For adults with Hodgkin lymphoma receiving first-line therapy, is the result of an interim positron emission tomography (PET) scan predictive of survival?

2020 ◽  
Author(s):  
Jane Burch ◽  
Benilde Cosmi
Keyword(s):  
Positron Emission Tomography ◽  
Hodgkin Lymphoma ◽  
Pet Scan ◽  
Emission Tomography ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Positron Emission

Influence of Baseline Positron Emission Tomography in Metastatic Gastroesophageal Cancer on Survival and Response to Therapy

Oncology ◽  
2021 ◽  
pp. 1-6
Author(s):  
Ahmed Abdelhakeem ◽  
Madhavi Patnana ◽  
Xuemei Wang ◽  
Jane E. Rogers ◽  
Mariela Blum Murphy ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Response To Therapy ◽  
Emission Tomography ◽  
Gastroesophageal Cancer ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Positron Emission ◽  
Pet Ct ◽  
Metastatic Burden

<b><i>Background:</i></b> The value of baseline fluorodeoxyglucose-positron emission tomography-computed tomography (PET-CT) remains uncertain once gastroesophageal cancer is metastatic. We hypothesized that assessment of detailed PET-CT parameters (maximum standardized uptake value [SUVmax] and/or total lesion glycolysis [TLG]), and the extent of metastatic burden could aid prediction of probability of response or prognosticate. <b><i>Methods:</i></b> We retrospectively analyzed treatment-naive patients with stage 4 gastroesophageal cancer (December 2002–August 2017) who had initial PET-CT for cancer staging at MD Anderson Cancer Center. SUVmax and TLG were compared with treatment outcomes for the full cohort and subgroups based on metastatic burden (≤2 or &#x3e;2 metastatic sites). <b><i>Results:</i></b> We identified 129 patients with metastatic gastroesophageal cancer who underwent PET-CT before first-line therapy. The median follow-up time was 61 months. The median overall survival (OS) was 18.5 months; the first progression-free survival (PFS) was 5.5 months. SUVmax or TLG of the primary tumor or of all metastases combined had no influence on OS or PFS, whether the number of metastases was ≤2 or &#x3e;2. Overall response rates (ORRs) to first-line therapy were 48% and 45% for patients with ≤2 and &#x3e;2 metastases, respectively (nonsignificant). ORR did not differ based on low or high values of SUVmax or TLG. <b><i>Conclusions:</i></b> This is the first assessment of a unique set of PET-CT data and its association with outcomes in metastatic gastroesophageal cancer. In our large cohort of patients, detailed analyses of PET-CT (by SUVmax and/or TLG) did not discriminate any parameters examined. Thus, baseline PET-CT in untreated metastatic gastroesophageal cancer patients has limited or no utility.

Cost Effectiveness of Positron Emission Tomography in Patients With Hodgkin's Lymphoma in Unconfirmed Complete Remission or Partial Remission After First-Line Therapy

2010 ◽  
Vol 28 (8) ◽  
pp. 1415-1421 ◽  
Author(s):  
Juliano J. Cerci ◽  
Evelinda Trindade ◽  
Luís F. Pracchia ◽  
Felipe A. Pitella ◽  
Camila C.G. Linardi ◽  
...  
Keyword(s):  
Public Health ◽  
Positron Emission Tomography ◽  
Cost Effectiveness ◽  
Fdg Pet ◽  
Public Health Care ◽  
Emission Tomography ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Positron Emission

Purpose To assess the cost effectiveness of fluorine-18–fluorodeoxyglucose positron emission tomography (FDG-PET) in patients with Hodgkin's lymphoma (HL) with unconfirmed complete remission (CRu) or partial remission (PR) after first-line treatment. Patients and Methods One hundred thirty patients with HL were prospectively studied. After treatment, all patients with CRu/PR were evaluated with FDG-PET. In addition, PET-negative patients were evaluated with standard follow-up, and PET-positive patients were evaluated with biopsies of the positive lesions. Local unit costs of procedures and tests were evaluated. Cost effectiveness was determined by evaluating projected annual economic impact of strategies without and with FDG-PET on HL management. Results After treatment, CRu/PR was observed in 50 (40.0%) of the 127 patients; the sensitivity, specificity, and positive and negative predictive values of FDG-PET were 100%, 92.0%, 92.3%, and 100%, respectively (accuracy of 95.9%). Local restaging costs without PET were $350,050 compared with $283,262 with PET, a 19% decrease. The incremental cost-effectiveness ratio is −$3,268 to detect one true case. PET costs represented 1% of total costs of HL treatment. Simulated costs in the 974 patients registered in the 2008 Brazilian public health care database showed that the strategy including restaging PET would have a total program cost of $56,498,314, which is $516,942 less than without restaging PET, resulting in a 1% cost saving. Conclusion FDG-PET demonstrated 95.9% accuracy in restaging for patients with HL with CRu/PR after first-line therapy. Given the observed probabilities, FDG-PET is highly cost effective and would reduce costs for the public health care program in Brazil.

