Noninvasive phosphorus magnetic resonance spectroscopic imaging predicts outcome to first-line chemotherapy in newly diagnosed patients with diffuse large B-cell lymphoma.
OBJECTIVE
Based on their association with malignant proliferation, using noninvasive phosphorus MR spectroscopic imaging ((31)P MRSI), we measured the tumor content of the phospholipid-related phosphomonoesters (PME), phosphoethanolamine and phospholcholine, and its correlation with treatment outcome in newly diagnosed patients with diffuse large B-cell lymphoma (DLBCL) receiving standard first-line chemotherapy.


METHODS
The PME value normalized to nucleoside triphosphates (PME/NTP) was measured using (31)P MRSI in tumor masses of 20 patients with DLBCL before receiving standard first-line chemotherapy. Response at 6 months was complete in 13 patients and partial in seven. Time to treatment failure (TTF) was ≤11 months in eight patients, from 18 to 30 months in three, and ≥60 months in nine.


RESULTS
On a t test, the pretreatment tumor PME/NTP mean value (SD, n) of patients with a complete response at 6 months was 1.42 (0.41, 13), which was significantly different from the value of 2.46 (0.40, 7) in patients with partial response (P < .00001). A Fisher test significantly correlated the PME/NTP values with response at 6 months (sensitivity and specificity at 0.85, P < .004) while a Cox proportional hazards regression significantly correlated the PME/NTP values with TTF (hazard ratio = 5.21, P < .02). A Kaplan-Meier test set apart a group entirely composed of patients with TTF ≤ 11 months (hazard ratio = 8.66, P < .00001).


CONCLUSIONS
The pretreatment tumor PME/NTP values correlated with response to treatment at 6 months and time to treatment failure in newly diagnosed patients with DLBCL treated with first-line chemotherapy, and therefore they could be used to predict treatment outcome in these patients.
Department of Radiology, Columbia University, 710 W 168th St., Neurological Institute Basement, Room B-057, New York, NY 10032, USA. fa2003@columbia.edu
Fernando
F
Arias-Mendoza
Geoffrey S
GS
Payne
Kristen
K
Zakian
Marion
M
Stubbs
Owen A
OA
O'Connor
Hamed
H
Mojahed
Mitchell R
MR
Smith
Adam J
AJ
Schwarz
Amita
A
Shukla-Dave
Franklyn
F
Howe
Harish
H
Poptani
Seung-Cheol
SC
Lee
Ruth
R
Pettengel
Steven J
SJ
Schuster
David
D
Cunningham
Arend
A
Heerschap
Jerry D
JD
Glickson
John R
JR
Griffiths
Jason A
JA
Koutcher
Martin O
MO
Leach
Truman R
TR
Brown
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D014408:Biomarkers, Tumor / Q000032:analysis*; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000175:diagnosis* / Q000378:metabolism*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010743:Phospholipids / Q000032:analysis*; D010759:Phosphorus Isotopes / Q000032:analysis; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
D014408:Biomarkers, Tumor; D010743:Phospholipids; D010759:Phosphorus Isotopes; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
In vivo; MR spectroscopy; lymphoma; metabolic imaging; prediction of therapy outcome