PET/CT in primary mediastinal large B-cell lymphoma responding to rituximab-CHOP: An analysis of 106 patients regarding prognostic significance and implications for subsequent radiotherapy

Vassilakopoulos, T.; Pangalis, Gerasimos; Chatziioannou, Sofia; Papageorgiou, Sotirios G.; Angelopoulou, Maria K.; Galani, Zacharoula; Kourti, Georgia; Prassopoulos, Vassilios; Leonidopoulou, Theoni; Terpos, Evangelos; Dimopoulou, Maria; Sachanas, Sotirios; Kalpadakis, Christina; Konstantinidou, Pavlina; Boutsis, Dimitrios; Stefanoudaki, Ekaterini; Kyriazopoulou, Lydia; Siakantaris, Marina P.; Mc, Kyrtsonis; Variami, Eleni; Kotsianidis, Ιoannis; Symeonidis, Argiris; Michali, Evridiki; Katodritou, Eirini; Kokkini, Garyfallia; Tsatalas, Costas; Papadaki, Helen Α.; Dimopoulos, Meletios Α.; Sotiropoulos, Vasileios; Pappa, Vasiliki; Karmiris, Themis; Meletis, John; Apostolidis, John; Datseris, Ioannis; Panayiotidis, Panayiotis; Konstantopoulos, Kostas; Roussou, Parascevi; Rondogianni, P

doi:10.1038/leu.2015.120

Cited by 43 publications

(44 citation statements)

References 15 publications

(13 reference statements)

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Section: Primary Mediastinal Large B-cell Lymphomamentioning

confidence: 93%

“…More importantly, iPETnificantly inferior outcomes [40,42]. Since even patients with marked FDG uptake can be salvaged with RT and the majority of PET-positive patients after immunochemotherapy will be cured following RT [40], patients with PMLBCL should not be referred for high-dose therapy and autologous transplantation solely based on a positive PET/CT, especially if uptake is not marked [40,44]. Conversely, whether RT could be safely omitted or not in PET-negative patients is currently evaluated by the International Extranodal Lymphoma Study Group (IELSG)-37 randomized trial [45].…”

Section: Randomized Trials Of Pet-guided Therapy In Hodgkin Lymphomamentioning

confidence: 97%

“…If irradiated, PET/CT-positive residual masses are effectively controlled in 65-70 % of cases [40,41]. The outcome is extremely favorable in patients with 5-PS score 3, who reproducibly enjoy very high cure rates even up to 100 %, with all progressions restricted to patients with 5-PS scores 4-5 [40,41,43]. Among the latter subgroup, the intensity of FDG uptake may be important; patients with higher SUVmax (for example ≥ 5) probably have sigwith that of patients with CR or residual masses < 2.5 cm, who did not undergo PET/CT [33].…”

Section: Primary Mediastinal Large B-cell Lymphomamentioning

confidence: 98%

“…A negative PET/CT after Rituximab, cyclophosphamide, adriamycin, vincristine, prednisone (R-CHOP), Rituximab, methotrexate, adriamycin, cyclophosphamide, vincristine, prednisone, bleomycin (R-MACOP-B), or Rituximab plus dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, adriamycin (R-da-EPOCH) is associated with≥ 95 % cure rates in PMLBCL, even when RT is omitted in many patients [40][41][42]. If irradiated, PET/CT-positive residual masses are effectively controlled in 65-70 % of cases [40,41].…”

Section: Primary Mediastinal Large B-cell Lymphomamentioning

confidence: 99%

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Role of FDG-PET/CT in staging and first-line treatment of Hodgkin and aggressive B-cell lymphomas

Vassilakopoulos¹,

Prassopoulos

Rondogianni

et al. 2015

memo

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Positron emission tomography with integrated computed tomography (PET/CT) is increasingly used for the initial staging, final or even interim (mid-treatment) response assessment in malignant lymphomas. Extensive clinical experience has been gained with Hodgkin lymphoma (HL) and aggressive B-cell non-Hodgkin lymphomas, including diffuse large B-cell lymphoma (DLBCL), primary mediastinal large B-cell lymphoma (PMLBCL) and other subtypes, which are the subject of the present review. The use of PET/CT is now considered mandatory for baseline staging in these entities, providing more accurate information and obviating the need of bone marrow biopsy (BMB) at least in HL. PET/CT has been the long-standing "gold standard" for final response assessment. Furthermore, early interim PET evaluation provides valuable prognostic information in HL and DLBCL. In HL, it appears that treatment intensification with Bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone (BEACOPP)-escalated can improve disease control in patients with persistent PET positivity after two cycles of ABVD. However, there is no randomized evidence of survival benefit as yet. In contrast, regimens effective in overcoming the adverse impact of persistent PET positivity have not been yet described in DLBCL. The 2014 recommendations suggest the use of PET/CT for baseline staging and final response assessment in all [ 18 F]fluorodeoxyglucose (FDG)-avid lymphoma subtypes, including the above named ones. The use of interim evaluation is not considered fully documented yet. The exact role of PET/CT in guiding treatment decisions has to be defined by ongoing and future randomized trials and evidence-based approaches are expected to become available in the near future.

