Department of Hematology, University Hospital of Brest, Brest, France.
Department of Nuclear Medicine, University Hospital of Brest, Brest, France.
Q J Nucl Med Mol Imaging. 2021 Dec;65(4):402-409. doi: 10.23736/S1824-4785.16.02894-6. Epub 2016 Nov 30.
BACKGROUND: Advanced age is an independent poor prognostic factor of diffuse large B-cell lymphoma (DLBCL). PMitCEBO (mitoxantrone, cyclophosphamide, etoposide, vincristine, bleomycin, and prednisolone) is an alternative to the cyclophosphamide, doxorubicin, vincristine, and prednisolone regimen to decrease side effects in elderly patients. Many studies have shown prognostic value of an interim FDG PET-CT to predict survival. A recent consensus (ICML, Lugano 2013) has suggested using the 5-point scale Deauville criteria instead of those of the International Harmonization Project (IHP) to visually assess the response on interim PET. The objective of this study was to evaluate the prognostic value of an interim FDG PET-CT in patients older than 60 with treated DLBCL and to compare IHP and 5-PS Deauville visual interpretation to predict survival. METHODS: Forty-eight patients (mean age 73.2±5.2 years) treated by R-PMitCEBO for DLBCL undergoing FDG PET-CT before and after 3 cycles of treatment were retrospectively included. Event-free survival and overall survival were determined by Kaplan-Meier method and compared with interim PET-CT results using IHP and 5-PS Deauville criteria. RESULTS: Interim PET results using 5-PS Deauville criteria were significantly correlated with EFS (P<0.0001) and OS (P=0.001) whereas they were moderately correlated with EFS (P=0.046) and not with OS (P=0.106) using IHP criteria. Two-year EFS and OS rates were 86.5% and 89.2%, respectively, for patients in 1-3 score group, and 27.3% and 36.4%, respectively, for patients in ≥4 score group using the Deauville criteria. CONCLUSIONS: Our results confirmed the prognostic value of an interim PET-CT in elderly patients with DLBCL and the better performance of the 5-PS Deauville criteria.
背景：年龄较大是弥漫性大 B 细胞淋巴瘤（DLBCL）的一个独立的预后不良因素。PMitCEBO（米托蒽醌、环磷酰胺、依托泊苷、长春新碱、博来霉素和泼尼松龙）是一种替代环磷酰胺、多柔比星、长春新碱和泼尼松龙方案的选择，可以减少老年患者的副作用。许多研究表明，中期 18F-FDG PET-CT 预测生存的预后价值。最近的一项共识（ICML，卢加诺 2013 年）建议使用 Deauville 五分制标准，而不是国际协调项目（IHP）的标准，来对中期 PET 上的反应进行视觉评估。本研究的目的是评估在接受 R-PMitCEBO 治疗的 60 岁以上的 DLBCL 患者中，中期 18F-FDG PET-CT 的预后价值，并比较 IHP 和 5-PS Deauville 视觉解读来预测生存。
方法：回顾性纳入 48 例接受 R-PMitCEBO 治疗的 DLBCL 患者，这些患者在 3 个周期的治疗前和治疗后均接受了 FDG PET-CT 检查。采用 Kaplan-Meier 法确定无进展生存（EFS）和总生存（OS），并将中期 PET-CT 结果与 IHP 和 5-PS Deauville 标准进行比较。
结果：5-PS Deauville 标准的中期 PET 结果与 EFS（P<0.0001）和 OS（P=0.001）显著相关，而与 IHP 标准的 EFS（P=0.046）中度相关，与 OS 无关（P=0.106）。使用 Deauville 标准，在 1-3 分组的患者中，2 年 EFS 和 OS 率分别为 86.5%和 89.2%，而在≥4 分组的患者中，2 年 EFS 和 OS 率分别为 27.3%和 36.4%。
结论：我们的结果证实了在老年 DLBCL 患者中，中期 PET-CT 具有预后价值，并且 5-PS Deauville 标准的性能更好。
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