title: Utility of baseline 18FDG-PET/CT functional parameters in defining prognosis of primary mediastinal (thymic) large B-cell lymphoma.
abstract: The International Extranodal Lymphoma Study Group (IELSG) 26 study was designed to evaluate the role of (18)F-fluorodeoxyglucose (18FDG) positron emission tomography/computed tomography (PET/CT) in the management of primary mediastinal (thymic) large B-cell lymphoma (PMBCL). We examined the prognostic impact of functional PET parameters at diagnosis. Metabolic activity defined by the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) was measured on baseline 18FDG PET/CT following a standard protocol in a prospectively enrolled cohort of 103 PMBCL patients. All received combination chemoimmunotherapy with doxorubicin- and rituximab-based regimens; 93 had consolidation radiotherapy. Cutoff values were determined using the receiver-operating characteristic curve. At a median follow-up of 36 months, progression-free survival (PFS) and overall survival (OS) were 87% and 94%, respectively. In univariate analysis, elevated MTV and TLG were significantly associated with worse PFS and OS. Only TLG retained statistical significance for both OS (P = .001) and PFS (P < .001) in multivariate analysis. At 5 years, OS was 100% for patients with low TLG vs 80% for those with high TLG (P = .0001), whereas PFS was 99% vs 64%, respectively (P < .0001). TLG on baseline PET appeared to be a powerful predictor of PMBCL outcomes and warrants further validation as a biomarker. The IELSG 26 study was registered at www.clinicaltrials.gov as #NCT00944567.
authors.affiliation: Oncology Institute of Southern Switzerland, Bellinzona, Switzerland;
authors.forename: Luca
authors.initials: L
authors.lastname: Ceriani
authors.affiliation: Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy;
authors.forename: Maurizio
authors.initials: M
authors.lastname: Martelli
authors.affiliation: Institute of Hematology and Medical Oncology, Policlinico S. Orsola-Malpighi, Bologna, Italy;
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Zinzani
authors.affiliation: Department of Oncology, Unit of Lymphoid Malignancies, San Raffaele Scientific Institute, Milan, Italy;
authors.forename: Andrés J M
authors.initials: AJ
authors.lastname: Ferreri
authors.affiliation: Hematology, Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy;
authors.forename: Barbara
authors.initials: B
authors.lastname: Botto
authors.affiliation: Hematology, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy;
authors.forename: Caterina
authors.initials: C
authors.lastname: Stelitano
authors.affiliation: Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;
authors.forename: Manuel
authors.initials: M
authors.lastname: Gotti
authors.affiliation: Hematology, Ospedale Businco, Cagliari, Italy;
authors.forename: Maria Giuseppina
authors.initials: MG
authors.lastname: Cabras
authors.affiliation: Hematology, Policlinico Careggi, Florence, Italy;
authors.forename: Luigi
authors.initials: L
authors.lastname: Rigacci
authors.affiliation: Department of Hematology, Niguarda Ca' Granda Hospital, Milan, Italy;
authors.forename: Livio
authors.initials: L
authors.lastname: Gargantini
authors.affiliation: Hematology Unit, Department of Oncology, Azienda Ospedaliera ASMN IRCCS Reggio Emilia, Italy;
authors.forename: Francesco
authors.initials: F
authors.lastname: Merli
authors.affiliation: Medical Oncology Unit, Ospedale di Circolo Fondazione Macchi, Varese, Italy;
authors.forename: Graziella
authors.initials: G
authors.lastname: Pinotti
authors.affiliation: Department of Hematology, Azienda Ospedaliera Papardo, Messina, Italy;
authors.forename: Donato
authors.initials: D
authors.lastname: Mannina
authors.affiliation: Onco-Hematology Department, Modena University, Modena, Italy; and.
authors.forename: Stefano
authors.identifier: http://orcid.org/0000-0001-8446-2285
authors.initials: S
authors.lastname: Luminari
authors.affiliation: Oncology Institute of Southern Switzerland, Bellinzona, Switzerland;
authors.forename: Anastasios
authors.initials: A
authors.lastname: Stathis
authors.affiliation: Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy;
authors.forename: Eleonora
authors.initials: E
authors.lastname: Russo
authors.affiliation: Oncology Institute of Southern Switzerland, Bellinzona, Switzerland;
authors.forename: Franco
authors.initials: F
authors.lastname: Cavalli
authors.affiliation: Oncology Institute of Southern Switzerland, Bellinzona, Switzerland;
authors.forename: Luca
authors.initials: L
authors.lastname: Giovanella
authors.affiliation: Cancer Research UK Centre, University of Southampton, Southampton, United Kingdom.
authors.forename: Peter W M
authors.initials: PW
authors.lastname: Johnson
authors.affiliation: Oncology Institute of Southern Switzerland, Bellinzona, Switzerland;
authors.forename: Emanuele
authors.initials: E
authors.lastname: Zucca
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D019540:Area Under Curve; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D053208:Kaplan-Meier Estimate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality; D064847:Multimodal Imaging; D009367:Neoplasm Staging / Q000379:methods*; D049268:Positron-Emission Tomography; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18