Response-adapted therapy for aggressive non-Hodgkin's lymphomas based on early [18F] FDG-PET scanning

ECOG-ACRIN Cancer Research Group study (E3404)

Lode J. Swinnen, Hailun Li, Andrew Quon, Randy Gascoyne, Fangxin Hong, Erik A. Ranheim, Thomas Matthew Habermann, Brad S. Kahl, Sandra J. Horning, Ranjana H. Advani

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

A persistently positive positron emission tomography (PET) scan during therapy for diffuse large B-cell lymphoma (DLBCL) is predictive of treatment failure. A response-adapted strategy consisting of an early treatment change to four cycles of R-ICE (rituximab, ifosfamide, carboplatin, etoposide) was studied in the Eastern Cooperative Oncology Group E3404 trial. Previously untreated patients with DLBCL stage III, IV, or bulky II, were eligible. PET scan was performed after three cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and scored as positive or negative by central review during the fourth cycle. PET-positive patients received four cycles of R-ICE, PET-negative patients received two more cycles of R-CHOP. A ≥45% 2-year progression-free survival (PFS) for mid-treatment PET-positive patients was viewed as promising. Of 74 patients, 16% were PET positive, 79% negative. The PET positivity rate was much lower than the 33% expected. Two-year PFS was 70%; 42% [90% confidence interval (CI), 19-63%] for PET-positives and 76% (90% CI 65-84%) for PET-negatives. Three-year overall survival (OS) was 69% (90% CI 43-85%) and 93% (90% CI 86-97%) for PET-positive and -negative cases, respectively. The 2-year PFS for mid-treatment PET-positive patients intensified to R-ICE was 42%, with a wide confidence interval due to the low proportion of positive mid-treatment PET scans. Treatment modification based on early PET scanning should remain confined to clinical trials.

Original languageEnglish (US)
Pages (from-to)56-65
Number of pages10
JournalBritish Journal of Haematology
Volume170
Issue number1
DOIs
StatePublished - Jul 1 2015

Fingerprint

Fluorodeoxyglucose F18
Positron-Emission Tomography
Non-Hodgkin's Lymphoma
Research
Neoplasms
Ifosfamide
Confidence Intervals
Therapeutics
Carboplatin
Etoposide
Disease-Free Survival
Lymphoma, Large B-Cell, Diffuse
Vincristine
Prednisone
Doxorubicin
Cyclophosphamide
Treatment Failure
Rituximab
Clinical Trials

Keywords

  • Diffuse large B-cell lymphoma
  • Interim positron emission tomography scan
  • R-CHOP
  • R-ICE
  • Response-adapted therapy

ASJC Scopus subject areas

  • Hematology

Cite this

Response-adapted therapy for aggressive non-Hodgkin's lymphomas based on early [18F] FDG-PET scanning : ECOG-ACRIN Cancer Research Group study (E3404). / Swinnen, Lode J.; Li, Hailun; Quon, Andrew; Gascoyne, Randy; Hong, Fangxin; Ranheim, Erik A.; Habermann, Thomas Matthew; Kahl, Brad S.; Horning, Sandra J.; Advani, Ranjana H.

In: British Journal of Haematology, Vol. 170, No. 1, 01.07.2015, p. 56-65.

Research output: Contribution to journalArticle

Swinnen, Lode J. ; Li, Hailun ; Quon, Andrew ; Gascoyne, Randy ; Hong, Fangxin ; Ranheim, Erik A. ; Habermann, Thomas Matthew ; Kahl, Brad S. ; Horning, Sandra J. ; Advani, Ranjana H. / Response-adapted therapy for aggressive non-Hodgkin's lymphomas based on early [18F] FDG-PET scanning : ECOG-ACRIN Cancer Research Group study (E3404). In: British Journal of Haematology. 2015 ; Vol. 170, No. 1. pp. 56-65.
@article{40929caafb3b445e898f7bdb9d178708,
title = "Response-adapted therapy for aggressive non-Hodgkin's lymphomas based on early [18F] FDG-PET scanning: ECOG-ACRIN Cancer Research Group study (E3404)",
abstract = "A persistently positive positron emission tomography (PET) scan during therapy for diffuse large B-cell lymphoma (DLBCL) is predictive of treatment failure. A response-adapted strategy consisting of an early treatment change to four cycles of R-ICE (rituximab, ifosfamide, carboplatin, etoposide) was studied in the Eastern Cooperative Oncology Group E3404 trial. Previously untreated patients with DLBCL stage III, IV, or bulky II, were eligible. PET scan was performed after three cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and scored as positive or negative by central review during the fourth cycle. PET-positive patients received four cycles of R-ICE, PET-negative patients received two more cycles of R-CHOP. A ≥45{\%} 2-year progression-free survival (PFS) for mid-treatment PET-positive patients was viewed as promising. Of 74 patients, 16{\%} were PET positive, 79{\%} negative. The PET positivity rate was much lower than the 33{\%} expected. Two-year PFS was 70{\%}; 42{\%} [90{\%} confidence interval (CI), 19-63{\%}] for PET-positives and 76{\%} (90{\%} CI 65-84{\%}) for PET-negatives. Three-year overall survival (OS) was 69{\%} (90{\%} CI 43-85{\%}) and 93{\%} (90{\%} CI 86-97{\%}) for PET-positive and -negative cases, respectively. The 2-year PFS for mid-treatment PET-positive patients intensified to R-ICE was 42{\%}, with a wide confidence interval due to the low proportion of positive mid-treatment PET scans. Treatment modification based on early PET scanning should remain confined to clinical trials.",
keywords = "Diffuse large B-cell lymphoma, Interim positron emission tomography scan, R-CHOP, R-ICE, Response-adapted therapy",
author = "Swinnen, {Lode J.} and Hailun Li and Andrew Quon and Randy Gascoyne and Fangxin Hong and Ranheim, {Erik A.} and Habermann, {Thomas Matthew} and Kahl, {Brad S.} and Horning, {Sandra J.} and Advani, {Ranjana H.}",
year = "2015",
month = "7",
day = "1",
doi = "10.1111/bjh.13389",
language = "English (US)",
volume = "170",
pages = "56--65",
journal = "British Journal of Haematology",
issn = "0007-1048",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Response-adapted therapy for aggressive non-Hodgkin's lymphomas based on early [18F] FDG-PET scanning

