Utility of interim and end‐of‐treatment PET/CT in peripheral T‐cell lymphomas: A review of 124 patients

Abstract

According to the updated guidelines for imaging in lymphoma, 18F-FDG positron emission tomography/ computed tomography (PET/CT) is recommended for staging and evaluation of treatment response in FDGavid lymphomas. The purpose of the study was to evaluate the utility of PET/CT in nodal peripheral T-cell lymphomas (PTCL). Patients with newly diagnosed nodal PTCL (peripheral T-cell lymphoma NOS, anaplastic large-cell lymphoma, or angioimmunoblastic T-cell lymphoma) seen at five Danish hematology centers during the period 2006 to 2012 were included, if they had been pretherapeutically staged with PET/CT. Medical records were reviewed for baseline clinical and follow-up information. Staging, interim (I-PET), and end-of-treatment PET/CT (E-PET) studies were centrally reviewed, and reported using the Deauville 5-point score (DS). A total of 124 patients fulfilled the inclusion criteria. The median age was 58 years, and 88% received CHOP/CHOP-like therapy. Five years PFS and OS of the study population was 36.8% (95% CI 27.3-46.4) and 49.7% (95% CI 38.9-59.6), respectively. The presence of PET/CT-ascertained lung and/or liver involvement was associated with a worse outcome. The sensitivity of PET/CT for detecting biopsy-defined bone marrow involvement was only 18% (95% CI 4-43). An interim DS >3 was not prognostic for worse OS and PFS among CHOP/CHOP-like treated patients in uni-or multivariate analyses. A DS >3 after treatment predicted a worse prognosis. In conclusion, I-PET was not predictive of outcome in CHOP/CHOP-like treated PTCL patients when using the DS. Prospective studies are needed to determine the optimal use of PET/CT in PTCL including the role of quantitative PET/CT analysis.

18F-FDG PET for Measurement of Response and Prediction of Outcome to Relapsed or Refractory Mantle Cell Lymphoma Therapy with Bendamustine–Rituximab

“…Reports assessing the predictive value of 18 F-FDG PET after chemotherapy (most retrospective, with some prospective analyses in time-to-event studies) include the following hematologic malignancies: MCL (11,17,18), follicular lymphoma (19,20), chronic lymphoid leukemia/DLBCL (12,(21)(22)(23), and peripheral T-cell lymphomas (24).…”

Peripheral T-cell lymphoma, not otherwise specified

“…However, a more accurate description of disease extent at diagnosis, in particular in terms of extranodal presentation, may prove useful in response assessment and follow-up evaluation, and may also convey some prognostic information, given that the involvement of liver or lung has proven to be related to a possible worse outcome. 30 PET positivity found at the end of induction treatment 30,31 and in patients who have received autologous stem cell transplantation (autoSCT) is a strong predictor of reduced survival, 32 and this seems particularly true for PTCL-NOS and AITL patients. On the contrary, uncertainty still exists on the role of interim PET evaluation during induction treatment.…”

Predictive Value of PET Response Combined with Baseline Metabolic Tumor Volume in Peripheral T-Cell Lymphoma Patients

“…Of the 140 patients, 108 were part of a previously published study on the prognostic value of TMTV (5). In addition, 14 Danish patients were part of another previously published study (14); in the current study, the follow-up period of that previous study was extended from 29 to 47 mo. The current study was conducted in accordance with the Helsinki declaration and was approved by the Ethical Committee with a waiver of informed consent because of its retrospective, observational nature.…”

“…In PTCL, data concerning early response assessment with iPET are limited, as are the data on PET at the end of treatment (eotPET) for remission assessment. Studies have included relatively small numbers of patients with few comparisons between iPET and eotPET, with conflicting results (9)(10)(11)(12)(13)(14)(15). In this study, we evaluated the predictive value of PET restaging-both iPET and eotPET-and ascertained whether treatment response could be combined with TMTV to improve early stratification in nodal PTCL.…”