title: Phase II study of risk-adapted therapy of newly diagnosed, aggressive non-Hodgkin lymphoma based on midtreatment FDG-PET scanning.
abstract: In newly diagnosed aggressive non-Hodgkin lymphoma (NHL), a positive midtreatment fluorine-18 fluorodeoxyglucose positron emission tomography (PET) scan often carries a poor prognosis, with reported 2-year event-free survival (EFS) rates of 0% to 30% after standard therapy. To determine the outcome of early treatment intensification for midtreatment PET-positive disease, a phase II trial of risk-adapted therapy was conducted. Fifty-nine newly diagnosed patients, 98% with B cell lymphoma, had PET/CT performed after 2 or 3 cycles of first-line chemotherapy. Those with negative PET on semiquantitative visual interpretation completed standard therapy. Those with positive PET received platinum-based salvage chemotherapy, high-dose therapy, and autologous stem cell transplantation (ASCT). Midtreatment PET was positive in 33 (56%); 28 received ASCT with an actuarial 2-year EFS of 75% (95% confidence interval, 60%-93%). On intention-to-treat analysis, 2-year EFS was 67% (53%-86%) in all PET-positive patients and 89% (77%-100%) in PET-negative patients. No association was found between the International Prognostic Index category and the midtreatment PET result. The favorable outcome achieved here in historically poor-risk patients warrants further, more definitive investigation of treatment modification based on early PET scanning.
authors.affiliation: Johns Hopkins University, Baltimore, Maryland, USA. ykasamo1@jhmi.edu
authors.forename: Yvette L
authors.initials: YL
authors.lastname: Kasamon
authors.forename: Richard L
authors.initials: RL
authors.lastname: Wahl
authors.forename: Harvey A
authors.initials: HA
authors.lastname: Ziessman
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Blackford
authors.forename: Steven N
authors.initials: SN
authors.lastname: Goodman
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Fidyk
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Rogers
authors.forename: Javier
authors.initials: J
authors.lastname: Bolaños-Meade
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Borowitz
authors.forename: Richard F
authors.initials: RF
authors.lastname: Ambinder
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Jones
authors.forename: Lode J
authors.initials: LJ
authors.lastname: Swinnen
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D019788:Fluorodeoxyglucose F18; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016393:Lymphoma, B-Cell / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017671:Platinum Compounds / Q000627:therapeutic use; D049268:Positron-Emission Tomography; D011379:Prognosis; D018570:Risk Assessment; D016879:Salvage Therapy / Q000379:methods; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D017671:Platinum Compounds; D019788:Fluorodeoxyglucose F18