Prognostic significance of interim PET/CT response for the treatment of advanced-stage marginal zone lymphoma in the post-rituximab era

Abstract

There are still controversies about the use of interim positron emission tomography/computed tomography (PET/CT) in indolent non-Hodgkin lymphoma due to the variable fluorodeoxyglucose (FDG) avidity. Therefore, this study aimed to evaluate the roles of interim PET/CT in marginal zone lymphoma (MZL), a representative indolent lymphoma. We analyzed the data of 146 MZL patients. All were treated with rituximab-containing immunochemotherapy. Interim PET/CT scan was performed after 2-3 cycles of therapy, and the response was assessed using the Deauville 5-point scales (5-PS) and a semi-quantitative assessment using the SUVmax reduction rate (ΔSUVmax). Progressionfree survival (PFS) was well stratified according to a visual assessment of interim PET/CT using 5-PS (p < 0.001). Particularly, there was a significant difference in PFS between patients with interim score 1-2 and those with score 3. However, ΔSUVmax did not predict the survival outcome using 59.8% of the optimal cutoff value. In the multivariate analysis, failure to achievement of grade 1-2 in interim PET/CT was significantly associated with inferior PFS (HR, 2.154; 95% CI 1.071-4.332; p = 0.031). The interim PET/CT response based on the 5-PS is useful for predicting PFS of patients with MZL in the post-rituximab era.

The value of FDG PET/CT imaging in outcome prediction and response assessment of lymphoma patients treated with immunotherapy: a meta-analysis and systematic review

“…A total of 38 articles investigated response assessment via early 18 F-FDG PET/CT imaging in the anti-CD20 immunotherapy, and of these, 19 studies were included in the meta-analysis (Supplemental Table 2 ) [ 16 , 18 , 21 – 23 , 25 – 27 , 29 – 35 , 38 – 46 , 48 – 57 , 59 – 69 , 71 – 78 , 80 – 92 , 96 – 106 ]. The meta-analysis was carried out on the DS, IHP, and ΔSUVmax for PFS and OS, and the obtained results are depicted as forest plots in Figs.…”

“…Several studies have reported that interim 18 F-FDG PET/CT could have a key role in survival prediction and early response assessment of patients with lymphoma treated with anti-CD20 therapy [ 21 , 38 , 48 , 49 , 55 , 56 , 64 , 80 , 99 , 100 , 106 ]. In contrast, several studies reported a poor positive predictive value in early response assessment [ 45 , 46 , 54 , 60 , 66 , 72 , 97 , 104 ], whereby the interpretation of the 18 F-FDG PET/CT scan is of special importance.…”

“…For metabolic baseline parameters, we considered tumor burden indices, including metabolic tumor volume (MTV), and total lesion glycolysis (TLG), and tumor metabolism indices, including maximum of standardized uptake value (SUVmax). For the response assessment we considered visual methods, including Deauville score (DS) and ΔSUVmax as a semi-quantitative method [ 21 , 22 , 48 , 67 , 77 , 80 , 89 , 104 ].…”

“…80,99, Meta-analysis of baseline parameters, MTV, TLG, and SUVmax for PFS in studies on anti-CD20 therapy…”

What Prognostic Markers Should Be Evaluated in Marginal Zone Lymphoma? A Survey Among Leading International Experts

“…17 , 18 In response assessment, Song et al highlighted the prognostic value of a Deauville score-base interim 18 FDG-PET/CT response assessment on PFS in a set of 146 patients and across all subtypes (but mostly EMZL and NMZL). 19 In this paper, ∆SUVmax had no prognostic impact and TMTV was not assessed. Finally, Vaxman et al reported the prognostic role of SUVmax value at end-of-treatment on PFS in a set of 110 patients.…”