Metabolic Tumor Volume for Response Prediction in Advanced-Stage Hodgkin Lymphoma

Abstract

(F)fluoro-2-deoxy-D-glucose (F-FDG) positron emission tomography (PET)/computed tomography (CT) for staging Hodgkin lymphoma may allow for accurate and reliable assessment of the metabolic tumour volume (MTV) as baseline risk factor. Our aim was to analyse the prognostic impact of MTV measurements, obtained by different means in advanced-stage Hodgkin lymphoma patients treated within the German Hodgkin Study Group HD18 trial. Within the German Hodgkin Study Group trial HD18, 310 patients underwentF-FDG PET/CT scanning for staging which was available to the central review panel for quantitative analysis. We calculated the MTV by four different thresholding methods and performed receiver operating characteristic (ROC) analysis to evaluate the potential for prediction of early response determined by PET after two cycles (PET-2) dose-escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP). Logistic regression was used to evaluate its prognostic value concerning progression-free survival (PFS) and overall survival (OS). All different MTV calculations used predicted PET-2 response to a moderate and comparable degree (area under the curve = 0.62-0.63, = 0.01-0.06). With none of the measuring methods did the ROC curves point to any unique cut-off values, but indicated a wide range of possible cut-offs. However, none of the MTV measurements was prognostic for PFS (Hazard ratio 1.2-1.5, = 0.15-0.52) or OS (Hazard ratio 1.0-1.5, = 0.95 - 0.27). Baseline MTV as determined by different means, is a predictive factor for early response to eBEACOPP after two cycles. However, value as a prognostic factor after highly effective PET-2 adapted treatment strategy could not be observed.

Relationship between semiquantitative 18F-fluorodeoxyglucose positron emission tomography metrics and necrosis in classical Hodgkin lymphoma

“…In addition, previous investigations have suggested baseline TLG as a potentially useful prognostic marker for survival in cHL 20,54 and other lymphomas 58–63 . However, as mentioned earlier, inconsistent results 19,64 , the challenge of standardizing quantification 65,66 , as well as small study cohorts, raise doubts about the potential of MTV measurements in clinical practice. While in NHL attempts are being made to include standardized semiquantitative analysis in prospective trials 67 , larger, prospective studies with standardized guidelines for semiquantitative analysis and appropriate validation cohorts for the determination of relevant cut-off values are needed to conclusively assess the role of semiquantitative measures in cHL 19,57 .…”

FDG-PET Imaging for Hodgkin and Diffuse Large B-Cell Lymphoma—An Updated Overview

“…Interestingly, individuals with early-stage unfavorable disease can even be subdivided into low-and high-risk categories based on the MTV and TLG, as shown elsewhere [71]. A retrospective analysis including 310 patients identified that pretreatment MTV is also a predictive factor for early response to eBEACOPP after two cycles of chemotherapy in advanced-stage Hodgkin lymphoma [72]. Moreover, metabolic measures were reported to have a prognostic value in non-Hodgkin lymphoma.…”

Pre-Therapeutic Total Lesion Glycolysis on [18F]FDG-PET Enables Prognostication of 2-Year Progression-Free Survival in MALT Lymphoma Patients Treated with CD20-Antibody-Based Immunotherapy

“…Outcome prognostication and identification of risk groups play an important role in the management of patients with malignant lymphoma. An increasing number of recent studies suggest that, for patients with classical Hodgkin, diffuse large B cell (DLBCL), follicular, as well as T cell lymphomas, quantitative parameters derived from pretherapeutic positron emission tomography with 2-deoxy-2-[ 18 F]fluoro-D-glucose ([ 18 F]FDG)/positron emission tomography (PET)-such as maximum standardized uptake value (SUVmax), total metabolic tumor volume (TMTV), or total lesion glycolysis (TLG)-are prognostic for clinical outcomes, and may therefore improve risk stratification [1][2][3][4][5].…”