Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia.
Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.
Br J Haematol. 2023 May;201(3):502-509. doi: 10.1111/bjh.18644. Epub 2023 Apr 4.
Positron emission tomography (PET) response assessment using the Deauville score has prognostic utility in relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) undergoing autologous stem-cell transplantation (ASCT). Improved predictive methods are required to identify patients with poor outcomes who may be better considered for other salvage options. We investigated the prognostic value of mean tumour volume (MTV) and maximum standardised uptake value (SUVmax) at pre-salvage and pre-ASCT time-points, and the quantitative changes between scans (∆MTV and ∆SUVmax). One hundred and twenty-five patients with R/R DLBCL underwent salvage immunochemotherapy and ASCT: 80 patients had pre-salvage PET and 90 had pre-ASCT PET available. With a median follow-up of 5.6 years, 5-year progression-free survival (PFS) and overall survival (OS) were 52% and 65%, respectively. For patients with PET-positive residual disease after salvage therapy, pre-ASCT MTV was a significant negative prognosticator for PFS (HR 1.19 per 100 ml, p < 0.001) and OS (HR 1.78 per 100 ml, p < 0.001). Similarly, pre-ASCT SUVmax was negatively associated with PFS (HR 1.08, p < 0.001) and OS (HR 1.08, p < 0.001). Notably, pre-salvage MTV and SUVmax and ∆MTV and ∆SUVmax were not associated with PFS or OS. In conclusion, pre-ASCT MTV and SUVmax appear to be of greater predictive value than the degree of response. Potential application may exist for PET-directed management of R/R DLBCL patients.
正电子发射断层扫描（PET）使用 Deauville 评分进行反应评估，在接受自体干细胞移植（ASCT）的复发性/难治性（R/R）弥漫性大 B 细胞淋巴瘤（DLBCL）患者中有预后作用。需要改进预测方法来识别预后不良的患者，这些患者可能更适合考虑其他挽救治疗方案。我们研究了挽救治疗前和 ASCT 前时间点的平均肿瘤体积（MTV）和最大标准化摄取值（SUVmax）以及扫描之间的定量变化（∆MTV 和 ∆SUVmax）的预后价值。125 例 R/R DLBCL 患者接受了挽救性免疫化疗和 ASCT：80 例患者有挽救性 PET 检查，90 例患者有 ASCT 前 PET 检查。中位随访 5.6 年后，5 年无进展生存率（PFS）和总生存率（OS）分别为 52%和 65%。对于挽救治疗后残留疾病 PET 阳性的患者，ASCT 前 MTV 是 PFS（风险比 [HR] 每 100ml 增加 1.19，p<0.001）和 OS（HR 每 100ml 增加 1.78，p<0.001）的显著负预后因素。同样，ASCT 前 SUVmax 与 PFS（HR 1.08，p<0.001）和 OS（HR 1.08，p<0.001）呈负相关。值得注意的是，挽救前 MTV 和 SUVmax 以及 ∆MTV 和 ∆SUVmax 与 PFS 或 OS 无关。总之，ASCT 前 MTV 和 SUVmax 似乎比反应程度具有更大的预测价值。PET 指导的 R/R DLBCL 患者管理可能具有潜在应用。
