Positron Emission Tomography–Computed Tomography (PET-CT) After Induction Therapy Is Highly Predictive of Patient Outcome in Follicular Lymphoma: Analysis of PET-CT in a Subset of PRIMA Trial Participants

Trotman, Judith; Fournier, Michel; Lamy, Thierry; Seymour, John F.; Sonet, Anne; Janíková, Andrea; Shpilberg, Ofer; Gyan, Emmanuel; Tilly, Hervé; Estell, Jane; Forsyth, Cecily; Decaudin, Didier; Fabiani, Bettina; Gabarre, Jean; Salles, Bruno César Corrêa; Neste, Éric Van Den; Canioni, Danielle; Garin, Étienne; Fulham, Michael; Borght, Thierry Vander; Salles, Gilles

doi:10.1200/jco.2011.35.0736

Cited by 179 publications

(133 citation statements)

References 28 publications

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“…This observation confirms data of Trotman et al supporting the prognostic role of PET also in FL subset [24]. Agreement between PET and scan results was 81%.…”

Section: Discussionsupporting

confidence: 81%

Fludarabine‐mitoxantrone‐rituximab regimen in untreated intermediate/high‐risk follicular non‐Hodgkin's lymphoma: Experience on 142 patients

et al. 2013

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There is no international consensus on front-line optimal chemotherapy regimen for advanced stage follicular lymphoma (FL) patients, or a clear definition of cure for this disease. Aim of this study was to test the degree of effectiveness and the safety of the regimen containing fludarabine, mitoxantrone, and rituximab in a subset of poor prognosis FL patients with particular focus on the long-term disease-free survival. A retrospective study was conducted on 142 intermediate/high-risk FL patients treated in first-line with fludarabine, mitoxantrone, and rituximab regimen. Responses, safety, and survival were evaluated. The prognostic value of positron emission tomography (PET) was also investigated in a 56-patients subset. Overall response rate was 95.5% including 88% of complete responses. With a median follow-up of 48 months, 18% of patients had disease relapse, yielding an estimated 12-year disease-free survival (DFS) of 72%. All cases showed the lymphoma recurrence within 40 months: after this timing the DFS curve presented a plateau. Overall survival was 73% at 12 years. Post-treatment PET positivity remains a highly significant predictor of disease progression. The observed high rate of complete responses following the use of fludarabine, mitoxantrone-based regimen in combination with rituximab seems to be the first step to improve DFS. Our study could be the starting point to consider DFS as a potential alternative endpoint of future clinical trials on FL patients. Am. J. Hematol. 88:E273-E276,

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“…This observation confirms data of Trotman et al supporting the prognostic role of PET also in FL subset [24]. Agreement between PET and scan results was 81%.…”

Section: Discussionsupporting

confidence: 81%

Fludarabine‐mitoxantrone‐rituximab regimen in untreated intermediate/high‐risk follicular non‐Hodgkin's lymphoma: Experience on 142 patients

et al. 2013

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“…The independent prognostic significance of PET-CT performed at the end of induction therapy has been recently confirmed [38]; irrespective of conventional response [39], PET positivity was associated with a reduced PFS (33 vs. 71%) and an increased risk of death (HR, 7.0; P 5 0.001). However, no study addressed the management of patients with discordant CT and PET results.…”

Section: Issue 4: Assessment Of Response (Consensus-based Recommendatmentioning

confidence: 97%

SIE, SIES, GITMO revised guidelines for the management of follicular lymphoma

et al. 2013

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By using the GRADE system, we updated the guidelines for management of follicular cell lymphoma issued in 2006 from SIE, SIES, and GITMO group. We confirmed our recommendation to frontline chemoimmunotherapy in patients with Stage III-IV disease and/or high tumor burden. Maintenance rituximab was also recommended in responding patients. In patients relapsing after an interval longer than 12 months from frontline therapy, we recommended chemoimmunotherapy with non cross-resistant regimens followed by rituximab maintenance. High dose chemotherapy followed by hematopoietic stem cell transplant was recommended for young fit patients who achieve a response after salvage chemoimmunotherapy. Am. J. Hematol. 88:185-192, 2013. V

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“…Thirdly, 18F-FDG-PET can be used to evaluate treatment response if a patient has 18F-FDG-avid gastrointestinal lesions. In nodal follicular lymphoma, disappearance of 18F-FDG accumulation after completion of treatment has been associated with a favorable outcome [23][24][25] . Although the cost and benefit (e.g., sensitivity, specificity, and patient acceptability) of 18F-FDG-PET vs other modalities, including the combination of CT scanning and endoscopic examinations, remains to be investigated, 18F-FDG-PET represents an option for assessing the therapeutic effect in cases of gastrointestinal involvement of follicular lymphoma.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, nodal and extranodal lesions not detected by other modalities have been identified using 18F-FDG-PET, thereby resulting in a significant advance in lesion management [18][19][20][21][22] . The usefulness of posttreatment 18F-FDG-PET during the follow-up period in cases of follicular lymphoma has also been noted, with positive 18F-FDG accumulation suggesting an adverse outcome [23][24][25] . Consequently, 18F-FDG-PET is considered a valuable tool for the management of nodal follicular lymphoma.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic role of 18F-fluorodeoxyglucose positron emission tomography for follicular lymphoma with gastrointestinal involvement

Iwamuro

Okada²,

Takata³

et al. 2012

WJG

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AIM:To investigate the capacity for 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) to evaluate patients with gastrointestinal lesions of follicular lymphoma. METHODS:This retrospective case series consisted of 41 patients with follicular lymphoma and gastrointestinal involvement who underwent 18F-FDG-PET and endoscopic evaluations at ten different institutions between November 1996 and October 2011. Data for endoscopic, radiological, and biological examinations performed were retrospectively reviewed from clinical records. A semi-quantitative analysis of 18F-FDG uptake was performed for each involved area by calculating the maximum standardized uptake value (SUVmax). Based on the positivity of 18F-FDG uptake in the gastrointestinal lesions analyzed, patients were subdivided into two groups. To identify potential predictive factors for 18F-FDG positivity, these two groups were compared with respect to gender, age at diagnosis of lymphoma, histopathological grade, pattern of follicular dendritic cells, mitotic rate, clinical stage, soluble interleukin-2 receptor levels detected by 18F-FDG-PET, lactate dehydrogenase (LDH) levels, hemoglobin levels, bone marrow involvement, detectability of gastrointestinal lesions by computed tomography (CT) scanning, and follicular lymphoma international prognostic index (FLIPI) risk. ORIGINAL ARTICLE RESULTS:Involvement of follicular lymphoma in the stomach, duodenum, jejunum, ileum, cecum, colon, and rectum was identified in 1, 34, 6, 3, 2, 3, and 6 patients, respectively. No patient had esophageal involvement. In total, 19/41 (46.3%) patients exhibited true-positive 18F-FDG uptake in the lesions present in their gastrointestinal tract. In contrast, false-negative 18F-FDG uptake was detected in 24 patients (58.5%), while false-positive 18F-FDG uptake was detected in 5 patients (12.2%). In the former case, 2/19 patients had both 18F-FDG-positive lesions and 18F-FDGnegative lesions in the gastrointestinal tract. In patients with 18F-FDG avidity, the SUVmax value of the involved gastrointestinal tract ranged from 2.6 to 17.4 (median: 4.7). For the 18F-FDG-negative (n = 22) and -positive (n = 19) groups, there were no differences in the male to female ratios (10/12 vs 4/15, P = 0.186), patient age (63.6 ± 2.4 years vs 60.1 ± 2.6 years, P = 0.323), presence of histopathological grade 1 vs 2 (20/2 and 17/2, P = 1.000), follicular dendritic cell pattern (duodenal/nodal: 13/5 vs 10/3, P = 1.000), mitotic rate (low/ partly high, 14/1 vs 10/3, P = 0.311), clinical stage according to the Ann Arbor system (stages ⅠE and ⅡE/ other, 15/7 vs 15/4, P = 0.499), clinical stage according to the Lugano system (stages Ⅰ and Ⅱ-1/other, 14/8 vs 14/5, P = 0.489), soluble interleukin-2 receptor levels (495 ± 78 vs 402 ± 83, P = 0.884), LDH levels (188 ± 7 vs 183 ± 8, P = 0.749), hemoglobin levels (13.5 ± 0.3 vs 12.8 ± 0.4, P = 0.197), bone marrow involvement (positive/negative, 1/8 vs 1/10, P = 1.000), detectability by CT scanning (positive/negative, 1/16 vs 4/13, P = 0.335...

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Positron Emission Tomography–Computed Tomography (PET-CT) After Induction Therapy Is Highly Predictive of Patient Outcome in Follicular Lymphoma: Analysis of PET-CT in a Subset of PRIMA Trial Participants

Abstract: [(18)F]FDG PET-CT status at the end of immunochemotherapy induction in patients with FL is strongly predictive of outcome and should be considered a meaningful clinical end point in future studies.

Cited by 179 publications

References 28 publications

Fludarabine‐mitoxantrone‐rituximab regimen in untreated intermediate/high‐risk follicular non‐Hodgkin's lymphoma: Experience on 142 patients

Fludarabine‐mitoxantrone‐rituximab regimen in untreated intermediate/high‐risk follicular non‐Hodgkin's lymphoma: Experience on 142 patients

SIE, SIES, GITMO revised guidelines for the management of follicular lymphoma

Diagnostic role of 18F-fluorodeoxyglucose positron emission tomography for follicular lymphoma with gastrointestinal involvement

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