Sylvain Mareschal, Ph.D.
Bioinformatics postdoc
September 20, 2014 at 13:38
Alcantara et al, EJNMMI 2014
Eur J Nucl Med Mol Imaging. 2015 Feb;42(2):215-21.
doi: 10.1007/s00259-014-2896-2.
Epub 2014 Sep 20.

PET/CT before autologous stem cell transplantation predicts outcome in refractory/relapsed follicular lymphoma.

Alcantara M, Dupuis J, Mareschal S, Julian A, Cottereau AS, Becker S, Dubois S, Oberic L, Huynh A, Meignan M, Laurent G, Tilly H, Haioun C, Ysebaert L.

PURPOSE: Salvage of young patients with follicular lymphoma (FL) after R-CHOP includes salvage immunochemotherapy followed by autologous stem cell transplantation (ASCT). Previous studies dealing with relapsed Hodgkin lymphoma have shown the prognostic value of PET/CT prior to ASCT.
METHODS: We retrospectively analysed 59 patients with refractory/relapsed FL after first-line R-CHOP who were chemosensitive (as evaluated by CT) to the salvage treatment and who proceeded to ASCT. The role of PET/CT in this setting to define chemosensitivity is not definitely established. So we focused on the prognostic value of PET/CT performed after salvage treatment, before ASCT.
RESULTS: The estimated 3-year progression-free survival (PFS) and overall survival were 63.1% (50.9-78.3) and 90.5% (82.8-98.8) respectively, and did not differ significantly according to their Follicular Lymphoma International Prognostic Index at relapse, conditioning regimen, or type of salvage. PFS was significantly lower in PET/CT-positive patients, according to the International Harmonization Project revised response criteria, with a 3-year PFS of 45.5% (26.6- 77.8) versus 72.6% (58.5-90.0; p=0.039). To better refine prognosis, we applied two types of thresholds: a Deauville five-point scale positive threshold of >=3 (3-year PFS of 74.9%, range 61.0-92.1, versus 42.8%, range 24.7-74.4; p=0.02), and a >=70% dSUVmax threshold between presalvage and pre-ASCT PET/CT (3-year PFS of 72.4%, range 57.5-91.3 versus 13.3%, 2.2-81.7; p < 10^-3). The PET/CT findings before ASCT were independently correlated with PFS in our series.
CONCLUSION: PET/CT negativity before ASCT is a desirable and achievable goal in the management of chemosensitive FL relapsing after first-line R-CHOP.

Pubmed, PMID: 25239490