的 PFS 明显较低，3 年 PFS 为 45.5%（26.6-77.8%）与 72.6%（58.5-90.0%；p=0.039）。为了更好地细化预后，我们应用了两种类型的阈值：Deauville 五分制阳性阈值≥3（3 年 PFS 为 74.9%，范围 61.0-92.1%，与 42.8%，范围 24.7-74.4%；p=0.02），以及挽救性治疗前后 PET/CT 之间的≥70%∆SUVmax 阈值（3 年 PFS 为 72.4%，范围 57.5-91.3%与 13.3%，2.2-81.7%；p<10(-3)）。在我们的研究中，ASCT 前的 PET/CT 结果与 PFS 独立相关。
ASCT 前的 PET/CT 阴性是一线 R-CHOP 治疗后复发的化疗敏感 FL 患者管理中一个理想且可实现的目标。
