Risk-adapted dose-dense immunochemotherapy determined by interim FDG-PET in Advanced-stage diffuse large B-Cell lymphoma.

Abstract

PURPOSE In studies of diffuse large B-cell lymphoma, positron emission tomography with [(18)F]fluorodeoxyglucose (FDG-PET) performed after two to four cycles of chemotherapy has demonstrated prognostic significance. However, some patients treated with immunochemotherapy experience a favorable long-term outcome despite a positive interim FDG-PET scan. To clarify the significance of interim FDG-PET scans, we prospectively studied interim FDG-positive disease within a risk-adapted sequential immunochemotherapy program. PATIENTS AND METHODS From March 2002 to November 2006, 98 patients at Memorial Sloan-Kettering Cancer Center received induction therapy with four cycles of accelerated R-CHOP (rituximab + cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by an interim FDG-PET scan. If the FDG-PET scan was negative, patients received three cycles of ICE (ifosfamide, carboplatin, and etoposide) consolidation therapy. If residual FDG-positive disease was seen, patients underwent biopsy; if the biopsy was negative, they also received three cycles of ICE. Patients with a positive biopsy received ICE followed by autologous stem-cell transplantation. RESULTS At a median follow-up of 44 months, overall and progression-free survival were 90% and 79%, respectively. Ninety-seven patients underwent interim FDG-PET scans; 59 had a negative scan, 51 of whom are progression free. Thirty-eight patients with FDG-PET-positive disease underwent repeat biopsy; 33 were negative, and 26 remain progression free after ICE consolidation therapy. Progression-free survival of interim FDG-PET-positive/biopsy-negative patients was identical to that in patients with a negative interim FDG-PET scan (P = .27). CONCLUSION Interim or post-treatment FDG-PET evaluation did not predict outcome with this dose-dense, sequential immunochemotherapy program. Outside of a clinical trial, we recommend biopsy confirmation of an abnormal interim FDG-PET scan before changing therapy.

• Authors: Craig H Moskowitz, Heiko Schöder, Julie Teruya-Feldstein, Camelia Sima, Alexia Iasonos, Carol S Portlock, David Straus, Ariela Noy, Maria L Palomba, Owen A O'Connor, Steven Horwitz, Sarah A Weaver, Jessica L Meikle, Daniel A Filippa, James F Caravelli, Paul A Hamlin, Andrew D Zelenetz
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 28 Issue 11 Pg. 1896-903 (Apr 10 2010) ISSN: 1527-7755 [Electronic] United States
• PMID: 20212248 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Murine-Derived
• Radiopharmaceuticals
• Fluorodeoxyglucose F18
• Rituximab
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Prednisone

Topics

• Adolescent
• Adult
• Aged
• Antibodies, Monoclonal (administration & dosage)
• Antibodies, Monoclonal, Murine-Derived
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Cyclophosphamide (administration & dosage)
• Dose-Response Relationship, Drug
• Doxorubicin (administration & dosage)
• Female
• Fluorodeoxyglucose F18
• Humans
• Lymphoma, Large B-Cell, Diffuse (diagnostic imaging, drug therapy, immunology)
• Male
• Middle Aged
• Neoplasm Staging
• Positron-Emission Tomography
• Prednisone (administration & dosage)
• Prospective Studies
• Radiopharmaceuticals
• Risk Factors
• Rituximab
• Survival Rate
• Treatment Outcome
• Vincristine (administration & dosage)
• Young Adult