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- Title
Positron emission tomography after response to rituximab-CHOP in primary mediastinal large B-cell lymphoma: impact on outcomes and radiotherapy strategies.
- Authors
Vassilakopoulos, Theodoros P.; Papageorgiou, Sotirios G.; Angelopoulou, Maria K.; Chatziioannou, Sophia; Prassopoulos, Vassilios; Karakatsanis, Stamatios; Arapaki, Maria; Mellios, Zois; Sachanas, Sotirios; Kalpadakis, Christina; Katodritou, Eirini; Leonidopoulou, Theoni; Kotsianidis, Ioannis; Hatzimichael, Eleftheria; Kotsopoulou, Maria; Dimou, Maria; Variamis, Eleni; Boutsis, Dimitrios; Terpos, Evangelos; Michali, Evridiki
- Abstract
End-of-treatment (EoT) PET/CT is used as a guide to omit radiotherapy (RT) patients with primary mediastinal large B-cell lymphoma (PMBCL). We present the mature and extended results of a retrospective study evaluating the prognostic significance of EoT-PET/CT after adequate response to R-CHOP. Among 231 consecutive PMLBCL patients, 182 underwent EoT-PET/CT and were evaluated according to the Deauville 5-point scale (D5PS) criteria. Freedom from progression (FFP) was measured from the time of PET/CT examination. Among 182 patients, 72 (40%) had D5PS score 1 (D5PSS-1), 33 (18%) had 2, 28 (15%) had 3, 29 (16%) had 4, and 20 (11%) had 5. The 5-year FFP was 97, 94, 92, 82, and 44% for D5PSS-1, D5PSS-2, D5PSS-3, D5PSS-4, and D5PSS-5, respectively. Among 105 patients with unequivocally negative PET/CT (D5PSS-1/D5PSS-2), 49 (47%) received RT (median dose 3420 cGy) and 56 (53%) did not with relapses in 0/49 vs. 4/56 patients (2 mediastinum and 2 isolated CNS relapses).The 5-year FFP for those who received RT or not was 100% versus 96%, when isolated CNS relapses were censored (p = 0.159). Among D5PSS-3 patients (27/28 irradiated-median dose 3600 cGy), the 5-year FFP was 92%. The 5-year FFP for D5PSS-4 and D5PSS-5 was 82 and 44%; 44/49 patients received RT (median dose 4000 and 4400 cGy for D5PSS-4 and D5PSS-5). Our study supports the omission of RT in a sizeable fraction of PET/CT-negative patients and definitely discourages salvage chemotherapy and ASCT in patients with PMLBCL who conventionally respond to R-CHOP, solely based on PET/CT positivity in the absence of documented progressive or multifocal disease. The persistence of positive PET/CT with D5PSS < 5 after consolidative RT should not trigger the initiation of further salvage chemotherapy in the absence of conventionally defined PD.
- Subjects
POSITRON emission tomography; DISEASE progression; LYMPHOMAS; ANTINEOPLASTIC combined chemotherapy protocols; RADIOTHERAPY
- Publication
Annals of Hematology, 2021, Vol 100, Issue 9, p2279
- ISSN
0939-5555
- Publication type
Article
- DOI
10.1007/s00277-021-04421-2