Risk-adapted FDG-PET/CT-based follow-up in patients with diffuse large B-cell lymphoma after first-line therapy.
BACKGROUND
The purpose of this study was to evaluate the impact of 2-[fluorine-18]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) during follow-up of patients with diffuse large B-cell lymphoma (DLBCL) being in complete remission or unconfirmed complete remission after first-line therapy.


METHODS
DLBCL patients receiving FDG-PET/CT during follow-up were analyzed retrospectively. Confirmatory biopsy was mandatory in cases of suspected disease recurrence.


RESULTS
Seventy-five patients were analyzed and 23 (30%) had disease recurrence. The positive predictive value (PPV) of FDG-PET/CT was 0.85. Patients >60 years [P = 0.036, hazard ratio (HR) = 3.82, 95% confidence interval (CI) 1.02-7.77] and patients with symptoms indicative of a relapse (P = 0.015; HR = 4.1; 95% CI 1.20-14.03) had a significantly higher risk for relapse. A risk score on the basis of signs of relapse, age >60 years, or a combination of these factors identified patients at high risk for recurrence (P = 0.041).


CONCLUSIONS
FDG-PET/CT detects recurrent DLBCL after first-line therapy with high PPV. However, it should not be used routinely and if only in selected high-risk patients to reduce radiation burden and costs. On the basis of our retrospective data, FDG-PET/CT during follow-up is indicated for patients <60 years with clinical signs of relapse and in patients >60 years with and without clinical signs of relapse.
Department of Oncology, University Hospital Zurich.
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Petrausch
Department of Oncology, University Hospital Zurich.
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Samaras
Biostatistics Unit, Institute of Social and Preventive Medicine, University of Zurich.
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Haile
Division of Nuclear Medicine, Department of Medical Radiology, University Hospital Zurich, Zürich, Switzerland.
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Veit-Haibach
Division of Nuclear Medicine, Department of Medical Radiology, University Hospital Zurich, Zürich, Switzerland.
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JD
Soyka
Department of Oncology, University Hospital Zurich.
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A
Knuth
Division of Nuclear Medicine, Department of Medical Radiology, University Hospital Zurich, Zürich, Switzerland.
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TF
Hany
Department of Oncology, University Hospital Zurich.
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A
Mischo
Department of Oncology, University Hospital Zurich.
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C
Renner
Department of Oncology, University Hospital Zurich; Division of Nuclear Medicine, Department of Medical Radiology, University Hospital Zurich, Zürich, Switzerland. Electronic address: niklaus.schaefer@usz.ch.
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Schäefer
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging* / Q000188:drug therapy; D049268:Positron-Emission Tomography; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents; D019788:Fluorodeoxyglucose F18