Prognostic value of interim FDG-PET in diffuse large cell lymphoma: Results from the CALGB 50303 clinical trial

Heiko Schöder, Mei Yin C. Polley, Michael V. Knopp, Nathan Hall, Lale Kostakoglu, Jun Zhang, Howard R. Higley, Gary Kelloff, Heshan Liu, Andrew D. Zelenetz, Bruce D. Cheson, Nina Wagner-Johnston, Brad S. Kahl, Jonathan W. Friedberg, Eric D. Hsi, John P. Leonard, Lawrence H. Schwartz, Wyndham H. Wilson, Nancy L. Bartlett

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

As part of a randomized, prospective clinical trial in large cell lymphoma, we conducted serial fluorodeoxyglucose positron emission tomography (FDG-PET) at baseline, after 2 cycles of chemotherapy (interim PET [i-PET]), and at end of treatment (EoT) to identify biomarkers of response that are predictive of remission and survival. Scans were interpreted in a core laboratory by 2 imaging experts, using the visual Deauville 5-point scale (5-PS), and by calculating percent change in FDG uptake (change in standardized uptake value [DSUV]). Visual scores of 1 through 3 and DSUV ‡66% were prospectively defined as negative. Of 524 patients enrolled in the parent trial, 169 agreed to enroll in the PET substudy and 158 were eligible for final analysis. In this selected population, all had FDG-avid disease at baseline; by 5-PS, 55 (35%) remained positive on i-PET and 28 (18%) on EoT PET. Median DSUV on i-PET was 86.2%. With a median follow-up of 5 years, DSUV, as continuous variable, was associated with progression-free survival (PFS) (hazard ratio [HR] 5 0.99; 95% confidence interval [CI], 0.97-1.00; P 5.02) and overall survival (OS) (HR, 0.98; 95% CI, 0.97-0.99; P 5.03). DSUV ‡66% was predictive of OS (HR, 0.31; 95% CI, 0.11-0.85; P 5.02) but not PFS (HR, 0.47; 95% CI, 0.19-1.13; P 5.09). Visual 5-PS on i-PET did not predict outcome. DSUV, but not visual analysis, on i-PET predicted OS in DLBCL, although the low number of events limited the statistical analysis. These data may help guide future clinical trials using PET response-adapted therapy. This trial was registered at www. clinicaltrials.gov as #NCT00118209.

Original languageEnglish (US)
Pages (from-to)2224-2234
Number of pages11
JournalBlood
Volume135
Issue number25
DOIs
StatePublished - Jun 18 2020

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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