原发纵隔大 B 细胞淋巴瘤对利妥昔单抗 CHOP 反应后的正电子发射断层扫描：对结局和放疗策略的影响。
Positron emission tomography after response to rituximab-CHOP in primary mediastinal large B-cell lymphoma: impact on outcomes and radiotherapy strategies.
机构信息
Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 11527, Athens, Greece.
Second Department of Internal Medicine, Propaedeutic, Hematology Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece.
出版信息
Ann Hematol. 2021 Sep;100(9):2279-2292. doi: 10.1007/s00277-021-04421-2. Epub 2021 Feb 1.
End-of-treatment (EoT) PET/CT is used as a guide to omit radiotherapy (RT) patients with primary mediastinal large B-cell lymphoma (PMBCL). We present the mature and extended results of a retrospective study evaluating the prognostic significance of EoT-PET/CT after adequate response to R-CHOP. Among 231 consecutive PMLBCL patients, 182 underwent EoT-PET/CT and were evaluated according to the Deauville 5-point scale (D5PS) criteria. Freedom from progression (FFP) was measured from the time of PET/CT examination. Among 182 patients, 72 (40%) had D5PS score 1 (D5PSS-1), 33 (18%) had 2, 28 (15%) had 3, 29 (16%) had 4, and 20 (11%) had 5. The 5-year FFP was 97, 94, 92, 82, and 44% for D5PSS-1, D5PSS-2, D5PSS-3, D5PSS-4, and D5PSS-5, respectively. Among 105 patients with unequivocally negative PET/CT (D5PSS-1/D5PSS-2), 49 (47%) received RT (median dose 3420 cGy) and 56 (53%) did not with relapses in 0/49 vs. 4/56 patients (2 mediastinum and 2 isolated CNS relapses).The 5-year FFP for those who received RT or not was 100% versus 96%, when isolated CNS relapses were censored (p = 0.159). Among D5PSS-3 patients (27/28 irradiated-median dose 3600 cGy), the 5-year FFP was 92%. The 5-year FFP for D5PSS-4 and D5PSS-5 was 82 and 44%; 44/49 patients received RT (median dose 4000 and 4400 cGy for D5PSS-4 and D5PSS-5). Our study supports the omission of RT in a sizeable fraction of PET/CT-negative patients and definitely discourages salvage chemotherapy and ASCT in patients with PMLBCL who conventionally respond to R-CHOP, solely based on PET/CT positivity in the absence of documented progressive or multifocal disease. The persistence of positive PET/CT with D5PSS < 5 after consolidative RT should not trigger the initiation of further salvage chemotherapy in the absence of conventionally defined PD.
治疗结束（EoT）PET/CT 用于指导原发性纵隔大 B 细胞淋巴瘤（PMBCL）患者省略放疗（RT）。我们报告了一项回顾性研究的成熟和扩展结果，该研究评估了 R-CHOP 充分缓解后 EoT-PET/CT 的预后意义。在 231 例连续的 PMBCL 患者中，182 例行 EoT-PET/CT，并根据 Deauville 5 分标准（D5PS）进行评估。从 PET/CT 检查时开始测量无进展生存期（FFP）。在 182 例患者中，72 例（40%）D5PS 评分为 1（D5PSS-1），33 例（18%）为 2，28 例（15%）为 3，29 例（16%）为 4，20 例（11%）为 5。D5PSS-1、D5PSS-2、D5PSS-3、D5PSS-4 和 D5PSS-5 的 5 年 FFP 分别为 97%、94%、92%、82%和 44%。在 105 例 PET/CT 明确阴性（D5PSS-1/D5PSS-2）的患者中，49 例（47%）接受 RT（中位剂量 3420 cGy），56 例（53%）未接受，0/49 例 vs. 4/56 例（2 例纵隔和 2 例孤立性 CNS 复发）发生复发。当将孤立性 CNS 复发作为截尾事件时，接受或未接受 RT 的患者 5 年 FFP 分别为 100%和 96%（p = 0.159）。D5PSS-3 患者（28 例中有 27 例接受放疗-中位剂量 3600 cGy）的 5 年 FFP 为 92%。D5PSS-4 和 D5PSS-5 的 5 年 FFP 分别为 82%和 44%；49 例患者中 44 例（D5PSS-4 和 D5PSS-5 分别接受中位剂量 4000 和 4400 cGy）接受 RT。我们的研究支持在相当一部分 PET/CT 阴性患者中省略 RT，并且明确反对在常规对 R-CHOP 有反应的 PMBCL 患者中单独基于 PET/CT 阳性而不考虑明确的进行性或多灶性疾病而进行挽救性化疗和 ASCT。在接受巩固性 RT 后，D5PSS < 5 的 PET/CT 仍为阳性时，在没有常规定义的 PD 的情况下，不应引发进一步的挽救性化疗。
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