title: Conventional allogeneic hematopoietic stem cell transplantation for lymphoma may overcome the poor prognosis associated with a positive FDG-PET scan before transplantation.
abstract: A positive scan in pretransplantation fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) has been shown to be associated with a poor prognosis in patients with lymphoma undergoing high-dose chemotherapy followed by autologous stem cell transplantation (ASCT). For those with a positive FDG-PET scan, treatment that includes allogeneic stem cell transplantation (allo-SCT) may be an alternative. However, it is uncertain whether allo-SCT can overcome a poor prognosis. Therefore, we conducted a retrospective analysis of 14 patients with lymphoma who had undergone FDG-PET scan within one month before allo-SCT at our institution. Eleven patients were FDG-PET-positive and three were negative. With a median follow-up of 17 months (range: 6-44) after allo-SCT, the cumulative incidence of progression was 29.3% in FDG-PET-positive patients and 0% in the FDG-PET-negative patients. Four of the 11 patients who had post-transplantation FDG-PET showed FDG-avid lesions on the first post-transplantation scan. In two of the four, regression of the lesions was observed during the scheduled reduction of immunosuppressant without donor lymphocyte infusion and remained without progression at the last follow-up (34 and 8 months). Durable responses after allo-SCT, at least with conventional conditioning regimens, can be expected in patients with FDG-PET-positive lesions before transplantation. Thus, conventional allo-SCT could be an attractive modality compared to ASCT for patients with positive FDG-PET after the completion of conventional salvage chemotherapy, and particularly for patients with T and NK-cell lymphomas.
authors.affiliation: Department of Hematology and Oncology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Akihide
authors.initials: A
authors.lastname: Yoshimi
authors.forename: Koji
authors.initials: K
authors.lastname: Izutsu
authors.forename: Miwako
authors.initials: M
authors.lastname: Takahashi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kako
authors.forename: Kumi
authors.initials: K
authors.lastname: Oshima
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
authors.forename: Toru
authors.initials: T
authors.lastname: Motokura
authors.forename: Shigeru
authors.initials: S
authors.lastname: Chiba
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Momose
authors.forename: Kuni
authors.initials: K
authors.lastname: Ohtomo
authors.forename: Mineo
authors.initials: M
authors.lastname: Kurokawa
mesh_terms: D000328:Adult; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008223:Lymphoma / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D019788:Fluorodeoxyglucose F18