T2 - ECOG-ACRIN Cancer Research Group study (E3404)

AU - Swinnen, Lode J.

AU - Li, Hailun

AU - Quon, Andrew

AU - Gascoyne, Randy

AU - Hong, Fangxin

AU - Ranheim, Erik A.

AU - Habermann, Thomas Matthew

AU - Kahl, Brad S.

AU - Horning, Sandra J.

AU - Advani, Ranjana H.

PY - 2015/7/1

Y1 - 2015/7/1

N2 - A persistently positive positron emission tomography (PET) scan during therapy for diffuse large B-cell lymphoma (DLBCL) is predictive of treatment failure. A response-adapted strategy consisting of an early treatment change to four cycles of R-ICE (rituximab, ifosfamide, carboplatin, etoposide) was studied in the Eastern Cooperative Oncology Group E3404 trial. Previously untreated patients with DLBCL stage III, IV, or bulky II, were eligible. PET scan was performed after three cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and scored as positive or negative by central review during the fourth cycle. PET-positive patients received four cycles of R-ICE, PET-negative patients received two more cycles of R-CHOP. A ≥45% 2-year progression-free survival (PFS) for mid-treatment PET-positive patients was viewed as promising. Of 74 patients, 16% were PET positive, 79% negative. The PET positivity rate was much lower than the 33% expected. Two-year PFS was 70%; 42% [90% confidence interval (CI), 19-63%] for PET-positives and 76% (90% CI 65-84%) for PET-negatives. Three-year overall survival (OS) was 69% (90% CI 43-85%) and 93% (90% CI 86-97%) for PET-positive and -negative cases, respectively. The 2-year PFS for mid-treatment PET-positive patients intensified to R-ICE was 42%, with a wide confidence interval due to the low proportion of positive mid-treatment PET scans. Treatment modification based on early PET scanning should remain confined to clinical trials.

AB - A persistently positive positron emission tomography (PET) scan during therapy for diffuse large B-cell lymphoma (DLBCL) is predictive of treatment failure. A response-adapted strategy consisting of an early treatment change to four cycles of R-ICE (rituximab, ifosfamide, carboplatin, etoposide) was studied in the Eastern Cooperative Oncology Group E3404 trial. Previously untreated patients with DLBCL stage III, IV, or bulky II, were eligible. PET scan was performed after three cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and scored as positive or negative by central review during the fourth cycle. PET-positive patients received four cycles of R-ICE, PET-negative patients received two more cycles of R-CHOP. A ≥45% 2-year progression-free survival (PFS) for mid-treatment PET-positive patients was viewed as promising. Of 74 patients, 16% were PET positive, 79% negative. The PET positivity rate was much lower than the 33% expected. Two-year PFS was 70%; 42% [90% confidence interval (CI), 19-63%] for PET-positives and 76% (90% CI 65-84%) for PET-negatives. Three-year overall survival (OS) was 69% (90% CI 43-85%) and 93% (90% CI 86-97%) for PET-positive and -negative cases, respectively. The 2-year PFS for mid-treatment PET-positive patients intensified to R-ICE was 42%, with a wide confidence interval due to the low proportion of positive mid-treatment PET scans. Treatment modification based on early PET scanning should remain confined to clinical trials.

KW - Diffuse large B-cell lymphoma

KW - Interim positron emission tomography scan

KW - R-CHOP

KW - R-ICE

KW - Response-adapted therapy

UR - http://www.scopus.com/inward/record.url?scp=84931325322&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84931325322&partnerID=8YFLogxK

U2 - 10.1111/bjh.13389

DO - 10.1111/bjh.13389

M3 - Article

VL - 170

SP - 56

EP - 65

JO - British Journal of Haematology

JF - British Journal of Haematology

SN - 0007-1048

IS - 1

ER -