Prognostic Value of Positron Emission Tomography (PET) Scan in Patients with Relapsed Hodgkin Lymphoma or Aggressive Non-Hodgkin Lymphoma Receiving Salvage Chemotherapy Followed by Reduced-Intensity Allogeneic Stem Cell Transplantation.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3039-3039 ◽  
Author(s):  
Anna Dodero ◽  
Roberto Crocchiolo ◽  
Francesca Patriarca ◽  
Fabio Ciceri ◽  
Nicolo’ Frungillo ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Hodgkin Lymphoma ◽  
Prognostic Value ◽  
Pet Scan ◽  
Emission Tomography ◽  
Non Hodgkin Lymphoma ◽  
Positron Emission ◽  
18F Fdg ◽  
Pet Scans ◽  
Reduced Intensity

Abstract Positron emission tomography (PET) scan using 18-fluorodeoxyglucose [18F-FDG] has a prognostic value in patients (pts) with Hodgkin Lymphoma (HL) or aggressive Non-Hodgkin lymphoma (NHL) receiving chemotherapy. Chemosensitive disease is a critical prognostic factor for the success of both autologous and allogeneic stem cell transplantation (allo-SCT). We have recently shown a lower risk of death or progression for pts in CR versus those in PR before reduced-intensity conditioning (RIC) allo-SCT (Corradini P, Leukemia 2007). Thus, to better assess the value of pre-transplant disease response, we retrospectively assessed the prognostic role of PET scan before allotransplant. Between 2000 and 2007, 64 consecutive patients with a histologically proven diagnosis of aggressive NHL [n=30: diffuse large B cell lymphoma (n=18), peripheral T-cell lymphomas (n=11), Burkitt lymphoma (n=1)] or HL [n=34], responding to salvage therapy, were evaluated with a PET scan before and after allo-SCT. PET scans were performed at 3 different Nuclear Medicine Units. Presence (PET-positive) or absence (PET-negative) of abnormal 18F-FDG uptake was correlated to progression-free survival (PFS) and overall survival (OS) curves. Patients’ median age was 37 years (range, 17–65 years). Thirty-three pts (52%) were allografted from a HLA-identical sibling donor, 14 from a haploidentical donor and 17 from an unrelated donor. Pts had relapsed disease: 52 pts (81%) had failed autologous SCT, the median number of prior chemotherapy regimens was 3 (range, 1–6). All pts received a RIC regimen followed by allo-SCT. PET scans were performed at a median of 30 days prior to allograft (range, 3–90 days): 34 out of 64 pts showed an abnormal 18F-FDG uptake [NHL (n=16), HL (n=18)] whereas 30 were completely negative [NHL (n=14), HL (n=16)]. Patients with PET-positive or PET-negative scans were balanced in terms of diagnosis, previous treatments, and type of donor. At a median follow-up of 24 months (range, 6–86 months), 41 pts are alive and 23 died [toxicity n=10 (n= 5 NHL, n=5 HL), disease n=13 (n=8 NHL, n=5 HL)]. Overall, the estimated 3-year PFS in pts with negative or positive PET scans were 64% (95% CI, 42%–86%) versus 28% (95% CI, 8%–48%), respectively (p<0.005). A statistically significant higher cumulative risk of relapse was observed in pts with a positive PET scan before allografting as compared to the PET negatives (53% versus 21%, p< 0.022). The estimated 3-year OS in pts with negative or positive PET scans were 69% (95% CI; 51%–87%) versus 44% (95% CI;23%-65%), respectively (p=0.05). For NHL pts, the estimated 3-year PFS was 59% for PET-negative as compared to 38% for PET-positive (p<0.04). For HL pts, the estimated 3-year PFS was 70% for PET-negative as compared to 23% for PET-positive (p<0.05). PET scan has a clinical relevance before allo-SCT. Pts with a positive PET scan have a worse outcome, and should receive experimental therapies to target chemoresistant tumor cells.

