Ying Zhitao, Mi Lan, Zhou Nina, Wang Xuejuan, Yang Zhi, Song Yuqin, Wang Xiaopei, Zheng Wen, Lin Ningjing, Tu Meifeng, Xie Yan, Ping Lingyan, Zhang Chen, Liu Weiping, Deng Lijuan, Zhu Jun
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing 100142, China.
Chin J Cancer Res. 2019 Feb;31(1):162-170. doi: 10.21147/j.issn.1000-9604.2019.01.11.
High-dose chemotherapy (HDC) followed by autologous hematopoietic stem cell transplantation (auto-HSCT) plays an important role in improving outcomes of diffuse large B cell lymphoma (DLBCL) patients. F-fluorodeoxyglucose (F-FDG) positron emission tomography (PET)/computed tomography (CT) has been widely accepted in response assessment and prediction of prognosis in DLBCL. Here, we report the value of F-FDG PET/CT pre- and post-HSCT in predicting outcomes of patients with DLBCL.
DLBCL patients who had PET/CT scan before and after HSCT were included. PET results were interpreted based upon Deauville criteria. The prognostic value of F-FDG PET/CT in auto-HSCT was evaluated.
Eighty-four patients were enrolled. In univariate analysis, pre- and post-HSCT PET findings were correlated with 3-year progression-free survival (PFS) [hazard ratio (HR)=4.391, P=0.001; HR=7.607, P<0.001] and overall survival (OS) (HR=4.792, P=0.008; HR=26.138, P<0.001). Patients receiving upfront auto-HSCT after first-line treatment had better outcomes than relapsed/refractory DLBCL patients (3-year PFS, P<0.001; 3-year OS, P<0.001). In the relapsed/refractory patients, pre- and post-HSCT PET findings were also associated with 3-year PFS (P=0.003. P<0.001) and OS (P=0.027. P<0.001). A significant correlation was observed between clinical response to chemotherapy before auto-HSCT and outcomes of patients in the entire cohort (3-year PFS, P<0.001; 3-year OS, P<0.001) and in the subgroup of 21 patients with positive pre-HSCT PET (3-year PFS, P=0.084; 3-year OS, P=0.240). A significant association between survival and post-HSCT PET findings was observed in multivariate analysis (HR=5.168, P<0.001).
PET results before and after HSCT are useful prognostic factors for DLBCL patients receiving HSCT. Patients who responded to chemotherapy, even those with positive pre-HSCT PET, are appropriate candidates for auto-HSCT.
大剂量化疗（HDC）后行自体造血干细胞移植（auto-HSCT）在改善弥漫性大B细胞淋巴瘤（DLBCL）患者的预后方面发挥着重要作用。F-氟脱氧葡萄糖（F-FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）已在DLBCL的疗效评估和预后预测中得到广泛认可。在此，我们报告HSCT前后F-FDG PET/CT在预测DLBCL患者预后方面的价值。
纳入在HSCT前后进行PET/CT扫描的DLBCL患者。PET结果根据多维尔标准进行解读。评估F-FDG PET/CT在auto-HSCT中的预后价值。
共纳入84例患者。单因素分析显示，HSCT前后的PET结果与3年无进展生存期（PFS）相关[风险比（HR）=4.391，P=0.001；HR=7.607，P<0.001]和总生存期（OS）（HR=4.792，P=0.008；HR=26.138，P<0.001）。一线治疗后接受 upfront auto-HSCT的患者比复发/难治性DLBCL患者预后更好（3年PFS，P<0.001；3年OS, P<0.001）。在复发/难治性患者中，HSCT前后的PET结果也与3年PFS（P=0.003，P<0.001）和OS（P=0.027，P<0.001）相关。auto-HSCT前化疗的临床反应与整个队列患者的预后（3年PFS，P<0.001；3年OS，P<0.001）以及21例HSCT前PET阳性患者亚组的预后（3年PFS，P=0.084；3年OS，P=0.240）之间存在显著相关性。多因素分析显示生存与HSCT后PET结果之间存在显著关联（HR=5.168，P<0.001）。
HSCT前后的PET结果是接受HSCT的DLBCL患者有用的预后因素。对化疗有反应的患者，即使是HSCT前PET阳性的患者，也是auto-HSCT的合适候选者。
