JOSE CLAUDIO MENEGHETTI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
3 resultados
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- Combined PET and Biopsy Evidence of Marrow Involvement Improves Prognostic Prediction in Diffuse Large B-Cell Lymphoma(2014) CEREI, Juliano J.; GYORKE, Tamas; FANTI, Stefano; PAEZ, Diana; MENEGHETTI, Jose Claudio; REDONDO, Francisca; CELLI, Monica; AUEWARAKUL, Chirayu; RANGARAJAN, Venkatesh; GUJRAL, Sumeet; GOROSPE, Charity; CAMPO, Maejoy V.; CHUNG, June-Key; MORRIS, Tim P.; DONDI, Maurizio; CARR, RobertBone marrow is an important extranodal site in diffuse large B-cell lymphoma (DLBCL), and marrow histology has been incorporated into the new National Comprehensive Cancer Network international prognostic index. Marrow involvement demonstrated histologically confers poor prognosis but is identified by staging PET in more cases. How information from staging PET and biopsy should be combined to optimize outcome prediction remains unclear. Methods: The International Atomic Energy Agency sponsored a prospective international cohort study to better define the use of PET in DLBCL. As a planned subsidiary analysis, we examined the interplay of marrow involvement identified by PET and biopsy on clinical outcomes. Results: Eight countries contributed 327 cases with a median follow-up of 35 mo. The 2-y outcomes of cases with no evidence of marrow involvement (n = 231) were 81% (95% confidence interval [Cl], 76%-86%) for event-free survival (EFS) and 88% (83%-91%) for overall survival (OS); cases identified only on PET (n = 61), 81% (69%-89%) for EFS and 88% (77%-94%) for OS; cases indentified only on biopsy (n = 10), 80% (41%-95%) for EFS and 100% for OS; or cases identified by both PET and biopsy (n = 25), 45% (25%-64%) for EFS and 55% (32%-73%) for OS. The hazard ratios for PET-negative/biopsy-negative cases versus PET-positive/biopsy-positive cases were 2.67 (95% Cl, 1.48-4.79) for EFS and 3.94 (1.93-8.06) for OS. Conclusion: This large study demonstrates that positive iliac crest biopsy histology only confers poor prognosis for patients who also have abnormal marrow F-18-FDG uptake identified on the staging PET scan. Abnormal F-18-FDG uptake in marrow, when iliac crest biopsy histology is normal, has no adverse effect on outcomes.
conferenceObject Negative Interim PET Consistently Predicts for Better Outcome of DLBCL in an IAEA-Sponsored Multi-national Study(2012) PAEZ, D.; FANTI, S.; MENEGHETTI, J. C.; GYOERKE, T.; MONETA, F. R.; AUEWARAKUL, C. U.; NAIR, R.; VIADO-GOROSPE, C.; KUCUK, O.; MORRIS, T. P.; PADUA, R. A.; CERCI, J. J.; CARR, R.Aim The role of interim PET (i-PET) as a predictor of outcome in patients with diffuse large B-cell lymphoma (DLBCL) remains uncertain, with conflicting conclusions reported from studies of between 28 to 121 patients. Most report single centre experience in Western Europe or North America where clinical PET is well established. Variation in Rituximab use or timing of i-PET are suggested as explanation for inconsistent results. We hypothesised that such inconsistency might be greater in non-Western countries, where ethnicity and environmental factors might affect disease biology, and advanced disease alter rate of response. To address this and inform clinical practice in countries where PET has been more recently introduced, we devised a prospective international cohort study with the International Atomic Energy Agency (IAEA). We report interim results from all nine countries. Methods Within participating countries (Brazil, Chile, Hungary, India, Italy, Philippines, Thailand, Turkey, Korea) all patients were scanned in a single PET centre. Permitted treatment was R-CHOP or CHOP (12%). All had pre-treatment staging PET-CT, or CT and PET scans. Clinical factors comprising IPI and bulky disease were recorded. i-PET was after 2nd or 3rd(33%) cycle of chemotherapy. i-PET was classified as negative, minimal residual uptake (MRU), partial response (PR) or progressive disease (PD); negative and MRU were classified as i-PETnegative, PR and PD as i-PET-positive. All MRU and PR scans were centrally reviewed. End treatment PET confirmed clinical response. Treatment change in response to i-PET was not permitted, unless treatment failure was confirmed. Results 395 patients aged 16-83 years were recruited. Individual countries recruited between 9 and 72 (median 50) cases, 54 were excluded from analysis because of death before i-PET or major protocol violation. i-PET was negative in 220 (145 negative, 75 MRU) and positive in 121. At median 20.5 months follow up, disease progression had occurred in 12 (5%) subjects with negative i-PET, 43 (36%) with positive i-PET. Estimated 2 year EFS: i-PET-negative 90% (95%CI 85-94%), i-PET-positive 59% (49-68%); hazard ratio from a multivariable model was 4.9 (95% CI 2.8-8.6). We observed no evidence that recruiting country influenced the prognostic value of i-PET. Conclusion This large study confirms early i-PET as a consistent independent predictor of outcome in patients with DLBCL. The ability of i-PET to predict treatment outcome is generalisable to non-western populations and healthcare systems.- Prospective International Cohort Study Demonstrates Inability of Interim PET to Predict Treatment Failure in Diffuse Large B-Cell Lymphoma(2014) CARR, Robert; FANTI, Stefano; PAEZ, Diana; CERCI, Juliano; GYOERKE, Tamas; REDONDO, Francisca; MORRIS, Tim P.; MENEGHETTI, Claudio; AUEWARAKUL, Chirayu; NAIR, Reena; GOROSPE, Charity; CHUNG, June-Key; KUZU, Isinsu; CELLI, Monica; GUJRAL, Sumeet; PADUA, Rose Ann; DONDI, MaurizioThe International Atomic Energy Agency sponsored a large, multinational, prospective study to further define PET for risk stratification of diffuse large B-cell lymphoma and to test the hypothesis that international biological diversity or diversity of healthcare systems may influence the kinetics of treatment response as assessed by interim PET (I-PET). Methods: Cancer centers in Brazil, Chile, Hungary, India, Italy, the Philippines, South Korea, and Thailand followed a common protocol based on treatment with R-CHOP (cyclophosphamide, hydroxyadriamycin, vincristine, prednisolone with rituximab), with I-PET after 2-3 cycles of chemotherapy and at the end of chemotherapy scored visually. Results: Two-year survivals for all 327 patients (median follow-up, 35 mo) were 79% (95% confidence interval [CI], 74%-83%) for event-free survival (EFS) and 86% (95% CI, 81%-89%) for overall survival (OS). Two hundred ten patients (64%) were I-PET-negative, and 117 (36%) were I-PET-positive. Two-year EFS was 90% (95% CI, 85%-93%) for I-PET-negative and 58% (95% CI, 48%-66%) for I-PET-positive, with a hazard ratio of 5.31 (95% CI, 3.29-8.56). Two-year OS was 93% (95% CI, 88%-96%) for I-PET-negative and 72% (95% CI, 63%-80%) for I-PET-positive, with a hazard ratio of 3.86 (95% CI, 2.12-7.03). On sequential monitoring, 192 of 312 (62%) patients had complete response at both I-PET and end-of-chemotherapy PET, with an EFS of 97% (95% CI, 92%-98%); 110 of these with favorable clinical indicators had an EFS of 98% (95% CI, 92%-100%). In contrast, the 107 I-PET-positive cases segregated into 2 groups: 58 (54%) achieved PET-negative complete remission at the end of chemotherapy (EFS, 86%; 95% CI, 73%-93%); 46% remained PET-positive (EFS, 35%; 95% CI, 22%-48%). Heterogeneity analysis found no significant difference between countries for outcomes stratified by I-PET. Conclusion: This large international cohort delivers 3 novel findings: treatment response assessed by I-PET is comparable across disparate healthcare systems, secondly a negative I-PET findings together with good clinical status identifies a group with an EFS of 98%, and thirdly a single I-PET scan does not differentiate chemoresistant lymphoma from complete response and cannot be used to guide risk-adapted therapy.