Positive Positron Emission Tomography (PET) Scan in Non-Hodgkin Lymphoma Pre-Transplant Had No Impact On Relapse and Survival After Allogenenic Transplantation

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1999-1999
Author(s):  
Veronika Bachanova ◽  
Celalettin Ustun ◽  
Qing Cao ◽  
Froelich Jerry ◽  
Linda J Burns
Keyword(s):  
Positron Emission Tomography ◽  
Follicular Lymphoma ◽  
Hodgkin Lymphoma ◽  
Relapse Rate ◽  
Pet Imaging ◽  
Pet Scan ◽  
Emission Tomography ◽  
Non Hodgkin Lymphoma ◽  
Positron Emission

Abstract Abstract 1999 Allogeneic donor hematopoetic stem cell transplantation (HCT) is increasingly used for patients with non-Hodgkin lymphoma (NHL). Positron emission tomography (PET) has become a standard for lymphoma evaluation and a valuable prognostic tool to risk-stratify treatment and time of the autologous HCT. Role of PET imaging in allogeneic HCT setting is controversial. We sought to investigate the value of PET status pre-transplantation and at day 100 post donor HCT as an indicator predictive of relapse and survival post allograft. Seventy-three patients (median age 50 years [range 2–69 years]) with NHL received allogeneic HCT at University of Minnesota from 2004–2010 and had PET imaging within 4 weeks pre-transplant. All PET and CT images were reviewed centrally by nuclear medicine radiologist. Follicular lymphoma (n=26) was more common than large cell, mantle cell lymphoma and others. PET scan pre-transplant was positive in 44 patients (PET+ group 57% vs PET- group 43%). Two thirds of PET+ group were in partial remission (PR), 7% CR and 16% were chemo-refractory prior to transplant compared to 25% in PR, 68% in CR and 7% refractory in PET+ cohort (p<0.01). Forty percent had PET-avid extra-nodal involvement. In both PET positive and negative groups the two thirds received reduced intensity conditioning and related donor (52% and 51%) or umbilical cord blood grafts (55% and 41%, respectively). 5-years disease-free survival (DFS) and overall survival (OS) of the cohort was 51% (95%CI 35– 64%) and 60% (95%CI 44–73%). DFS and OS of PET+ group was similar to PET- group (DFS: 50% vs 52%, p=0.31; OS: 63% vs 56%, p=0.63). In univariate analysis, the lymphoma subtype, disease status at transplant, extranodal disease, elevated LDH, high B2 macroglobulin or marrow involvement at the time of transplant had no impact on survival or relapse rate. At median follow-up of 3.33 years (range 1.00–6.74) the cumulative 2 year relapse rate was 17%; similar in PET+ and PET- groups (19% [95% CI 7– 31%] vs 15% [95% CI 1– 28%]; p=0.48). Transplant mortality at 1-year was low for entire cohort (11% [95% CI 3–18%]) and particularly low in follicular lymphoma (4% [95%CI 0–10%]) compared to DL/MCL (10% [95%CI 0–21%]) and other NHL (25% [95%CI 4–46%]; p=0.51). PET status (pos vs neg) had no impact on grade III-IV acute GVHD and chronic GVHD. Fifty-four patients with available surveillance PET evaluation at day 100 post-transplant. The 1-year relapse rate and 5 yr DFS was significantly improved for those patient who were PET-negative (day 100 PET- vs PET+ group: relapse 9% vs 42%; p<0.01; DFS 57% vs 25%, p<0.01 and OS 68% vs 59%, p=0.63). In conclusion, pre-allo HCT PET scan for NHL does not predict transplant outcomes, however negative PET scan 100 days post-allo SCT is a valuable tool predictive of superior transplant DFS. Future studies evaluating role of PET in patients with specific lymphoma subsets and development of novel peri-transplant or post-transplant interventions for patients at high relapse risk are warranted. Disclosures: Off Label Use: decitabine for relapsed ALL vorinostat for relapsed ALL.

Can Childhood Hodgkin International Prognostic Score Mitigate Interim Positron Emission Tomography and Predict Survival of Children with Hodgkin Lymphoma in Resource Limited Countries?

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5370-5370
Author(s):  
Reham Khedr ◽  
Sally Mahfouz ◽  
Hoda Fathy ◽  
Lobna Shalaby
Keyword(s):  
Positron Emission Tomography ◽  
Hodgkin Lymphoma ◽  
Prognostic Score ◽  
Pet Scan ◽  
Emission Tomography ◽  
P Value ◽  
Prognostic Role ◽  
Positron Emission ◽  
Therapeutic Decisions ◽  
International Prognostic Score

