title: Predictive value of interim ¹⁸F-FDG-PET/CT for event-free survival in patients with diffuse large B-cell lymphoma homogenously treated in a phase II trial with six cycles of R-CHOP-14 plus pegfilgrastim as first-line treatment.
abstract: OBJECTIVE
  The predictive value of interim PET/computed tomography (I-PET/CT) in diffuse large B-cell lymphoma (DLBCL) is controversial. Our aim was to evaluate the predictive value of I-PET/CT for an event-free survival.
  
  
  METHODS
  We analyzed patients with DLBCL included in a prospective clinical trial who were treated with six cycles of dose-dense R-CHOP followed by pegfilgrastim and who had undergone an I-PET/CT (after two cycles) and a final PET [F-PET/CT (60 days after the sixth cycle)]. Event was defined as nonresponse, relapse, or death.
  
  
  RESULTS
  A total of 69 patients were included. Their median age was 60 years; 54% were male, 25% had bulky disease, and 67% had an International Prognostic Index of 0-2. The median follow-up duration was 28.8 months. I-PET/CT was positive in 34 (49%) patients and F-PET/CT was positive in 12 (17.4%). The 3-year event-free survival was 86% for patients who were I-PET/CT negative as against 64% for those who were I-PET/CT positive (P=0.036). The negative and positive predictive values, sensitivity, and specificity of I-PET/CT for an event were 83, 32, 65, and 56%, respectively. In a multivariate analysis including baseline characteristics, I-PET/CT, and F-PET/CT, F-PET/CT was the only significant predictor (P<0.0005).
  
  
  CONCLUSIONS
  In patients with DLBCL treated with dose-dense R-CHOP plus pegfilgrastim, a negative I-PET/CT is highly predictive of a favorable outcome and a positive I-PET/CT is of limited clinical value. These results do not support treatment intensification after a short course of chemotherapy based solely on a positive I-PET/CT.
authors.affiliation: Department of Hematology, Institut Català d'Oncologia, Hospital Duran i Reynals, Spain. e.gonzalez@iconcologia.net
authors.forename: Eva
authors.initials: E
authors.lastname: González-Barca
authors.forename: Miguel
authors.initials: M
authors.lastname: Canales
authors.forename: Montse
authors.initials: M
authors.lastname: Cortés
authors.forename: M Jesus
authors.initials: MJ
authors.lastname: Vidal
authors.forename: Antonio
authors.initials: A
authors.lastname: Salar
authors.forename: Albert
authors.initials: A
authors.lastname: Oriol
authors.forename: Joan
authors.initials: J
authors.lastname: Bargay
authors.forename: José L
authors.initials: JL
authors.lastname: Bello
authors.forename: José J
authors.initials: JJ
authors.lastname: Sánchez
authors.forename: José F
authors.initials: JF
authors.lastname: Tomás
authors.forename: Eva
authors.initials: E
authors.lastname: Donato
authors.forename: Secundino
authors.initials: S
authors.lastname: Ferrer
authors.forename: Dolores
authors.initials: D
authors.lastname: Caballero
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols; D003520:Cyclophosphamide; D018572:Disease-Free Survival; D004317:Doxorubicin; D005260:Female; D000069585:Filgrastim; D019788:Fluorodeoxyglucose F18; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D011092:Polyethylene Glycols; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011241:Prednisone; D011994:Recombinant Proteins / Q000627:therapeutic use; D012008:Recurrence; D000069283:Rituximab; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D014750:Vincristine; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D011994:Recombinant Proteins; D019788:Fluorodeoxyglucose F18; D016179:Granulocyte Colony-Stimulating Factor; C455861:pegfilgrastim; D011092:Polyethylene Glycols; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D000069585:Filgrastim; D011241:Prednisone