Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic.
Department of Radiology, University of Minnesota, Minneapolis, Minnesota.
Biol Blood Marrow Transplant. 2018 Jan;24(1):64-70. doi: 10.1016/j.bbmt.2017.09.006. Epub 2017 Sep 20.
Autologous hematopoietic cell transplantation (AHCT) is curative for 60% of patients with relapsed or refractory Hodgkin lymphoma (R/R HL). A more precise assessment of the depth of remission before AHCT may help to identify patients likely to benefit from AHCT. We aimed to determine whether positron emission tomography (PET)-based quantitative parameters of total metabolic tumor volume (TMTV), total lesion glycolysis (TLG), and maximal standardized uptake volume (SUV) measured before AHCT predict progression-free survival (PFS) after transplant. Pretransplant PET/computed tomography images of 96 consecutive patients with R/R HL were analyzed. Median TMTV, TLG, and SUV were 7.97 cm (range, 1.3 to 102.1), 23.7 (range, 4.0 to 813.1), and 5.23 (range, 2.7 to 23.2). Two-year PFS in patients with high TMTV (TMTVhigh; more than median; n = 17) was only 12% (95% CI, 1% to 38%) compared with 53% (95% CI, 28% to 73%; P = .05) in patients with TMTVlow (lower or equal to median; n = 17) and 63% (95% CI, 50% to 74%) in 61 patients with no metabolically active tumor (TMTV0; P > .01). In concordance, high TLG (>19) and SUV (>4.9) predicted inferior 2-year PFS. In multivariate analysis patients with TMTVhigh had a 3.5-fold higher risk of treatment failure compared with TMTV0/TMTVlow (HR, 3.49; 95% CI, 1.75 to 6.93; P < .01). Deauville (D)-scores of 4 to 5 before AHCT predicted worse PFS compared with D-scores of 1 to 3 (HR, 3.7; 95% CI, 1.92 to 7.28; P < .01). Yet, TMTV and D-scores were disconcordant in 12 subjects; 9 patients in the D4 group with TMTVlow had 2-year PFS of 44% (95% CI, 14% to 72%), which was 2-fold higher than predicted by D4 score. In conclusion, in patients with R/R HL and PET-positive residual disease, TMTVhigh can identify very poor AHCT responders. Patients with TMTVlow, TLG, and SUV before AHCT have similar outcomes to those without metabolically active disease.
自体造血细胞移植 (AHCT) 可治愈 60%的复发或难治性霍奇金淋巴瘤 (R/R HL) 患者。在 AHCT 前更精确地评估缓解深度，可能有助于识别可能从 AHCT 中获益的患者。我们旨在确定 AHCT 前基于正电子发射断层扫描 (PET) 的总代谢肿瘤体积 (TMTV)、总病变糖酵解 (TLG) 和最大标准化摄取值体积 (SUV) 的定量参数是否可以预测移植后的无进展生存期 (PFS)。分析了 96 例 R/R HL 连续患者的移植前 PET/计算机断层扫描图像。中位 TMTV、TLG 和 SUV 分别为 7.97cm(范围 1.3 至 102.1)、23.7(范围 4.0 至 813.1)和 5.23(范围 2.7 至 23.2)。TMTV 高 (TMTVhigh；n=17；大于中位数) 患者的 2 年 PFS 仅为 12%(95%CI，1%至 38%)，而 TMTV 低 (TMTVlow；n=17；低于或等于中位数) 和 61 例无代谢活性肿瘤 (TMTV0；n=61)患者的 2 年 PFS 分别为 53%(95%CI，28%至 73%；P=0.05)和 63%(95%CI，50%至 74%)。同样，高 TLG(>19)和 SUV(>4.9)预测 2 年 PFS 较差。多变量分析显示，与 TMTV0/TMTVlow 相比，TMTVhigh 患者的治疗失败风险高 3.5 倍 (HR，3.49；95%CI，1.75 至 6.93；P<0.01)。AHCT 前 Deauville(D)-评分 4 至 5 预测 PFS 较 D-评分 1 至 3 差 (HR，3.7；95%CI，1.92 至 7.28；P<0.01)。然而，12 名患者的 TMTV 和 D 评分不一致；D4 组的 9 名 TMTV 低患者的 2 年 PFS 为 44%(95%CI，14%至 72%)，比 D4 评分预测的高 2 倍。总之，在 R/R HL 患者中，PET 阳性残留疾病中，TMTVhigh 可识别出 AHCT 反应极差的患者。TMTVlow、TLG 和 SUV 低的患者与无代谢活性疾病患者的结局相似。
