Baseline SUV_max is related to tumor cell proliferation and patient outcome in follicular lymphoma

Abstract

Follicular lymphoma (FL) is the most common indolent lymphoma. Despite the clear benefit of CD20-based therapy, a subset of FL patients still progress to aggressive lymphoma. Thus, identifying early biomarkers that incorporate PET metrics could be helpful to identify patients with a high risk of treatment failure with Rituximab. We retrospectively included a total of 132 untreated FL patients separated into training and validation cohorts. Optimal threshold of baseline SUVmax was first determined in the training cohort (n=48) to predict progression-free survival (PFS). The PET results were investigated along with the tumor and immune microenvironment, which were determined by immunochemistry and transcriptome studies involving gene set enrichment analyses and immune cell deconvolution, together with the tumor mutation profile. We report that baseline SUVmax >14.5 was associated with poorer PFS than baseline SUVmax ≤14.5 (HR=0.28; p=0.00046). Neither immune T-cell infiltration nor immune checkpoint expression were associated with baseline PET metrics. By contrast, FL samples with Ki-67 staining ≥10% showed enrichment of cell cycle/DNA genes (p=0.013) and significantly higher SUVmax values (p=0.007). Despite similar oncogenic pathway alterations in both SUVmax groups of FL samples, 4 out of 5 cases harboring the infrequent FOXO1 transcription factor mutation were seen in FL patients with SUVmax >14.5. Thus, high baseline SUVmax reflects FL tumor proliferation and, together with Ki-67 proliferative index, can be used to identify patients at risk of early relapse with R-chemotherapy.

High Basal Maximal Standardized Uptake Value (SUVmax) in Follicular Lymphoma Identifies Patients with a Low Risk of Long-Term Relapse

“…The POD24 rate was, indeed, similar in the two groups. In recent studies that showed a higher rate of POD24 in patients with a high SUV max , most of the studied population was in an advanced stage at diagnosis and was classified as intermediate or high risk according to FLIPI score [27]. In our analysis, 40.4% of patients were in a limited stage, and 43% were classified as low-risk FLIPI (Table 1) and were equally distributed in the two groups.…”

An Immune-Clinical Prognostic Index (ICPI) for Patients With De Novo Follicular Lymphoma Treated With R-CHOP/CHOP Chemotherapy

“…FL is a heterogeneous disorder, and over the last decade, a number of clinical parameters have emerged as significant prognostic factors (43,44). Aiming to establish a prognostic system, we utilized variables of clinical significance that had been previously related to outcomes for FL, as well as peripheral blood T-lymphocytes which were immunologically relevant effective and simple biomarkers.…”

Deep Learning Approach to Automatize TMTV Calculations Regardless of Segmentation Methodology for Major FDG-Avid Lymphomas

“…The study population included 2030 baseline PET/CT of FDG-avid lymphomas—HL (n = 777), DLBCL (n = 851) and FL (n = 402)—collected from anonymized multicenter imaging trial datasets of the Lymphoma Study Association (LYSA): 703 for AHL2011 [ 12 ], 573 for GAINED [ 13 ], 277 for RELEVANCE [ 14 ], 217 for REMARC [ 3 ], 125 for FLIP [ 15 ], 61 LNH2007-3B [ 16 ] and 74 for PVAB [ 17 ] ( Table 1 ).…”