From the Departments of Nuclear Medicine and Molecular Imaging.
Pediatric Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
Clin Nucl Med. 2020 Mar;45(3):182-186. doi: 10.1097/RLU.0000000000002927.
The event-free survival in pediatric anaplastic large cell lymphoma (ALCL) remains at 70% irrespective of the diverse chemotherapy regimens used. There is lack of valid prognostic factors identifying high-risk patients. We investigated the prognostic value of baseline metabolic parameters and interim response on F-FDG PET/CT in pediatric ALCL patients.
We retrospectively reviewed 40 pediatric ALCL patients with paired F-FDG PET/CT and treated uniformly on vinblastine-based institution protocol. The SUVmax, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis of the lymphomatous lesion were measured. Continuous PET parameters were stratified by their median values. Deauville scoring system was used to assess response to chemotherapy in the interim scan. Prognostic factors for overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method, log-rank test, and Cox proportional hazards model.
At median follow-up of 52 months, 13 patients died and 13 had recurrence. On univariate analysis, higher whole-body MTV (WBMTV) and partial response on interim scan were statistically associated with OS. High-risk features, WBMTV, and partial response were statistically associated with DFS. On multivariate analysis combining baseline characteristics and interim response, interim response (hazard ratio, 3.56; P = 0.034) was statistically significant for OS. Multivariate analysis for DFS using only baseline characteristics revealed WBMTV as statistically significant (hazard ratio, 4.08; P = 0.035), but none of the parameters was statistically significant when baseline characteristics and interim response were evaluated together.
Whole-body tumor burden assessment with MTV and interim response may help to identify high-risk patients who might get benefitted from intensive therapy.
儿科间变性大细胞淋巴瘤（ALCL）的无事件生存（EFS）率仍保持在 70%，无论使用何种化疗方案。目前缺乏有效的预后因素来识别高危患者。我们研究了基线代谢参数和 F-FDG PET/CT 中期反应在儿科 ALCL 患者中的预后价值。
我们回顾性分析了 40 例接受基于长春碱的机构方案治疗的配对 F-FDG PET/CT 的儿科 ALCL 患者。测量了淋巴瘤病变的 SUVmax、SUVmean、代谢肿瘤体积（MTV）和总病变糖酵解。连续 PET 参数按中位数分层。使用 Deauville 评分系统评估中期扫描的化疗反应。使用 Kaplan-Meier 方法、对数秩检验和 Cox 比例风险模型估计总生存（OS）和无病生存（DFS）的预后因素。
中位随访 52 个月后，13 例患者死亡，13 例患者复发。单因素分析显示，全身 MTV（WBMTV）较高和中期扫描部分缓解与 OS 具有统计学相关性。高危特征、WBMTV 和部分缓解与 DFS 具有统计学相关性。在结合基线特征和中期反应的多变量分析中，中期反应（危险比，3.56；P = 0.034）与 OS 具有统计学意义。仅使用基线特征进行 DFS 的多变量分析显示 WBMTV 具有统计学意义（危险比，4.08；P = 0.035），但当评估基线特征和中期反应时，没有任何参数具有统计学意义。
使用 MTV 和中期反应评估全身肿瘤负荷有助于识别可能受益于强化治疗的高危患者。
