title: Diffuse Large B-Cell Lymphoma: Prospective Multicenter Comparison of Early Interim FLT PET/CT versus FDG PET/CT with IHP, EORTC, Deauville, and PERCIST Criteria for Early Therapeutic Monitoring.
abstract: Purpose To compare the performance characteristics of interim fluorine 18 ((18)F) fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) (after two cycles of chemotherapy) by using the most prominent standardized interpretive criteria (including International Harmonization Project [IHP] criteria, European Organization for Research and Treatment of Cancer [EORTC] criteria, and PET Response Criteria in Solid Tumors (PERCIST) versus those of interim (18)F fluorothymidine (FLT) PET/CT and simple visual interpretation. Materials and Methods This HIPAA-compliant prospective study was approved by the institutional review boards, and written informed consent was obtained. Patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) underwent both FLT and FDG PET/CT 18-24 days after two cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone or rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin. For FDG PET/CT interpretation, IHP criteria, EORTC criteria, PERCIST, Deauville criteria, standardized uptake value, total lesion glycolysis, and metabolic tumor volume were used. FLT PET/CT images were interpreted with visual assessment by two reviewers in consensus. The interim (after cycle 2) FDG and FLT PET/CT studies were then compared with the end-of-treatment FDG PET/CT studies to determine which interim examination and/or criteria best predicted the result after six cycles of chemotherapy. Results From November 2011 to May 2014, there were 60 potential patients for inclusion, of whom 46 patients (24 men [mean age, 60.9 years ± 13.7; range, 28-78 years] and 22 women [mean age, 57.2 years ± 13.4; range, 25-76 years]) fulfilled the criteria. Thirty-four patients had complete response, and 12 had residual disease at the end of treatment. FLT PET/CT had a significantly higher positive predictive value (PPV) (91%) in predicting residual disease than did any FDG PET/CT interpretation method (42%-46%). No difference in negative predictive value (NPV) was found between FLT PET/CT (94%) and FDG PET/CT (82%-95%), regardless of the interpretive criteria used. FLT PET/CT showed statistically higher (P < .001-.008) or similar NPVs than did FDG PET/CT. Conclusion Early interim FLT PET/CT had a significantly higher PPV than standardized FDG PET/CT-based interpretation for therapeutic response assessment in DLBCL. (©) RSNA, 2016 Online supplemental material is available for this article.
authors: From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.).
authors: Ryogo
authors: R
authors: Minamimoto
authors: From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.).
authors: Luis
authors: L
authors: Fayad
authors: From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.).
authors: Ranjana
authors: R
authors: Advani
authors: From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.).
authors: Julie
authors: J
authors: Vose
authors: From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.).
authors: Homer
authors: H
authors: Macapinlac
authors: From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.).
authors: Jane
authors: J
authors: Meza
authors: From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.).
authors: Jordan
authors: J
authors: Hankins
authors: From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.).
authors: Felix
authors: F
authors: Mottaghy
authors: From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.).
authors: Malik
authors: M
authors: Juweid
authors: From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.).
authors: Andrew
authors: A
authors: Quon
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D066066:Response Evaluation Criteria in Solid Tumors; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18