Page 165 - 2020_07-Haematologica-web

Non-Hodgkin Lymphoma
Pre-treatment maximum standardized uptake value predicts outcome after frontline therapy in patients with advanced stage follicular lymphoma
Ferrata Storti Foundation
Haematologica 2020 Volume 105(7):1907-1913
Paolo Strati,1 Mohamed Amin Ahmed,1 Nathan H. Fowler,1
Loretta J. Nastoupil,1 Felipe Samaniego,1 Luis E. Fayad,1
Fredrick B. Hagemeister,1 Jorge E. Romaguera,1 Alma Rodriguez,1
Michael Wang,1 Jason R. Westin,1 Chan Cheah,1 Mansoor Noorani,1 Lei Feng,2 Richard E. Davis1 and Sattva S. Neelapu1
1Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center and 2Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
ABSTRACT
The impact of pre-treatment maximum standardized uptake value
(SUVmax) on the outcome of follicular lymphoma (FL) following specif-
ic frontline regimens has not been explored. We performed a retro-
spective analysis of 346 patients with advanced stage follicular lymphoma
(FL) without histological evidence of transformation, and analyzed the
impact of SUV on outcome after frontline therapy. Fifty-two (15%) max
patients had a SUV >18, and a large lymph node ≥6 cm was the only factor max
associating with SUVmax >18 on multivariate analysis (odds ratio 2.7, 95% confidence interval [CI]: 1.3-5.3, P=0.006). The complete response rate was significantly lower among patients treated with non-anthracycline-based regimens if SUVmax was >18 (45% vs. 92%, P<0.001), but not among patients treated with R-CHOP (P=1). SUVmax >18 was associated with significantly shorter progression-free survival among patients treated with non-anthracy- cline-based regimens (77 months vs. not reached, P=0.02), but not among patients treated with R-CHOP (P=0.73). SUVmax >18 associated with shorter overall survival (OS) both in patients treated with R-CHOP (8-year OS 70% vs. 90%, P=0.02) and non-anthracycline-based frontline regimens (8-year OS 50% vs. 85%, P=0.001). In conclusion, pre-treatment PET scan has prognos- tic and predictive value in patients with advanced stage FL receiving frontline treatment.
Introduction
Despite its indolent biology, follicular lymphoma (FL) can be fluorodeoxyglucose (FDG) avid on positron emission tomography (PET). A wide range of inter- and intra-patient degree of FDG avidity has been reported, with a maximum standard- ized uptake (SUVmax) value ranging between 3 and 40.1-4 PET scan is more sensitive and specific than standard computed tomography (CT) scan in identifying nodal and extra-nodal disease, altering stage assignation in 10-31% of patients with FL, and determining a treatment plan revision based on upstaging (I-II to III-IV) in 34- 45% of cases.5-10 PET-based imaging is also an effective tool for early detection of FL transformation, incremental threshold of SUVmax values associating with increas- ing test specificity.11-14 False positivity is still possible, though, and histological con- firmation through tissue biopsy is recommended.15,16
Despite its beneficial effect on staging reassignment and histological classifica- tion, the prognostic role of PET-based imaging at time of diagnosis remains unclear, with conflicting data published in the literature with regards to its impact on the Follicular Lymphoma International Prognostic Index (FLIPI) determination.6,8,17 In addition, while multiple studies have investigated the association between a post- treatment PET scan and the risk of relapse, limited data are available regarding the predictive role of pre-treatment PET data in the frontline setting.18-22 We provide a
Correspondence:
SATTVA S. NEELAPU
sneelapu@mdanderson.org
Received: June 28, 2019. Accepted: October 4, 2019. Pre-published: October 10, 2019.
doi:10.3324/haematol.2019.230649
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/105/7/1907
©2020 Ferrata Storti Foundation
Material published in Haematologica is covered by copyright. All rights are reserved to the Ferrata Storti Foundation. Use of published material is allowed under the following terms and conditions: https://creativecommons.org/licenses/by-nc/4.0/legalcode. Copies of published material are allowed for personal or inter- nal use. Sharing published material for non-commercial pur- poses is subject to the following conditions: https://creativecommons.org/licenses/by-nc/4.0/legalcode, sect. 3. Reproducing and sharing published material for com- mercial purposes is not allowed without permission in writing from the publisher.
haematologica | 2020; 105(7)
1907
ARTICLE