Department of Hematology, Amsterdam UMC, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
J Nucl Med. 2022 Jul;63(7):1001-1007. doi: 10.2967/jnumed.121.262205. Epub 2021 Oct 21.
We aimed to determine the added value of baseline metabolic tumor volume (MTV) and interim PET (I-PET) to the age-adjusted international prognostic index (aaIPI) to predict 2-y progression-free survival (PFS) in diffuse large B-cell lymphoma. Secondary objectives were to investigate optimal I-PET response criteria (using Deauville score [DS] or quantitative change in SUV [ΔSUV] between baseline and I-PET4 [observational I-PET scans after 4 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone administered in 2-wk intervals with intensified rituximab in the first 4 cycles [R(R)-CHOP14]). I-PET4 scans in the HOVON-84 (Hemato-Oncologie voor Volwassenen Nederland [Haemato Oncology Foundation for Adults in the Netherlands]) randomized clinical trial (EudraCT 2006-005174-42) were centrally reviewed using DS (cutoff, 4-5). Additionally, ΔSUV (prespecified cutoff, 70%) and baseline MTV were measured. Multivariable hazard ratio (HR), positive predictive value (PPV), and negative predictive value (NPV) were obtained for 2-y PFS. In total, 513 I-PET4 scans were reviewed according to DS, and ΔSUV and baseline MTV were available for 367 and 296 patients. The NPV of I-PET ranged between 82% and 86% for all PET response criteria. Univariate HR and PPV were better for ΔSUV (4.8% and 53%, respectively) than for DS (3.1% and 38%, respectively). aaIPI and ΔSUV independently predicted 2-y PFS (HR, 3.2 and 5.0, respectively); adding MTV brought about a slight improvement. Low or low-intermediate aaIPI combined with a ΔSUV of more than 70% (37% of patients) yielded an NPV of 93%, and the combination of high-intermediate or high aaIPI and a ΔSUV of 70% or less yielded a PPV of 65%. In this study on diffuse large B-cell lymphoma, I-PET after 4 cycles of R(R)-CHOP14 added predictive value to aaIPI for 2-y PFS, and both were independent response biomarkers in a multivariable Cox model. We externally validated that ΔSUV outperformed DS in 2-y PFS prediction.
我们旨在确定基线代谢肿瘤体积（MTV）和中期 PET（I-PET）相对于年龄调整的国际预后指数（aaIPI）在弥漫性大 B 细胞淋巴瘤中预测 2 年无进展生存（PFS）的附加价值。次要目标是研究最佳的 I-PET 反应标准（使用 Deauville 评分[DS]或 SUV 的基线与 I-PET4 之间的定量变化[SUV]），其中 I-PET4 是在 rituximab、环磷酰胺、阿霉素、长春新碱和泼尼松的 4 个周期后进行的观测性 I-PET 扫描[每 2 周进行一次，在第 4 个周期中加强 rituximab 的使用[R（R）-CHOP14]）。HOVON-84（荷兰成人血液肿瘤学[荷兰成人血液肿瘤学基金会]）随机临床试验中的 I-PET4 扫描（EudraCT 2006-005174-42）使用 DS（临界值，4-5）进行了中心审查。此外，还测量了 SUV 的基线 MTV。对于 2 年 PFS，获得了多变量风险比（HR）、阳性预测值（PPV）和阴性预测值（NPV）。共有 513 次 I-PET4 扫描根据 DS 进行了审查，367 例和 296 例患者可获得 SUV 的基线 MTV。所有 PET 反应标准的 I-PET 的 NPV 范围在 82%至 86%之间。对于 SUV 的 SUV 具有更好的单变量 HR 和 PPV（分别为 4.8%和 53%），而对于 DS（分别为 3.1%和 38%）。aaIPI 和 SUV 独立预测了 2 年 PFS（HR，分别为 3.2 和 5.0）；添加 MTV 带来了微小的改善。低或低中级 aaIPI 与 SUV 大于 70%（37%的患者）相结合，NPV 为 93%，而高中级或高 aaIPI 与 SUV 小于或等于 70%的组合的 PPV 为 65%。在这项弥漫性大 B 细胞淋巴瘤研究中，R（R）-CHOP14 后的 I-PET4 为 2 年 PFS 添加了 aaIPI 的预测价值，并且在多变量 Cox 模型中都是独立的反应生物标志物。我们在外部验证了 SUV 优于 DS 在 2 年 PFS 预测中的作用。