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Section: Primary Mediastinal Large B-cell Lymphomamentioning

confidence: 93%

Section: Randomized Trials Of Pet-guided Therapy In Hodgkin Lymphomamentioning

confidence: 97%

Section: Primary Mediastinal Large B-cell Lymphomamentioning

confidence: 98%

Section: Primary Mediastinal Large B-cell Lymphomamentioning

confidence: 99%

See 2 more Smart Citations

Role of FDG-PET/CT in staging and first-line treatment of Hodgkin and aggressive B-cell lymphomas

Vassilakopoulos¹,

Prassopoulos

Rondogianni

et al. 2015

memo

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“…Note that the relapse rates were higher in other comparable studies, with relapse rates up to 9.4% in PMBCL patients with negative end-of-treatment FDG-PET results after immunochemotherapy who did not receive radiotherapy. [2][3][4] Of note, in diffuse large B-cell lymphoma (DLBCL), which has a considerably higher incidence of disease relapse than PMBCL, the NPV of end-of-treatment FDG-PET decreases enormously.…”

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confidence: 99%

Unproven value of end-of-treatment and serial follow-up FDG-PET in primary mediastinal B-cell lymphoma

Adams

Kwee

2018

Haematologica

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Real world experience of R‐CHOP with or without consolidative radiotherapy vs DA‐EPOCH‐R in the first‐line treatment of primary mediastinal B‐cell lymphoma

et al. 2019

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Primary mediastinal large B‐cell lymphoma (PMBCL) is a distinct clinico‐pathological subtype of diffuse large B‐cell lymphoma with unclear prognostic factors and limited clinical data. Optimal treatment and role for radiotherapy is not fully defined. We performed a multicenter retrospective review of 124 patients with newly diagnosed PMBCL between 2001 and 2016. Treatment regimens were R‐CHOP (n = 41), R‐CHOP + RT (n = 37), and DA‐EPOCH‐R (n = 46). 6% (n = 3) in the DA‐EPOCH‐R group received RT. With a median follow up of 45 months, the overall 5‐year OS and PFS was 89.4% and 82.4%, respectively. The type of chemo‐radiotherapy regimen, B symptoms and Ann‐Arbor staging showed a significant association with OS on univariate analysis but only B symptoms remained prognostic ( P = 0.012) after multivariate analysis. The chemo‐radiotherapy regimen, Japanese IPI and Ann‐Arbor stage was significantly associated with PFS in univariate analysis, but only chemo‐radiotherapy regimen remained significant ( P = 0.02) after multivariate analysis. Patients who received R‐CHOP + RT or DA‐EPOCH‐R had better PFS than those receiving R‐CHOP alone, with 5‐year PFS of 90% vs 88.5% vs 56%, respectively ( P = 0.02). In the subgroup analysis of patients with bulk (n = 71), R‐CHOP alone (n = 21) had inferior 5‐year PFS 56.6% compared to those who received R‐CHOP + RT (n = 23) 91.3% or DA‐EPOCH‐R (n = 27) 92.6% ( P = 0.007). In contrast, in patients without bulk (n = 42), there was no impact of treatment regimen on PFS ( P = 0.25). In conclusion, R‐CHOP + RT and DA‐EPOCH‐R provide excellent outcomes in patients with PMBCL. In patients with bulky disease, the use of DA‐EPOCH‐R may be preferable as it allows omission of RT without reduction in efficacy.

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PET/CT in primary mediastinal large B-cell lymphoma responding to rituximab-CHOP: An analysis of 106 patients regarding prognostic significance and implications for subsequent radiotherapy

Cited by 43 publications

References 15 publications

Role of FDG-PET/CT in staging and first-line treatment of Hodgkin and aggressive B-cell lymphomas

Role of FDG-PET/CT in staging and first-line treatment of Hodgkin and aggressive B-cell lymphomas

Unproven value of end-of-treatment and serial follow-up FDG-PET in primary mediastinal B-cell lymphoma

Real world experience of R‐CHOP with or without consolidative radiotherapy vs DA‐EPOCH‐R in the first‐line treatment of primary mediastinal B‐cell lymphoma

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