Nuclear Medicine Department, Tenon Hospital AP-HP, University Pierre and Marie Curie, Paris, France
Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.
J Nucl Med. 2018 Apr;59(4):589-595. doi: 10.2967/jnumed.117.193946. Epub 2017 Sep 1.
Peripheral T-cell lymphoma (PTCL) is a heterogeneous group of aggressive non-Hodgkin lymphomas with poor outcomes on current therapy. We investigated whether response assessed with PET/CT combined with baseline total metabolic tumor volume (TMTV) could detect early relapse or refractory disease. From 7 European centers, 140 patients with nodal PTCL who underwent baseline PET/CT were selected. Forty-three had interim PET (iPET) performed after 2 cycles (iPET2), 95 had iPET performed after 3 or 4 cycles (iPET3/4), and 96 had end-of-treatment PET (eotPET). Baseline TMTV was computed with a 41% SUV threshold, and PET response was reported using the Deauville 5-point scale. With a median of 43 mo of follow-up, the 2-y progression-free survival (PFS) and overall survival (OS) were 51% and 67%, respectively. iPET2-positive patients (Deauville score ≥ 4) had a significantly worse outcome than iPET2-negative patients ( < 0.0001, hazard ratio of 6.8 for PFS; < 0.0001, hazard ratio of 6.6 for OS). The value of iPET3/4 was also confirmed for PFS ( < 0.0001) and OS ( < 0.0001). The 2-y PFS and OS for iPET3/4-positive ( = 28) and iPET3/4-negative ( = 67) patients were 16% and 32% versus 75% and 85%, respectively. The eotPET results also reflected patient outcome. A model combining TMTV and iPET3/4 stratified the population into distinct risk groups (TMTV ≤ 230 cm and iPET3/4-negative [2-y PFS/OS, 79%/85%]; TMTV > 230 cm and iPET3/4-negative [59%/84%]; TMTV ≤ 230 cm and iPET3/4-positive [42%/50%]; TMTV > 230 cm and iPET3/4-positive [0%/18%]). iPET response is predictive of outcome and allows early detection of high-risk PTCL patients. Combining iPET with TMTV improves risk stratification in individual patients.
外周 T 细胞淋巴瘤 (PTCL) 是一组异质性侵袭性非霍奇金淋巴瘤，目前的治疗方法预后较差。我们研究了使用 PET/CT 结合基线总代谢肿瘤体积 (TMTV) 评估的反应是否能够早期检测复发或难治性疾病。 从 7 个欧洲中心选择了 140 名接受基线 PET/CT 的结外 PTCL 患者。43 名患者在第 2 周期后进行了中期 PET (iPET2)，95 名患者在第 3 或 4 周期后进行了 iPET3/4，96 名患者在治疗结束时进行了 eotPET。基线 TMTV 使用 41%SUV 阈值计算，PET 反应使用 Deauville 5 分制报告。 在中位随访 43 个月时，2 年无进展生存率 (PFS) 和总生存率 (OS) 分别为 51%和 67%。iPET2 阳性患者 (Deauville 评分≥4) 的预后明显差于 iPET2 阴性患者 ( < 0.0001，PFS 的危险比为 6.8； < 0.0001，OS 的危险比为 6.6)。iPET3/4 对 PFS( < 0.0001) 和 OS( < 0.0001) 也有肯定的价值。iPET3/4 阳性 (=28)和 iPET3/4 阴性 (=67)患者的 2 年 PFS 和 OS 分别为 16%和 32%和 75%和 85%。eotPET 结果也反映了患者的预后。一个结合 TMTV 和 iPET3/4 的模型将人群分为不同的风险组 (TMTV ≤ 230 cm 和 iPET3/4 阴性 [2 年 PFS/OS，79%/85%]；TMTV > 230 cm 和 iPET3/4 阴性 [59%/84%]；TMTV ≤ 230 cm 和 iPET3/4 阳性 [42%/50%]；TMTV > 230 cm 和 iPET3/4 阳性 [0%/18%])。 iPET 反应是预后的预测指标，可早期发现高危 PTCL 患者。将 iPET 与 TMTV 结合可提高个体患者的风险分层。
