title: PET/CT before autologous stem cell transplantation predicts outcome in refractory/relapsed follicular lymphoma.
abstract: OBJECTIVE
  Salvage of young patients with follicular lymphoma (FL) after R-CHOP includes salvage immunochemotherapy followed by autologous stem cell transplantation (ASCT). Previous studies dealing with relapsed Hodgkin lymphoma have shown the prognostic value of PET/CT prior to ASCT.
  
  
  METHODS
  We retrospectively analysed 59 patients with refractory/relapsed FL after first-line R-CHOP who were chemosensitive (as evaluated by CT) to the salvage treatment and who proceeded to ASCT. The role of PET/CT in this setting to define chemosensitivity is not definitely established. So we focused on the prognostic value of PET/CT performed after salvage treatment, before ASCT.
  
  
  RESULTS
  The estimated 3-year progression-free survival (PFS) and overall survival were 63.1% (50.9-78.3%) and 90.5% (82.8 - 98.8%), respectively, and did not differ significantly according to their Follicular Lymphoma International Prognostic Index at relapse, conditioning regimen, or type of salvage. PFS was significantly lower in PET/CT-positive patients, according to the International Harmonization Project revised response criteria, with a 3-year PFS of 45.5% (26.6 - 77.8%) versus 72.6% (58.5 - 90.0%; p = 0.039). To better refine prognosis, we applied two types of throsholds: a Deauville five-point scale positive threshold of ≥3 (3-year PFS of 74.9%, range 61.0 - 92.1% %, versus 42.8%, range 24.7 - 74.4%; p = 0.02), and a ≥70% ∆SUVmax threshold between presalvage and pre-ASCT PET/CT (3-year PFS of 72.4%, range 57.5 - 91.3% versus 13.3%, 2.2 - 81.7%; p < 10(-3)). The PET/CT findings before ASCT were independently correlated with PFS in our series.
  
  
  CONCLUSIONS
  PET/CT negativity before ASCT is a desirable and achievable goal in the management of chemosensitive FL relapsing after first-line R-CHOP.
authors.affiliation: Service d'Hématologie, Centre Henri Becquerel, Université de Rouen, rue d'Amiens, Rouen, Cedex 760381, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Alcantara
authors.forename: Jehan
authors.initials: J
authors.lastname: Dupuis
authors.forename: Sylvain
authors.initials: S
authors.lastname: Mareschal
authors.forename: Anne
authors.initials: A
authors.lastname: Julian
authors.forename: Anne Ségolène
authors.initials: AS
authors.lastname: Cottereau
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Becker
authors.forename: Sydney
authors.initials: S
authors.lastname: Dubois
authors.forename: Lucie
authors.initials: L
authors.lastname: Oberic
authors.forename: Anne
authors.initials: A
authors.lastname: Huynh
authors.forename: Michel
authors.initials: M
authors.lastname: Meignan
authors.forename: Guy
authors.initials: G
authors.lastname: Laurent
authors.forename: Hervé
authors.initials: H
authors.lastname: Tilly
authors.forename: Corinne
authors.initials: C
authors.lastname: Haioun
authors.forename: Loïc
authors.initials: L
authors.lastname: Ysebaert
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008224:Lymphoma, Follicular / Q000000981:diagnostic imaging* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000628:therapy; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D033581:Stem Cell Transplantation; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous; D016896:Treatment Outcome