title: Risk-adapted dose-dense immunochemotherapy determined by interim FDG-PET in Advanced-stage diffuse large B-Cell lymphoma.
abstract: PURPOSE In studies of diffuse large B-cell lymphoma, positron emission tomography with [(18)F]fluorodeoxyglucose (FDG-PET) performed after two to four cycles of chemotherapy has demonstrated prognostic significance. However, some patients treated with immunochemotherapy experience a favorable long-term outcome despite a positive interim FDG-PET scan. To clarify the significance of interim FDG-PET scans, we prospectively studied interim FDG-positive disease within a risk-adapted sequential immunochemotherapy program. PATIENTS AND METHODS From March 2002 to November 2006, 98 patients at Memorial Sloan-Kettering Cancer Center received induction therapy with four cycles of accelerated R-CHOP (rituximab + cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by an interim FDG-PET scan. If the FDG-PET scan was negative, patients received three cycles of ICE (ifosfamide, carboplatin, and etoposide) consolidation therapy. If residual FDG-positive disease was seen, patients underwent biopsy; if the biopsy was negative, they also received three cycles of ICE. Patients with a positive biopsy received ICE followed by autologous stem-cell transplantation. RESULTS At a median follow-up of 44 months, overall and progression-free survival were 90% and 79%, respectively. Ninety-seven patients underwent interim FDG-PET scans; 59 had a negative scan, 51 of whom are progression free. Thirty-eight patients with FDG-PET-positive disease underwent repeat biopsy; 33 were negative, and 26 remain progression free after ICE consolidation therapy. Progression-free survival of interim FDG-PET-positive/biopsy-negative patients was identical to that in patients with a negative interim FDG-PET scan (P = .27). CONCLUSION Interim or post-treatment FDG-PET evaluation did not predict outcome with this dose-dense, sequential immunochemotherapy program. Outside of a clinical trial, we recommend biopsy confirmation of an abnormal interim FDG-PET scan before changing therapy.
authors.affiliation: Departments of Medicine, Radiology, Pathology, and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA. moskowic@mskcc.org
authors.forename: Craig H
authors.initials: CH
authors.lastname: Moskowitz
authors.forename: Heiko
authors.initials: H
authors.lastname: Schöder
authors.forename: Julie
authors.initials: J
authors.lastname: Teruya-Feldstein
authors.forename: Camelia
authors.initials: C
authors.lastname: Sima
authors.forename: Alexia
authors.initials: A
authors.lastname: Iasonos
authors.forename: Carol S
authors.initials: CS
authors.lastname: Portlock
authors.forename: David
authors.initials: D
authors.lastname: Straus
authors.forename: Ariela
authors.initials: A
authors.lastname: Noy
authors.forename: Maria L
authors.initials: ML
authors.lastname: Palomba
authors.forename: Owen A
authors.initials: OA
authors.lastname: O'Connor
authors.forename: Steven
authors.initials: S
authors.lastname: Horwitz
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Weaver
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Meikle
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Filippa
authors.forename: James F
authors.initials: JF
authors.lastname: Caravelli
authors.forename: Paul A
authors.initials: PA
authors.lastname: Hamlin
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Zelenetz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011241:Prednisone / Q000008:administration & dosage; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012307:Risk Factors; D000069283:Rituximab; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone