title: Baseline total lesion glycolysis measured with (18)F-FDG PET/CT as a predictor of progression-free survival in diffuse large B-cell lymphoma: a pilot study.
abstract: This pilot study investigates the value of baseline total lesion glycolysis (TLG) in (18)F-FDG PET/CT scans for prediction of progression-free survival (PFS) in patients with Diffuse Large B-Cell Lymphoma (DLBCL). We also evaluate the role of other quantitative parameters measured at baseline and interim PET/CT for prediction of PFS. A retrospective review (2003-2010) of patients with DLBCL who underwent (18)F-FDG PET/CT before, after cycle two, and after completion of R-CHOP treatment, identified 84 patients. Twenty patients fulfilled the inclusion criteria. Standardized uptake values (SUVmax and SUVmean), total metabolic tumor volume (TMTV), and TLG were measured in baseline and interim PET/CT. Relationship between quantitative parameters and PFS was statistically analyzed using Log-rank test and univariate Cox-regression analysis. Of 20 patients (F/M: 7/13, range: 20-73 years), six patients (30%) developed recurrence after chemotherapy (mean follow-up: 51.35±17.05 months, range: 12-81 months). Results of statistical analysis showed TLG as the only discriminator of recurrence at baseline (cut-point: 704.77 g, HR: 11.21, CI: 1.29-97, P=0.02). Among the interim PET/CT parameters, SUVmean (cut -point: 2.07, HR: 6.31, CI: 1.25-31.61), SUVmax (cut-point: 2.3, HR: 6.31, CI: 1.25-31.61), and TLG (cut-point: 96.5 g, HR: 6.38, CI: 1.29 - 31.61) could all help predict PFS (P<0.05). Although not routinely reported, high baseline TLG may be a useful index to identify patients with DLBCL who are at increased risk for relapse after conventional R-CHOP. If confirmed in larger prospective studies, this may allow the selection of alternate therapeutic choices at the onset of treatment.
authors: Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital Boston, MA.
authors: Shadi A
authors: SA
authors: Esfahani
authors: Pedram
authors: P
authors: Heidari
authors: Elkan F
authors: EF
authors: Halpern
authors: Ephraim P
authors: EP
authors: Hochberg
authors: Edwin L
authors: EL
authors: Palmer
authors: Umar
authors: U
authors: Mahmood
keywords: 18F-FDG PET/CT; Diffuse large B-cell lymphoma; progression-free survival; quantitative parameters
references: Ann Nucl Med. 2011 Dec;25(10):701-16
references: 22037934
references: J Nucl Med. 2010 Dec;51(12):1857-62
references: 21078789
references: Int J Radiat Oncol Biol Phys. 2007 Oct 1;69(2):328-33
references: 17869659
references: Haematologica. 2000 Jun;85(6):613-8
references: 10870118
references: Blood. 2010 Sep 23;116(12):2040-5
references: 20548096
references: Leuk Lymphoma. 2009 Nov;50(11):1753-6
references: 19863178
references: J Nucl Med. 1994 Aug;35(8):1308-12
references: 8046485
references: Eur J Nucl Med Mol Imaging. 2010 Mar;37(3):494-504
references: 19820933
references: J Clin Oncol. 2007 Feb 10;25(5):571-8
references: 17242397
references: Nucl Med Commun. 2012 Sep;33(9):974-81
references: 22811258
references: Ann Hematol. 2012 May;91(5):697-703
references: 22071570
references: Int J Comput Assist Radiol Surg. 2013 Mar;8(2):181-91
references: 22644386
references: Nucl Med Commun. 2008 Jun;29(6):521-6
references: 18458598
references: Ann Nucl Med. 2011 Jul;25(6):406-13
references: 21409347
references: J Nucl Med. 2007 Oct;48(10):1626-32
references: 17873129
references: J Nucl Med. 2012 Oct;53(10):1506-13
references: 22895812
references: Radiology. 2012 Aug;264(2):559-66
references: 22692034
references: J Nucl Med. 2002 Aug;43(8):1018-27
references: 12163626
references: J Nucl Med. 2009 May;50 Suppl 1:122S-50S
references: 19403881
references: Cancer. 2013 Mar 15;119(6):1195-202
references: 23212736
references: Blood. 2012 Mar 1;119(9):2066-73
references: 22234681
references: Head Neck. 2013 Jan;35(1):15-22
references: 22307893
references: Acta Radiol. 2011 Nov 1;52(9):995-1002
references: 21948597
references: Nucl Med Commun. 2012 Jun;33(6):613-20
references: 22407127
references: Eur J Cancer. 2011 Jun;47(9):1312-8
references: 21334197
references: Blood. 2011 Jul 7;118(1):37-43
references: 21518924
references: Ann Surg Oncol. 2010 Oct;17(10):2787-94
references: 20461469
references: Radiology. 1999 Nov;213(2):521-5
references: 10551235
references: Cancer Imaging. 2007;7:10-8
references: 17766210
references: Acta Oncol. 2013 Apr;52(3):619-26
references: 22873767
references: J Clin Oncol. 2010 Sep 20;28(27):4184-90
references: 20660832
references: Ann Nucl Med. 2012 Jan;26(1):58-66
references: 22033780
references: Methods Mol Biol. 2011;727:1-19
references: 21331925
references: Ann Oncol. 2005 Sep;16(9):1514-23
references: 15980161
references: Cancer Sci. 2012 Mar;103(3):477-82
references: 22126515
references: Rev Esp Med Nucl Imagen Mol. 2013 May-Jun;32(3):162-6
references: 22831777