FDG-PET/CT response assessment with qualitative Lugano criteria outperforms change in SUV as a predictive biomarker in frontline treatment of mantle cell lymphoma.

F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is routinely used for initial staging and response assessment for the majority of lymphoma subtypes. Several techniques for FDG-PET/CT response assessment have been studied, with the Lugano criteria utilizing the Deauville five-point scale (5-PS) becoming widely adopted as a favored approach. More recently, novel static and dynamic FDG-PET/CT parameters have been explored, including baseline maximum standardized uptake value (SUV) as well as change in SUV (ΔSUV) at either interim or end-of-treatment (EOT) response assessments, with a focus on diffuse large B cell lymphoma (DLBCL), the most common aggressive lymphoma. We performed a broad assessment of multiple FDG-PET/CT parameters in a diverse cohort of patients with newly diagnosed mantle cell lymphoma (MCL). In contrast to other subtypes of lymphoma, we surprisingly found that higher baseline SUV was not associated with other well-established adverse risk factors in MCL and was not prognostic for patient outcomes. We explored ΔSUV at interim and EOT assessments, observing remarkably weak relationships between these parameters and patient outcomes, which also contrasted with the strong relationships between these parameters and patient outcomes in DLBCL. Instead, standard response assessment via the Lugano criteria utilizing the Deauville 5-PS score had the most robust prognostic value of the FDG-PET/CT parameters assessed in our study. Overall, we provide evidence for applying caution when extrapolating the prognostic value of FDG-PET/CT-based parameters across lymphoma subtypes.