弥漫性大 B 细胞淋巴瘤中 PET 中期评估的最佳时机和标准:一项 1692 例患者的对比研究。
Optimal timing and criteria of interim PET in DLBCL: a comparative study of 1692 patients.
机构信息
Department of Hematology, Cancer Center Amsterdam, and.
Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universeit Amsterdam, Amsterdam, The Netherlands.
出版信息
Blood Adv. 2021 May 11;5(9):2375-2384. doi: 10.1182/bloodadvances.2021004467.
Interim 18F-fluorodeoxyglucose positron emission tomography (Interim-18F-FDG-PET, hereafter I-PET) has the potential to guide treatment of patients with diffuse large B-cell lymphoma (DLBCL) if the prognostic value is known. The aim of this study was to determine the optimal timing and response criteria for evaluating prognosis with I-PET in DLBCL. Individual patient data from 1692 patients with de novo DLBCL were combined and scans were harmonized. I-PET was performed at various time points during treatment with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. Scans were interpreted using the Deauville score (DS) and change in maximum standardized uptake value (ΔSUVmax). Multilevel Cox proportional hazards models corrected for International Prognostic Index (IPI) score were used to study the effects of timing and response criteria on 2-year progression-free survival (PFS). I-PET after 2 cycles (I-PET2) and I-PET4 significantly discriminated good responders from poor responders, with the highest hazard ratios (HRs) for I-PET4. Multivariable HRs for a PET-positive result at I-PET2 and I-PET4 were 1.71 and 2.95 using DS4-5, 4.91 and 6.20 using DS5, and 2.93 and 4.65 using ΔSUVmax, respectively. ΔSUVmax identified a larger proportion of poor responders than DS5 did. For all criteria, the negative predictive value was >80%, and positive predictive values ranged from 30% to 70% at I-PET2 and I-PET4. Unlike I-PET1, I-PET3 discriminated good responders from poor responders using DS4-5 and DS5 thresholds (HRs, 2.94 and 4.67, respectively). I-PET2 and I-PET4 predict good response equally during R-CHOP therapy in DLBCL. Optimal timing and response criteria depend on the clinical context. Good response at I-PET2 is suggested for de-escalation trials, and poor response using ΔSUVmax at I-PET4 is suggested for randomized trials that are evaluating new therapies.
中期 18F-氟代脱氧葡萄糖正电子发射断层扫描(中期 18F-FDG-PET,以下简称 I-PET)如果具有预后价值,则有可能指导弥漫性大 B 细胞淋巴瘤(DLBCL)患者的治疗。本研究的目的是确定在 DLBCL 中使用 I-PET 评估预后的最佳时间点和反应标准。对 1692 例初治 DLBCL 患者的个体患者数据进行了合并,并对扫描进行了协调。I-PET 在利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松(R-CHOP)治疗期间的不同时间点进行。使用 Deauville 评分(DS)和最大标准化摄取值变化(ΔSUVmax)对扫描进行解释。使用校正国际预后指数(IPI)评分的多级 Cox 比例风险模型研究了时间和反应标准对 2 年无进展生存(PFS)的影响。2 周期后 I-PET(I-PET2)和 4 周期后 I-PET(I-PET4)显著区分了良好反应者和不良反应者,I-PET4 的风险比(HR)最高。I-PET2 和 I-PET4 中 DS4-5 和 DS5 的 PET 阳性结果的多变量 HR 分别为 1.71 和 2.95,分别为 4.91 和 6.20,以及 2.93 和 4.65。与 DS5 相比,ΔSUVmax 可识别出更大比例的不良反应者。对于所有标准,阴性预测值均>80%,I-PET2 和 I-PET4 的阳性预测值范围分别为 30%至 70%。与 I-PET1 不同,I-PET2 和 I-PET4 使用 DS4-5 和 DS5 阈值区分了良好反应者和不良反应者(HRs 分别为 2.94 和 4.67)。在 DLBCL 的 R-CHOP 治疗期间,I-PET2 和 I-PET4 同样可预测良好反应。最佳时间点和反应标准取决于临床情况。建议在 I-PET2 时出现良好反应,以进行降级试验,而在 I-PET4 时使用 ΔSUVmax 出现不良反应,以进行评估新疗法的随机试验。