Risk stratification on the basis of Deauville score on PET-CT and the presence of Epstein-Barr virus DNA after completion of primary treatment for extranodal natural killer/T-cell lymphoma, nasal type: a multicentre, retrospective analysis

Kim, Seok Jin; Choi, Joon Young; Hyun, Seung Hyup; Ki, Chang‐Seok; Oh, Dongryul; Ahn, Yong Chan; Ko, Young Hyeh; Choi, Sung Yong; Jung, Sin‐Ho; Khong, Pek‐Lan; Tang, Tiffany; Yan, Xuexian; Lim, Soon Thye; Kwong, Yok–Lam; Kim, Won Seog

doi:10.1016/s2352-3026(15)00002-2

Cited by 83 publications

(80 citation statements)

References 23 publications

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“…Owing to the remarkably lower PPV, a biopsy may be required if further treatment is considered. In our study, the E-PET was an independent predictor of PFS and OS in ENKL, and this result was consistent with the findings of Jiang C15 and Kim SJ46. A study that used the SMILE protocol, mentioned above, also showed that the 5-PS score of the E-PET was a significant independent predictor of both PFS ( P = 0.014) and OS ( P = 0.018)18.…”

Section: Discussionsupporting

confidence: 91%

Utility of baseline, interim and end-of-treatment 18F-FDG PET/CT in extranodal natural killer/T-cell lymphoma patients treated with L-asparaginase/pegaspargase

Chang

Sun

et al. 2017

Sci Rep

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Positron emission tomography-computed tomography (PET/CT) is widely used for initial staging and monitoring treatment responses in Hodgkin and diffuse large B-cell lymphoma. However, its prognostic value in extranodal natural killer (NK)/T-cell lymphoma (ENKL) remains unclear. Here, we conducted a retrospective study to determine the impact of PET/CT in ENKL. Fifty-two patients newly diagnosed with ENKL were enrolled. Baseline maximum standardized uptake values (SUVmax), whole-body metabolic tumor volume (WBMTV) and whole-body total lesion glycolysis (WBTLG) were recorded. Additionally, interim PET/CT (I-PET) and end-of-treatment PET/CT (E-PET) results were scored using a 5-point scale. Patients were divided into groups using baseline parameter cut-off values; significant differences were found in overall survival (OS) and progression-free survival (PFS) between the high and low WBMTV and WBTLG groups and in OS between the two SUVmax groups. Positive I-PET and E-PET results predicted inferior PFS and OS. A multivariate analysis showed that baseline WBTLG, I-PET and E-PET results were associated with PFS and OS, and baseline SUVmax was an independent predictor of OS. Thus, baseline WBTLG, I-PET and E-PET results are good predictors of PFS and OS in ENKL patients who received L-asparaginase/pegaspargase in their first-line treatment, and baseline SUVmax is a valuable tool for assessing OS.

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Section: Discussionsupporting

confidence: 91%

Utility of baseline, interim and end-of-treatment 18F-FDG PET/CT in extranodal natural killer/T-cell lymphoma patients treated with L-asparaginase/pegaspargase

Chang

Sun

et al. 2017

Sci Rep

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“…Recent reports from retrospective studies suggest that posttreatment PET/CT using the Deauville 5PS may be a valuable tool for response assessment in patients with newly diagnosed and R/R disease. [53][54][55] In a retrospective analysis of 102 patients with newly diagnosed ENKL, Deauville 5PS and EBV DNA after completion of initial treatment were independently associated with PFS and OS in the multivariable analysis. 54 Given the primarily extranodal sites of involvement often outside of the chest, abdomen, and pelvis, PET/CT is also preferred for followup to better assess these sites.…”

Section: Response Assessment and Additional Therapymentioning

confidence: 99%

NCCN Guidelines Insights: T-Cell Lymphomas, Version 2.2018

Horwitz

Ansell

et al. 2018

J Natl Compr Canc Netw

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Natural killer (NK)/T-cell lymphomas are a rare and distinct subtype of non-Hodgkin's lymphomas. NK/T-cell lymphomas are predominantly extranodal and most of these are nasal type, often localized to the upper aerodigestive tract. Because extranodal NK/T-cell lymphomas (ENKL) are rare malignancies, randomized trials comparing different regimens have not been conducted to date and standard therapy has not yet been established for these patients. These NCCN Guidelines Insights discuss the recommendations for the diagnosis and management of patients with ENKL as outlined in the NCCN Guidelines for T-Cell Lymphomas.

