[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in aggressive lymphoma: an early prognostic tool for predicting patient outcome

• Published in: Blood 2005-08, Vol.106 (4), p.1376-1381
• Main Authors: Haioun, Corinne, Itti, Emmanuel, Rahmouni, Alain, Brice, Pauline, Rain, Jean-Didier, Belhadj, Karim, Gaulard, Philippe, Garderet, Laurent, Lepage, Eric, Reyes, Felix, Meignan, Michel
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anthracyclines - therapeutic use; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Female; Fluorodeoxyglucose F18; Hematologic and hematopoietic diseases; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma - diagnosis; Lymphoma - drug therapy; Lymphoma - mortality; Male; Medical sciences; Middle Aged; Positron-Emission Tomography; Prognosis; Prospective Studies; Remission Induction; Rituximab; Survival Analysis
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2005-01-0272

Assessment of early therapeutic response using metabolic imaging is potentially useful to determine prognosis in aggressive lymphoma. Between January 2000 and January 2004, 90 patients with newly diagnosed aggressive lymphoma (median age 53 years, 94% diffuse large B-cell) were prospectively explored with [18F]fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) prior to induction chemotherapy, after 2 cycles (“early PET”), and after induction completion. Therapeutic response was evaluated using conventional diagnostic methods at 4 cycles. Induction treatment with an anthracycline-containing regimen was administered to all patients, associated with rituximab in 41%. According to the International Prognostic Index (IPI), 37 patients and 53 patients belonged to the lower- and higher-risk groups, respectively. At midinduction, “early PET” was considered negative in 54 patients and positive in 36. After completion of induction, 83% of PET-negative patients achieved complete remission compared with only 58% of PET-positive patients. Outcome differed significantly between PET-negative and PET-positive groups; the 2-year estimates of event-free survival reached 82% and 43%, respectively (P < .001), and the 2-year estimates of overall survival reached 90% and 61%, respectively (P = .006). Predictive value of “early PET” was observed in both the lower-risk and higher-risk groups, indicating prognostic independence from the IPI. Therefore, FDG-PET should be an early guide to first-line strategies in aggressive lymphoma. (Blood. 2005;106:1376-1381)