title: Final Results of a Prospective Evaluation of the Predictive Value of Interim Positron Emission Tomography in Patients With Diffuse Large B-Cell Lymphoma Treated With R-CHOP-14 (SAKK 38/07).
abstract: OBJECTIVE
  Our main objective was to prospectively determine the prognostic value of [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) after two cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone given every 14 days (R-CHOP-14) under standardized treatment and PET evaluation criteria.
  
  
  METHODS
  Patients with any stage of diffuse large B-cell lymphoma were treated with six cycles of R-CHOP-14 followed by two cycles of rituximab. PET/CT examinations were performed at baseline, after two cycles (and after four cycles if the patient was PET-positive after two cycles), and at the end of treatment. PET/CT examinations were evaluated locally and by central review. The primary end point was event-free survival at 2 years (2-year EFS).
  
  
  RESULTS
  Median age of the 138 evaluable patients was 58.5 years with a WHO performance status of 0, 1, or 2 in 56%, 36%, or 8% of the patients, respectively. By local assessment, 83 PET/CT scans (60%) were reported as positive and 55 (40%) as negative after two cycles of R-CHOP-14. Two-year EFS was significantly shorter for PET-positive compared with PET-negative patients (48% v 74%; P = .004). Overall survival at 2 years was not significantly different, with 88% for PET-positive versus 91% for PET-negative patients (P = .46). By using central review and the Deauville criteria, 2-year EFS was 41% versus 76% (P < .001) for patients who had interim PET/CT scans after two cycles of R-CHOP-14 and 24% versus 72% (P < .001) for patients who had PET/CT scans at the end of treatment.
  
  
  CONCLUSIONS
  Our results confirmed that an interim PET/CT scan has limited prognostic value in patients with diffuse large B-cell lymphoma homogeneously treated with six cycles of R-CHOP-14 in a large prospective trial. At this point, interim PET/CT scanning is not ready for clinical use to guide treatment decisions in individual patients.
authors.affiliation: Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy. christoph.mamot@ksa.ch.
authors.forename: Christoph
authors.initials: C
authors.lastname: Mamot
authors.affiliation: Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy.
authors.forename: Dirk
authors.initials: D
authors.lastname: Klingbiel
authors.affiliation: Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy.
authors.forename: Felicitas
authors.initials: F
authors.lastname: Hitz
authors.affiliation: Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy.
authors.forename: Christoph
authors.initials: C
authors.lastname: Renner
authors.affiliation: Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pabst
authors.affiliation: Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy.
authors.forename: Christoph
authors.initials: C
authors.lastname: Driessen
authors.affiliation: Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Mey
authors.affiliation: Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy.
authors.forename: Miklos
authors.initials: M
authors.lastname: Pless
authors.affiliation: Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Bargetzi
authors.affiliation: Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy.
authors.forename: Fatime
authors.initials: F
authors.lastname: Krasniqi
authors.affiliation: Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Gigli
authors.affiliation: Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hany
authors.affiliation: Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy.
authors.forename: Andrei
authors.initials: A
authors.lastname: Samarin
authors.affiliation: Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy.
authors.forename: Christine
authors.initials: C
authors.lastname: Biaggi
authors.affiliation: Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy.
authors.forename: Corinne
authors.initials: C
authors.lastname: Rusterholz
authors.affiliation: Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy.
authors.forename: Stephan
authors.initials: S
authors.lastname: Dirnhofer
authors.affiliation: Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Zucca
authors.affiliation: Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Martinelli
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D011237:Predictive Value of Tests; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D000069283:Rituximab; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone