title: Positron Emission Tomography/Computed Tomography Assessment After Immunochemotherapy and Irradiation Using the Lugano Classification Criteria in the IELSG-26 Study of Primary Mediastinal B-Cell Lymphoma.
abstract: To assess the predictive value of18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for disease recurrence after immunochemotherapy (R-CHT) and mediastinal irradiation (RT), using the recently published criteria of the Lugano classification to predict outcomes for patients with primary mediastinal large B-cell lymphoma.
  
  
  
  Among 125 patients prospectively enrolled in the IELSG-26 study, 88 were eligible for central review of PET/CT scans after completion of RT. Responses were evaluated using the 5-point Deauville scale at the end of induction R-CHT and after consolidation RT. According to the Lugano classification, a complete metabolic response (CMR) was defined by a Deauville score (DS) ≤3.
  
  
  
  The CMR (DS1, -2, or -3) rate increased from 74% (65 patients) after R-CHT to 89% (78 patients) after consolidation RT. Among the 10 patients (11%) with persistently positive scans, the residual uptake after RT was slightly higher than the liver uptake in 6 patients (DS4; 7%) and markedly higher in 4 patients (DS5; 4%): these patients had a significantly poorer 5-year progression-free survival and overall survival. At a median follow-up of 60 months (range, 35-107 months), no patients with a CMR after RT have relapsed. Among the 10 patients who did not reach a CMR, 3 of the 4 patients (positive predictive value, 75%) with DS5 after RT had subsequent disease progression (within the RT volume in all cases) and died. All patients with DS4 had good outcomes without recurrence.
  
  
  
  All the patients obtaining a CMR defined as DS ≤3 remained progression-free at 5 years, confirming the excellent negative predictive value of the Lugano classification criteria in primary mediastinal large B-cell lymphoma patients. The few patients with DS4 also had an excellent outcome, suggesting that they do not necessarily require additional therapy, because the residual18F-fluorodeoxyglucose uptake may not reflect persistent lymphoma.
authors.affiliation: Nuclear Medicine and PET-CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland. Electronic address: luca.ceriani@eoc.ch.
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: Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Maria K
authors.initials: MK
authors.lastname: Gospodarowicz
authors.affiliation: Department of Oncology, University of Torino, Torino, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Ricardi
authors.affiliation: Unit of Lymphoid Malignancies, Department of Onco-Hematology, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milano, Italy.
authors.forename: Andrés J M
authors.initials: AJ
authors.lastname: Ferreri
authors.affiliation: Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Torino, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Chiappella
authors.affiliation: Hematology, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Stelitano
authors.affiliation: Hematology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Balzarotti
authors.affiliation: Hematology, Hospital del Salvador, Universidad de Chile, Santiago, Chile.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Cabrera
authors.affiliation: Department of Medicine, The Royal Marsden National Health Service Foundation Trust, London and Surrey, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Cunningham
authors.affiliation: Hematology Unit, Istituto Nazionale Tumori Giovanni Paolo II IRCCS, Bari, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Guarini
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: Nuclear Medicine and PET-CT Center, 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 Department, 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 / Q000008:administration & dosage / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D018450:Disease Progression; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006801:Humans; D007167:Immunotherapy; D002955:Leucovorin / Q000008:administration & dosage; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism; D016393:Lymphoma, B-Cell / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000378:metabolism / Q000532:radiotherapy*; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000378:metabolism / Q000532:radiotherapy*; D008727:Methotrexate / Q000008:administration & dosage; D018365:Neoplasm, Residual; D000072078:Positron Emission Tomography Computed Tomography; D011241:Prednisone / Q000008:administration & dosage; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D012008:Recurrence; D000069283:Rituximab / Q000627:therapeutic use; D018709:Statistics, Nonparametric; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D001761:Bleomycin; D000069283:Rituximab; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D002955:Leucovorin; D011241:Prednisone; D008727:Methotrexate