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“…7,20 Published data using PET scans for patients with ENKTL are sparse, but several parameters, such as standardized uptake value (SUVmax), whole-body metabolic tumor volume, and recently, Deauville score have shown good correlation with clinical outcomes. 12,21 In the current study, we applied a Deauville score based on PET/CT to assess tumor response, because it has been reported to be feasible and reproducible, with good interobserver agreement. 22 So far consensus has not been achieved on the positive and negative thresholds of Deauville five-point scale, recent studies have suggested the prognostic value of negative PET/CT response (DS 1-3) before ASCT for significant PFS and OS in patients with diffuse large B-cell lymphoma and follicular lymphoma.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, we recently reported that treatment failure after completion of primary treatment was more frequent in ENKTL patients with posttreatment DS 1-2 who tested positive for EBV than those who were EBV-negative (67% vs 15%) and suggested that posttreatment Deauville score on PET-CT scan with the presence of EBV DNA could predict the risk of treatment failure more accurately. 12 Therefore, we hypothesized that prognostic impact could be increased by a combined evaluation of tumor response and EBV DNA status at the time of pretransplantation evaluation. As a result, the statistical significance obtained for both PFS and OS (P = 0.019 and P = 0.017, Figure 2) and pretransplant DS based on PET-CT and EBV DNA was the only significant prognostic factor influencing progression and survival after ASCT, regardless of NKPI, IPI and stage.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, our group suggested that post-treatment Deauville score (DS) based on PET/CT scan combined with the status of circulating EBV DNA at the end of treatment could predict the risk of treatment failure in patients with ENKTL. 12 Therefore, in this study, we aimed to assess the prognostic value of pretransplant DS on PET/CT in conjunction with whole-blood EBV DNA positivity in patients with ENKTL who underwent autologous stem cell transplantation.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic relevance of pretransplant Deauville score on PET-CT and presence of EBV DNA in patients who underwent autologous stem cell transplantation for ENKTL

Lim

et al. 2016

Bone Marrow Transplant

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High-dose chemotherapy and autologous stem cell transplantation (ASCT) for extranodal natural killer/T-cell lymphoma (ENKTL) is a reasonable option for a subset of patients. The impact of response status, according to positron emission tomography/computed tomography (PET/CT) results and/or presence of circulating EBV DNA prior to ASCT, has not yet been established. We analyzed 27 ENKTL patients with pre-ASCT circulating EBV DNA who had undergone pre-ASCT PET/CT between 2009 and 2014. We classified patients into two groups based on the result of pretransplantation assessment: a favorable risk group (pretransplant five-point Deauville score (DS) of 1-2 based on PET/CT and no detectable EBV DNA) and an unfavorable risk group (DS 1-2 with detectable EBV DNA, DS 3-5 with or without detectable EBV DNA). After a median follow-up of 37 months, overall survival and PFS were significantly different between the two groups (median OS: not reached for favorable risk group vs 7.0 months for unfavorable risk group, P = 0.017; median PFS: 16.0 vs 5.0 months, P = 0.019). Multivariate analysis revealed that pre-ASCT DS and EBV DNA was the only independent prognostic factor considering stage, IPI and NKPI. Precise assessment of the status of disease before transplantation may provide more benefit from ASCT to ENKTL patients.Bone Marrow Transplantation (2016) 51, 807-812; doi:10.1038/bmt.2016.6; published online 8 February 2016 INTRODUCTIONExtranodal natural killer/T-cell lymphoma (ENKTL) is a rare and distinct subtype of non-Hodgkin lymphoma (NHL), which is characterized by clinically aggressive behavior leading to poor survival among all T-cell lymphoma subtypes. 1 Concurrent chemoradiotherapy (CCRT) followed by chemotherapy has shown promising results with manageable toxicities for localized disease, 2,3 and the application of nonanthracycline-based chemotherapy incorporating L-asparaginase has improved survival outcome of advanced, relapsed or refractory ENKTL patients. [4][5][6] However, treatment failure still occurs frequently, and thus the unmet need persists for additional therapies to improve outcomes for patients with ENKTL. Accordingly, highdose chemotherapy with autologous stem cell transplantation (ASCT) has been evaluated as a consolidation therapy for ENKTL. However, previous studies have failed to clearly determine the efficacy of ASCT, because most of them were retrospective analyses with small sample sizes, and the enrolled patient populations were very heterogeneous, including various transplantation settings. 7-11 Moreover, although previous data showed that disease status at the time of ASCT was the most important prognostic factor for survival and relapse-free survival, 9,11 the optimal response assessment with respect to existing computed tomography (CT) scans, positron emission tomography/computed tomography (PET/CT) findings, and EBV

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Risk stratification on the basis of Deauville score on PET-CT and the presence of Epstein-Barr virus DNA after completion of primary treatment for extranodal natural killer/T-cell lymphoma, nasal type: a multicentre, retrospective analysis

Cited by 83 publications

References 23 publications

Utility of baseline, interim and end-of-treatment 18F-FDG PET/CT in extranodal natural killer/T-cell lymphoma patients treated with L-asparaginase/pegaspargase

Utility of baseline, interim and end-of-treatment 18F-FDG PET/CT in extranodal natural killer/T-cell lymphoma patients treated with L-asparaginase/pegaspargase

NCCN Guidelines Insights: T-Cell Lymphomas, Version 2.2018

Prognostic relevance of pretransplant Deauville score on PET-CT and presence of EBV DNA in patients who underwent autologous stem cell transplantation for ENKTL

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