Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Nuclear Medicine, Ultrasound & PET, Sydney Westmead Hospital, Sydney, NSW, Australia.
Eur J Nucl Med Mol Imaging. 2022 Nov;49(13):4661-4676. doi: 10.1007/s00259-022-05918-2. Epub 2022 Aug 6.
Treatment strategies of lymphoid malignancies have been revolutionized by immunotherapy. Because of the inherent property of Hodgkin lymphoma and some subtypes of non-Hodgkin lymphoma as a highly FDG-avid tumor, functional F-FDG PET/CT imaging is already embedded in their routine care. Nevertheless, the question is whether it is still valuable in the context of these tumors being treated with immunotherapy. Herein, we will review the value of F-FDG PET/CT imaging lymphoid tumors treated with immunotherapy regimens.
A comprehensive literature search of the PubMed database was conducted on the value of the F-FDG PET/CT for immunotherapy response monitoring of patients with malignant lymphoma. The articles were considered eligible if they met all of the following inclusion criteria: (a) clinical studies on patients with different types of malignant lymphoma, (b) treatment with anti-CD20 antibodies, immune checkpoint inhibitors or immune cell therapies, (c) and incorporated PET/CT with F-FDG as the PET tracer.
From the initial 1488 papers identified, 91 were ultimately included in our study. In anti-CD20 therapy, the highest pooled hazard ratios (HRs) of baseline, early, and late response monitoring parameters for progression-free survival (PFS) belong to metabolic tumor volume (MTV) (3.19 (95%CI: 2.36-4.30)), maximum standardized uptake value (SUVmax) (3.25 (95%CI: 2.08-5.08)), and Deauville score (DS) (3.73 (95%CI: 2.50-5.56)), respectively. These measurements for overall survival (OS) were MTV (4.39 (95%CI: 2.71-7.08)), DS (3.23 (95%CI: 1.87-5.58)), and DS (3.64 (95%CI: 1.40-9.43)), respectively. Early and late F-FDG PET/CT response assessment in immune checkpoint inhibitors (ICI) and immune cell therapy might be an effective tool for prediction of clinical outcome.
For anti-CD20 therapy of lymphoma, the MTV as a baseline F-FDG PET/CT-derived parameter has the highest HRs for PFS and OS. The DS as visual criteria in early and late response assessment has higher HRs for PFS and OS compared to the international harmonization project (IHP) visual criteria in anti-CD20 therapy. Early changes in F-FDG PET parameters may be predictive of response to ICIs and cell therapy in lymphoma patients.
免疫疗法彻底改变了淋巴恶性肿瘤的治疗策略。由于霍奇金淋巴瘤和某些非霍奇金淋巴瘤亚型作为高度 FDG 摄取肿瘤的固有特性，功能 F-FDG PET/CT 成像已经嵌入到其常规治疗中。然而，问题是在使用免疫疗法治疗这些肿瘤的情况下，它是否仍然有价值。在此，我们将回顾 F-FDG PET/CT 成像在接受免疫治疗方案治疗的淋巴肿瘤中的价值。
对 PubMed 数据库进行了全面的文献检索，以评估 F-FDG PET/CT 在监测恶性淋巴瘤患者免疫治疗反应中的价值。如果符合以下所有纳入标准的文章，则被认为是合格的：（a）不同类型恶性淋巴瘤患者的临床研究，（b）使用抗 CD20 抗体、免疫检查点抑制剂或免疫细胞疗法治疗，（c）并纳入 F-FDG 作为 PET 示踪剂的 PET/CT。
从最初确定的 1488 篇论文中，最终有 91 篇被纳入我们的研究。在抗 CD20 治疗中，无进展生存期（PFS）的基线、早期和晚期反应监测参数的最高合并危险比（HR）属于代谢肿瘤体积（MTV）（3.19（95%CI：2.36-4.30））、最大标准化摄取值（SUVmax）（3.25（95%CI：2.08-5.08））和 Deauville 评分（DS）（3.73（95%CI：2.50-5.56））。这些用于总生存期（OS）的测量值分别为 MTV（4.39（95%CI：2.71-7.08））、DS（3.23（95%CI：1.87-5.58））和 DS（3.64（95%CI：1.40-9.43））。免疫检查点抑制剂（ICI）和免疫细胞治疗的早期和晚期 F-FDG PET/CT 反应评估可能是预测临床结局的有效工具。
对于淋巴瘤的抗 CD20 治疗，基线 F-FDG PET/CT 衍生参数 MTV 对 PFS 和 OS 的 HR 最高。与抗 CD20 治疗中的国际协调项目（IHP）视觉标准相比，早期和晚期反应评估中的 DS 作为视觉标准，对 PFS 和 OS 的 HR 更高。F-FDG PET 参数的早期变化可能预测淋巴瘤患者对 ICI 和细胞治疗的反应。
