Positron emission tomography-computed tomography predictors of progression after DA-R-EPOCH for PMBCL.

Abstract

Dose-adjusted rituximab plus etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-R-EPOCH) has produced good outcomes in primary mediastinal B-cell lymphoma (PMBCL), but predictors of resistance to this treatment are unclear. We investigated whether [18F]fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) findings could identify patients with PMBCL who would not respond completely to DA-R-EPOCH. We performed a retrospective analysis of 65 patients with newly diagnosed stage I to IV PMBCL treated at 2 tertiary cancer centers who had PET-CT scans available before and after frontline therapy with DA-R-EPOCH. Pretreatment variables assessed included metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Optimal cutoff points for progression-free survival (PFS) were determined by a machine learning approach. Univariate and multivariable models were constructed to assess associations between radiographic variables and PFS. At a median follow-up of 36.6 months (95% confidence interval, 28.1-45.1), 2-year PFS and overall survival rates for the 65 patients were 81.4% and 98.4%, respectively. Machine learning-derived thresholds for baseline MTV and TLG were associated with inferior PFS (elevated MTV: hazard ratio [HR], 11.5; P = .019; elevated TLG: HR, 8.99; P = .005); other pretreatment clinical factors, including International Prognostic Index and bulky (>10 cm) disease, were not. On multivariable analysis, only TLG retained statistical significance (P = .049). Univariate analysis of posttreatment variables revealed that residual CT tumor volume, maximum standardized uptake value, and Deauville score were associated with PFS; a Deauville score of 5 remained significant on multivariable analysis (P = .006). A model combining baseline TLG and end-of-therapy Deauville score identified patients at increased risk of progression.

• Authors: Chelsea C Pinnix, Andrea K Ng, Bouthaina S Dabaja, Sarah A Milgrom, Jillian R Gunther, C David Fuller, Grace L Smith, Zeinab Abou Yehia, Wei Qiao, Christine F Wogan, Mani Akhtari, Osama Mawlawi, L Jeffrey Medeiros, Hubert H Chuang, William Martin-Doyle, Philippe Armand, Ann S LaCasce, Yasuhiro Oki, Michelle Fanale, Jason Westin, Sattva Neelapu, Loretta Nastoupil
• Journal: Blood advances (Blood Adv) Vol. 2 Issue 11 Pg. 1334-1343 (06 12 2018) ISSN: 2473-9537 [Electronic] United States
• PMID: 29895624 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: © 2018 by The American Society of Hematology.

Chemical References

• Vincristine
• Etoposide
• Doxorubicin
• Cyclophosphamide

Topics

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage)
• Cyclophosphamide (administration & dosage)
• Disease-Free Survival
• Doxorubicin (administration & dosage)
• Etoposide (administration & dosage)
• Female
• Humans
• Lymphoma, B-Cell (diagnostic imaging, drug therapy, mortality)
• Male
• Mediastinal Neoplasms (diagnostic imaging, drug therapy, mortality)
• Middle Aged
• Models, Biological
• Positron-Emission Tomography
• Predictive Value of Tests
• Survival Rate
• Tomography, X-Ray Computed
• Vincristine (administration & dosage)