Analysis of prognostic value of complete response by PET-CT and further stratification by clinical and biological markers in DLBCL patients.

Abstract

Positron emission tomography-computed tomography (PET-CT) is performed as the standard method for response assessment of diffuse large B cell lymphoma (DLBCL) patients. However, a substantial proportion of patients experience relapse even if they have achieved complete response (CR) defined by PET-CT. We validated the prognostic value of CR by PET-CT and applied the National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI) and cell of origin (COO) to patients with CR by PET-CT to evaluate their additional predictive ability for survival outcomes. We retrospectively analyzed DLBCL patients who were treated with R-CHOP or an R-CHOP-like regimen and who achieved CR by PET-CT or CT only. A total of 185 patients were analyzed: 114 patients achieved CR by PET-CT and 71 patients by CT only. Patients with CR by PET-CT had significantly better overall survival (OS) than those with CR by CT (5-year OS, 87.5 vs. 62.4%, P = 0.003). Patients with high risk according to the NCCN-IPI had a dismal outcome despite achieving CR by PET-CT (5-year OS, 61.8%). In contrast, low-, low-intermediate-, and high-intermediate-risk patients had excellent outcomes (5-year OS, 100, 89.7, and 93.5%, respectively). Among patients with CR by PET-CT, patients with germinal center B cell (GCB) DLBCL (n = 40) had significantly better survival than those with non-GCB DLBCL (n = 57) (5-year OS, 96.9 vs. 75.5%, P = 0.039). We demonstrated that CR by PET-CT was a better predictor of survival outcomes than CR by CT only. The NCCN-IPI and COO subtypes could identify a subpopulation of poor-risk patients among those who achieved CR by PET-CT.

• Authors: Yusuke Kanemasa, Tatsu Shimoyama, Yuki Sasaki, Miho Tamura, Takeshi Sawada, Yasushi Omuro, Tsunekazu Hishima, Yoshiharu Maeda
• Journal: Medical oncology (Northwood, London, England) (Med Oncol) Vol. 34 Issue 2 Pg. 29 (Feb 2017) ISSN: 1559-131X [Electronic] United States
• PMID: 28083854 (Publication Type: Journal Article)

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• Biomarkers, Tumor
• R-CHOP protocol
• Rituximab
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Prednisone

Topics

• Adult
• Aged
• Aged, 80 and over
• Antibodies, Monoclonal, Murine-Derived (administration & dosage)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, therapeutic use)
• Biomarkers, Tumor (metabolism)
• Cyclophosphamide (administration & dosage)
• Doxorubicin (administration & dosage)
• Female
• Humans
• Lymphoma, Large B-Cell, Diffuse (diagnostic imaging, drug therapy, metabolism)
• Male
• Middle Aged
• Positron Emission Tomography Computed Tomography (methods)
• Prednisone (administration & dosage)
• Prognosis
• Retrospective Studies
• Rituximab
• Survival Rate
• Vincristine (administration & dosage)