title: Week one FLT-PET response predicts complete remission to R-CHOP and survival in DLBCL.
abstract: Despite improved survival in the Rituximab (R) era, a considerable number of patients with diffuse large B-cell lymphoma (DLBCL) ultimately die from the disease. Functional imaging using [18F]fluorodeoxyglucose-PET is suggested for assessment of residual viable tumor very early during treatment but is compromised by non-specific tracer retention in inflammatory lesions. The PET tracer [18F]fluorodeoxythymidine (FLT) as surrogate marker of tumor proliferation may overcome this limitation. We present results of a prospective clinical study testing FLT-PET as superior and early predictor of response to chemotherapy and outcome in DLBCL. 54 patients underwent FLT-PET prior to and one week after the start of R-CHOP chemotherapy. Repetitive FLT-PET imaging was readily implemented into the diagnostic work-up. Our data demonstrate that the reduction of FLT standard uptake valuemean (SUVmean) and SUVmax one week after chemotherapy was significantly higher in patients achieving complete response (CR, n=48; non-CR, n=6; p<0.006). Martingale-residual and Cox proportional hazard analyses showed a significant monotonous decrease of mortality risk with increasing change in SUV. Consistent with these results, early FLT-PET response showed relevant discriminative ability in predicting CR. In conclusion, very early FLT-PET in the course of R-CHOP chemotherapy is feasible and enables identification of patients at risk for treatment failure.
authors: Department of Nuclear Medicine, Technische Universität München, Munich, Germany. Department of Nuclear Medicine, Universitätsklinikum Würzburg, Würzburg, Germany. These Authors contributed equally to this work.
authors: Ken
authors: K
authors: Herrmann
authors: Department of Nuclear Medicine, Technische Universität München, Munich, Germany. Department of Nuclear Medicine, Universitätsklinikum Würzburg, Würzburg, Germany. These Authors contributed equally to this work.
authors: Andreas K
authors: AK
authors: Buck
authors: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
authors: Tibor
authors: T
authors: Schuster
authors: III. Medical Department, Technische Universität München, Munich, Germany.
authors: Kathrin
authors: K
authors: Abbrederis
authors: Department of Nuclear Medicine, Universitätsklinikum Würzburg, Würzburg, Germany.
authors: Christina
authors: C
authors: Blümel
authors: Department of Nuclear Medicine, Technische Universität München, Munich, Germany.
authors: Ivan
authors: I
authors: Santi
authors: Institute of Pathology, Technische Universität München, Munich, Germany. Institute of Pathology, Universitätsklinikum Würzburg, Würzburg, Germany.
authors: Martina
authors: M
authors: Rudelius
authors: Department of Nuclear Medicine, Technische Universität München, Munich, Germany.
authors: Hans-Jürgen
authors: HJ
authors: Wester
authors: III. Medical Department, Technische Universität München, Munich, Germany.
authors: Christian
authors: C
authors: Peschel
authors: Department of Nuclear Medicine, Technische Universität München, Munich, Germany.
authors: Markus
authors: M
authors: Schwaiger
authors: III. Medical Department, Technische Universität München, Munich, Germany. Oncology Ravensburg, Ravensburg, Germany.
authors: Tobias
authors: T
authors: Dechow
authors: III. Medical Department, Technische Universität München, Munich, Germany.
authors: Ulrich
authors: U
authors: Keller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D000069283:Rituximab; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone