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(18)F-fluorodeoxyglucose-positron emission tomography/computed tomography after one cycle of chemotherapy in patients with diffuse large B-cell lymphoma: results of a Nordic/US intergroup study.

https://arctichealth.org/en/permalink/ahliterature272653
Source
Leuk Lymphoma. 2015 Jul;56(7):2005-12
Publication Type
Article
Date
Jul-2015
Author
Karen Juul Mylam
Lale Kostakoglu
Martin Hutchings
Morton Coleman
Dominick Lamonica
Myron S Czuczman
Louis F Diehl
Anne L Nielsen
Paw Jensen
Annika Loft
Helle W Hendel
Victor Iyer
Sirpa Leppä
Sirkku Jyrkkiö
Harald Holte
Mikael Eriksson
Dorte Gillstrøm
Per B Hansen
Marko Seppänen
Karin Hjorthaug
Peter de Nully Brown
Lars M Pedersen
Source
Leuk Lymphoma. 2015 Jul;56(7):2005-12
Date
Jul-2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Denmark
Female
Finland
Fluorodeoxyglucose F18 - pharmacokinetics
Follow-Up Studies
Humans
Lymphoma, Large B-Cell, Diffuse - drug therapy - mortality - pathology
Male
Middle Aged
Multimodal Imaging
Neoplasm Staging
Norway
Positron-Emission Tomography - methods
Prognosis
Prospective Studies
Radiopharmaceuticals - pharmacokinetics
Survival Rate
Sweden
Tissue Distribution
Tomography, X-Ray Computed - methods
United States
Young Adult
Abstract
We evaluated the predictive value of interim positon emission tomography (I-PET) after one course of chemoimmunotherapy in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). One hundred and twelve patients with DLBCL were enrolled. All patients had PET/computed tomography (CT) scans performed after one course of chemotherapy (PET-1). I-PET scans were categorized according to International Harmonization Project criteria (IHP), Deauville 5-point scale (D 5PS) with scores 1-3 considered negative (D 5PS > 3) and D 5PS with scores 1-4 considered negative (D 5PS = 5). Ratios of tumor maximum standardized uptake value (SUVmax) to liver SUVmax were also analyzed. We found no difference in progression-free survival (PFS) between PET-negative and PET-positive patients according to IHP and D 5PS > 3. The 2-year PFS using D 5PS = 5 was 50.9% in the PET-positive group and 84.8% in the PET-negative group (p = 0.002). A tumor/liver SUVmax cut-off of 3.1 to distinguish D 5PS scores of 4 and 5 provided the best prognostic value. PET after one course of chemotherapy was not able to safely discriminate PET-positive and PET-negative patients in different prognostic groups.
PubMed ID
25330442 View in PubMed
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Routine Imaging for Diffuse Large B-Cell Lymphoma in First Complete Remission Does Not Improve Post-Treatment Survival: A Danish-Swedish Population-Based Study.

https://arctichealth.org/en/permalink/ahliterature270756
Source
J Clin Oncol. 2015 Dec 1;33(34):3993-8
Publication Type
Article
Date
Dec-1-2015
Author
Tarec Christoffer El-Galaly
Lasse Hjort Jakobsen
Martin Hutchings
Peter de Nully Brown
Herman Nilsson-Ehle
Elisabeth Székely
Karen Juul Mylam
Viktoria Hjalmar
Hans Erik Johnsen
Martin Bøgsted
Mats Jerkeman
Source
J Clin Oncol. 2015 Dec 1;33(34):3993-8
Date
Dec-1-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Cohort Studies
Denmark - epidemiology
Female
Follow-Up Studies
Humans
Lymphoma, Large B-Cell, Diffuse - drug therapy - epidemiology - mortality - pathology
Male
Middle Aged
Neoplasm Staging
Prognosis
Remission Induction
Survival Rate
Sweden - epidemiology
Tomography, X-Ray Computed - methods
Young Adult
Abstract
Routine imaging for diffuse large B-cell lymphoma (DLBCL) in first complete remission (CR) is controversial and plays a limited role in detecting relapse. This population-based study compared the survival of Danish and Swedish patients with DLBCL for whom traditions for routine imaging have been different.
Patients from the Danish and Swedish lymphoma registries were included according to the following criteria: newly diagnosed DLBCL from 2007 to 2012, age 18 to 65 years, and CR after R-CHOP/CHOEP. Follow-up for Swedish patients included symptom assessment, clinical examinations, and blood tests at 3- to 4-month intervals for 2 years, with longer intervals later in follow-up. Imaging was only recommended when relapse was clinically suspected. Follow-up for Danish patients was similar but included routine imaging (usually computed tomography every 6 months for 2 years).
Danish (n = 525) and Swedish (n = 696) patients with DLBCL had comparable baseline characteristics. Cumulative 2-year progression rate after CR was 6% (95% CI, 4 to 9) for International Prognostic Index (IPI) = 2 versus 21% (95% CI, 13 to 28) for IPI > 2. Age > 60 years (hazard ratio [HR], 2.3; 95% CI, 1.6 to 3.4), elevated lactate dehydrogenase (HR, 2.3; 95% CI, 1.4 to 3.8), B symptoms (HR, 1.7; 95% CI, 1.1 to 2.5), and Eastern Cooperative Oncology Group performance status = 2 (HR, 1.8; 95% CI, 1.0 to 3.0) were associated with worse post-CR survival. Imaging-based follow-up strategy had no impact on survival, neither for all patients nor for IPI-specific subgroups.
DLBCL relapse after first CR is infrequent, and the widespread use of routine imaging in Denmark did not translate into better survival. This favors follow-up without routine imaging and, more generally, a shift of focus from relapse detection to improved survivorship.
Notes
Comment In: J Clin Oncol. 2015 Dec 1;33(34):3983-426438116
PubMed ID
26438115 View in PubMed
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