Abstract Background & aim: Although 'interim' positron emission tomography (PET) may inform therapeutic decisions, Risk stratification at diagnosis allow earlier and potentially better modification during the treatment of HL. In this study, we aimed to identify the prognostic role of both the IPET and the CHIPS in predicting the prognosis of HL in our center. Patients and methods: This is a retrospective, single-center study done at the National Cancer Institute (NCI) Cairo University starting January 2011 to the end of December 2015. A total of 140 patients with newly diagnosed Hodgkin lymphoma were enrolled for analysis of all clinical, pathological and Laboratory Data. Only 83 patients were eligible for analysis of both IPET and CHIPS scoring. PET scan was performed at baseline and after two cycles of chemotherapy. Treatment was not changed according to the results of the interim scan. Childhood Hodgkin International Prognostic Score (CHIPS), was evaluated. Log-rank testing was used to compare EFS for each CHIPS (0-3). Results: Eight three scans out of 140 patients were eligible for analysis of both IPET and CHIPS scoring. Twenty-six patients were scored positive (31.3%) and 57 (68.7%) as negative. The 5- years overall survival (OS) was 94%, 83% for patients with interim positive scans and 97% for patients with interim negative scans (P 0.01). The 5-year Event-free survival (EFS) rate was 86.7% for the whole study population, 76% for patients with interim positive scans and 91% for patients with interim negative scans (P 0.04). The 5 year OS was 100% for patients with CHIPS = 0, 80.4% for patients with CHIPS = 1, 75% for patients with CHIPS = 2, and 100% for patients with CHIPS = 3 (a very limited number of patients), with a p-value of (0.055). Hemoglobin level </= 10) and initial Total Leucocytic count(</= 15,000) were independent prognostic predictors; OS P- value (0.003 and <0.001 ) respectively- and EFS P- value (0.03 and <0.001 ) respectively. Conclusion: The prognostic role and validity of using the interim PET scan response have been confirmed to be strongly related to treatment outcome by the present study; however, the use of CHIPS is a good inexpensive approach to predicting risk in patients with HL that may improve ability to tailor therapy to risk factors known at diagnosis. Other Variables including TLC as well as Hb level will need further larger studies to identify their impact. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

Positron Emission Tomography Status and Tandem High-Dose Therapy Favorably Influence Outcome of Patients with Relapsed and/or Refractory Hodgkin Lymphoma

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 335-335
Author(s):  
Raynier Devillier ◽  
Diane Coso ◽  
Luca Castagna ◽  
Isabelle Brenot-Rossi ◽  
Antonella Anastasia ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Hodgkin Lymphoma ◽  
Predictive Value ◽  
Emission Tomography ◽  
High Dose ◽  
Significant Prognostic Factor ◽  
First Line ◽  
Poor Outcome ◽  
Positron Emission ◽  
Refractory Hodgkin Lymphoma

Abstract Abstract 335 The cure of relapsed or refractory Hodgkin Lymphoma (HL) still remains a challenge. High dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard of care but almost half of patients relapse after ASCT and have poor outcome. Predictive factors including an interval from end of first line therapy to relapse shorter than 12 months, an Ann-Arbor stage III or IV at relapse, and relapse in previously irradiated field are currently used to identify patients with poor outcome. Development of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) assessment improves evaluation of response both in first line and salvage treatments. The aim of our study is first to confirm the predictive value of PET status before ASCT and then to compare ASCT strategy (single versus tandem) in patients with relapsed and/or refractory HL. We here report a series of 111 consecutive patients with relapsed and/or refractory HL who achieved at least partial remission (PR) at PET evaluation after one line of salvage chemotherapy and who underwent single or tandem ASCT. PET response assessment showed 85 (77%) patients in CR (PET- group) and 26 (23%) in PR (PET+ group). Five-year overall (OS) and progression free survival (PFS) were 81% and 64% respectively. There were significant differences in 5-year PFS (79% versus 23%, p<0.001) and 5-year OS (90% versus 55%, p=0.001) between PET- and PET+ groups respectively. This predictive value remained significant in both favorable/intermediate and unfavorable subgroups. In PET+ subgroup analysis, tandem ASCT dramatically improved 5-years PFS, from 0% to 43% (p=0.034) compared to single ASCT. Multivariate analysis showed that PET status (HR: 5.26 [2.57–10.73]) and tandem ASCT (HR: 0.39 [0.19–0.78]) but not relapse risk (HR: 1.77 [0.80–3.92]) significantly influenced PFS, while only PET status significantly influenced OS (HR: 4.03 [1.38–11.75]). Our results suggest that I) PET status before ASCT must be considered as a strong and significant prognostic factor influencing outcome and identifying high risk patients for more intensive strategy II) Tandem ASCT improved outcome compared to single ASCT, especially for PET+ patients. Disclosures: No relevant conflicts of interest to declare.

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