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Pre-treatment PET in advanced FL
RCHOP & SUVmax ≤18 RCHOP & SUVmax >18
Others & SUVmax ≤18 Others & SUVmax >18
P=0.73
P=0.02 Figure 2. Association between progression-free sur-
vival (PFS)
(SUVmax) separated by frontline treatment arm.
and maximum standardized uptake
Table 2. Multivariate analysis of baseline characteristics associated with pre-treatment maximum standardized uptake value (SUVmax) >18 Number (percentage)
Total (N=263)
Female
Male 140 β2-microglobulin
135
> ULN 128 LDH
P-multi 1.9 [0.9-3.8] 0.08
1.3 [0.6-2.7] 0.56
2 [0.9-4.1] 0.08
1.5 [0.7-3.1] 0.26
≤ ULN
123
OR [95% CI]
≤ ULN
218 >ULN 45
B-symptoms
absent 214
present
Largest lymph node
<6cm
genase; ULN: upper limit of normal; SUVmax: maximum standardized uptake value.
pies (including BR, R-FND, R2 and single agent rituximab). Abou-Nassar et al. had previously reported similar find- ings, likely reflecting the treating physician’s concern for occult transformation, and subsequent need for anthracy- cline-based therapy.17 We acknowledge as a potential bias of our study that patients with SUVmax >18 treated with other therapies may have not been fit for R-CHOP, based on variables not analyzed in this study, such as comorbidi- ties, reflecting a clinician’s therapeutic bias, and therefore more likely to experience a dismal outcome.
Of interest, in our study, the association between SUVmax >18 and lower CR rate, observed for the whole popula-
49 169
2.7 [1.3-5.3]
tion, was lost among patients treated with R-CHOP. In the rituximab era, the use of anthracycline-based regimens, such as R-CHOP, has significantly improved the outcome of patients with previously untreated transformed FL, resulting in response rates and survival similar to what has been observed in de novo DLBCL.35-38 Our results indicate that patients with more aggressive forms of FL, as suggest- ed by pre-treatment SUVmax >18, may benefit from anthra- cycline-based therapies as the CR rates were significantly lower with alternative regimens. This is further supported by the fact that in our analysis the lower PFS associated with SUVmax >18 (including high rates of progressions
≥6cm 94
Overall, 263 of 346 patients had no missing values for all five variables, and were included in the model: 42 with SUVmax >18 and 221 with SUVmax ≤18. LDH: lactate dehydro-
0.006
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