Durmo Rexhep, Chauvie Stephane, Fallanca Federico, Bergesio Fabrizio, Pinto Antonio, Del Giudice Ilaria, Coscia Marta, Corradini Paolo, Angelucci Emanuele, Tosi Patrizia, Freilone Roberto, Ballerini Filippo, Bari Alessia, Pastore Domenico, Zinzani Pier Luigi, Bolis Silvia, Flenghi Leonardo, Liso Arcangelo, Olivieri Jacopo, Marcheselli Luigi, Merli Michele, Versari Annibale, Guerra Luca, Luminari Stefano
Nuclear Medicine Division, Azienda Unità Sanitaria LocaleI Istituto di Ricerca e Cura a Carattere Scientifico of Reggio Emilia, Reggio Emilia, Italy.
Medical Physics Division, Santa Croce e Carle Hospital, Cuneo, Italy.
Blood Adv. 2025 Jun 24;9(12):2927-2934. doi: 10.1182/bloodadvances.2024014790.
We analyzed metabolic response using interim positron emission tomography scan (iPET) in a subset of patients with follicular lymphoma (FL) enrolled in the randomized FOLL12 trial. Patients with grade 1-3a FL with an iPET performed between cycles 4 and 5 of first-line immunochemotherapy (ICT) were included; PET scan had to be centrally reviewed for the definition of Deauville score (DS) and were considered positive for DS 4-5. Overall 123 patients out of 211 with iPET were available for central review. Of these, 43% were older than 60, 33% had high-risk FLIPI2, and 47% received rituximab-bendamustine as the induction regimen. iPET showed a complete metabolic response (CMR) in 83% of cases. CMR at the end-of-induction therapy PET scan (eoiPET) was confirmed in 91% of iPET-negative patients. The 5-year progression-free survival (PFS) was 70% for iPET-negative and 34% for iPET-positive cases. In multivariate analysis, positive iPET was an independent prognostic factor for PFS. Combining iPET and eoiPET, the 3-year PFS was 78% for both negative iPET and eoiPET, with a reduced risk of progression compared to double-positive iPET/eoiPET cases. The 5-year overall survival rate was 96% for iPET-negative and 85% for DS 4-5. Our results confirm that iPET in patients with FL treated with standard ICT is a strong prognostic factor. Assessment of early metabolic response in FL may be considered for defining a novel generation of early response-adapted trials in FL. This trial was registered at www.ClinicalTrials.gov as #NCT02063685.
我们在纳入随机FOLL12试验的一部分滤泡性淋巴瘤（FL）患者中，使用中期正电子发射断层扫描（iPET）分析了代谢反应。纳入标准为1-3a级FL患者，且在一线免疫化疗（ICT）的第4和第5周期之间进行了iPET检查；PET扫描必须进行中心阅片以确定Deauville评分（DS），DS 4-5被视为阳性。211例接受iPET检查的患者中，共有123例可供中心阅片。其中，43%的患者年龄超过60岁，33%的患者具有高危FLIPI2，47%的患者接受利妥昔单抗-苯达莫司汀作为诱导方案。iPET显示83%的病例有完全代谢缓解（CMR）。诱导治疗结束时PET扫描（eoiPET）的CMR在91%的iPET阴性患者中得到证实。iPET阴性患者的5年无进展生存期（PFS）为70%，iPET阳性患者为34%。多因素分析显示，iPET阳性是PFS的独立预后因素。结合iPET和eoiPET，iPET和eoiPET均为阴性的患者3年PFS为78%，与iPET/eoiPET均为阳性的病例相比，进展风险降低。iPET阴性患者的5年总生存率为96%，DS 4-5患者为85%。我们的结果证实，接受标准ICT治疗的FL患者的iPET是一个强有力的预后因素。评估FL的早期代谢反应可考虑用于定义新一代FL早期反应适应性试验。该试验已在www.ClinicalTrials.gov上注册，注册号为#NCT02063685。
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