Prognostic impact of pre-transplantation computed tomography and 67gallium scanning in chemosensitive diffuse large B cell lymphoma patients undergoing hematopoietic stem-cell transplantation.
OBJECTIVE
In the present study, we evaluated computed tomography (CT) and (67)gallium scanning ((67)Ga scan) pre-transplant as prognostic factors for overall survival (OS) and event-free survival (EFS) in patients with diffuse large B cell lymphoma, undergoing high-dose chemotherapy and stem-cell transplantation.


METHODS
Forty-two patients were included. Of these, 9 (21%) had both positive CT and (67)Ga scans, 17 (41%) negative results with both techniques, and 16 (38%) positive CT/negative (67)Ga scan. Whole-body planar imaging and single-photon emission computed tomography (SPECT) were performed 72 h after an intravenous administration of (67)Ga citrate measuring between 7 mCi and 10 mCi (259-370 MBq).


RESULTS
Patients with positive CT/positive (67)Ga scan had a significantly worse EFS and OS at 5 years than those with negative (67)Ga scan regardless of whether it was associated with a positive or a negative CT scan (29% and 16% vs. 81% and 93% vs. 88% and 100%, respectively, P < 0.001). After a median follow-up of 43 months (range 4-130 months), no differences were observed between patients with negative CT/negative (67)Ga scan and those with positive CT/negative (67)Ga scan, with an EFS and OS at 5 years of 88% versus 81% and 100% versus 93%, respectively. In multivariate analysis, the presence of a pre-transplant positive CT/(67)Ga scans adversely influenced both EFS and OS [HR 8, 95% confidence interval (CI) (1.4-38), P = 0.03 and HR 2; 95% CI (1.3-8), P = 0.02, respectively].


CONCLUSIONS
(67)Ga scan helps to identify, in the pre-transplant evaluation, two groups with a different outcome: one group of patients with positive CT and negative (67)Ga scans pre-transplant, who showed a favorable outcome with a low rate of relapse, and the other group of patients with both positive CT and (67)Ga scans pre-transplant, who showed a poor prognosis and did not benefit from autologous stem-cell transplantation. They should have been offered other therapeutic strategies.
Department of Hematology, University Clínic Hospital of Salamanca, Paseo de San Vicente s/n, Salamanca, Spain. naxto@hotmail.com
Ignacio G
IG
Escobar
Pilar T
PT
Alonso
Dolores C
DC
Barrigon
Jose A
JA
Perez-Simon
Maria V
MV
Mateos Manteca
Jesus F
JF
San Miguel Izquierdo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000592:standards; D018572:Disease-Free Survival; D005260:Female; D005710:Gallium Radioisotopes / Q000493:pharmacokinetics*; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality / Q000592:standards; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012008:Recurrence; D012074:Remission Induction; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D051598:Whole Body Imaging
D005710:Gallium Radioisotopes; D019275:Radiopharmaceuticals