Prognostic value of 18F-fluorodeoxyglucose positron emission tomography using Deauville criteria in diffuse large B cell lymphoma treated with autologous hematopoietic stem cell transplantation

Abstract

ObjectiveHigh-dose chemotherapy (HDC) followed by autologous hematopoietic stem cell transplantation (auto-HSCT) plays an important role in improving outcomes of diffuse large B cell lymphoma (DLBCL) patients. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) has been widely accepted in response assessment and prediction of prognosis in DLBCL. Here, we report the value of 18F-FDG PET/CT pre- and post-HSCT in predicting outcomes of patients with DLBCL. MethodsDLBCL patients who had PET/CT scan before and after HSCT were included. PET results were interpreted based upon Deauville criteria. The prognostic value of 18F-FDG PET/CT in auto-HSCT was evaluated. ResultsEighty-four patients were enrolled. In univariate analysis, pre- and post-HSCT PET findings were correlated with 3-year progression-free survival (PFS) [hazard ratio (HR)=4.391, P=0.001; HR=7.607, P<0.001] and overall survival (OS) (HR=4.792, P=0.008; HR=26.138, P<0.001). Patients receiving upfront auto-HSCT after first-line treatment had better outcomes than relapsed/refractory DLBCL patients (3-year PFS, P<0.001; 3-year OS, P<0.001). In the relapsed/refractory patients, pre- and post-HSCT PET findings were also associated with 3-year PFS (P=0.003vs. P<0.001) and OS (P=0.027vs. P<0.001). A significant correlation was observed between clinical response to chemotherapy before auto-HSCT and outcomes of patients in the entire cohort (3-year PFS, P<0.001; 3-year OS, P<0.001) and in the subgroup of 21 patients with positive pre-HSCT PET (3-year PFS, P=0.084; 3-year OS, P=0.240). A significant association between survival and post-HSCT PET findings was observed in multivariate analysis (HR=5.168, P<0.001). ConclusionsPET results before and after HSCT are useful prognostic factors for DLBCL patients receiving HSCT. Patients who responded to chemotherapy, even those with positive pre-HSCT PET, are appropriate candidates for auto-HSCT.

Prognostic Value of 2-Deoxy-2-[18F]fluoro-D-glucose Positron Emission Tomography/Computed Tomography after Autologous Hematopoietic Stem Cell Transplantation in Lymphoma Using Deauville Scores

“…A few of studies have assessed the prognostic value of post-ASCT [ 18 F]F-FDG PET-CT for lymphoma [29][30][31][32][33][34]. Most of these studies have confirmed the prognostic value of post-ASCT [ 18 F]F-FDG PET-CT [29][30][31]. However, in Palmer's multivariate analysis, the post-ASCT [ 18 F]F-FDG PET-CT scan cannot predict the outcome for patients undergoing ASCT [32].…”

PET/CT Evaluation of the Effect of Allogeneic Hematopoietic Stem Cell Transplantation in the Treatment of T‐Cell Lymphoblastic Lymphoma

“…18 F-FDG PET/CT cannot well predict the OS of patients, but there is a strong correlation between the detection results and PFS, indicating that 18 F-FDG PET/CT detection can effectively guide the subsequent clinical treatment options. Ying et al [34] presented that, based on multivariate analysis, HSC transplantation after HDC treatment could predict survival using 18 F-FDG PET/CT detection in patients with lymphoma. Based on the above content, 18 F-FDG PET/CT can not only effectively monitor various reactions (drug sensitivity, adverse reactions, etc.)…”

“…Reference [34] PET results were associated with 3-year PFS [HR � 4.391, P � 0.001; HR � 7.607, P < 0.001] and OS (HR � 4.792, P � 0.008; HR � 26.138, P < 0.001).…”

“…In order to better explore the clinical and therapeutic effects of allogeneic hematopoietic stem cell transplantation, a number of studies have used positron emission tomography/computerized tomographic scanning (PET/ CT) for efficacy evaluation [18]. Studies have shown that 18 F-FDG PET/CT before and after allogeneic hematopoietic stem cell transplantation is a predictor of overall survival (OS) and disease-free survival (DFS) in acute leukemia (AL) [19,20].…”

Chinese Society of Clinical Oncology (CSCO) diagnosis and treatment guidelines for malignant lymphoma 2021 (English version)

“…Salvage chemotherapy with individualized regimens such as ICE (ifosfamide, carboplatin and etoposide), GDP (gemcitabine, dexamethasone and cisplatin) or DHAP (dexamethasone, high-dose cytarabine and cisplatin) is recommended for relapsed/refractory patients. Autologous stem cell transplantation (ASCT) consolidation is recommended for transplant-eligible patients who achieved remission from salvage therapy ( 7 ). Clinical trials including chimeric antigen receptor T-cell immunotherapy (CAR-T) are options, especially for patients who are ineligible for ASCT or resistant to salvage therapy.…”