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|Title:||Negative Interim PET Consistently Predicts for Better Outcome of DLBCL in an IAEA-Sponsored Multi-national Study|
|Authors:||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.|
|Citation:||EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING, v.39, suppl.2, p.S222-S223, 2012|
|Abstract:||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.|
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Comunicações em Eventos - HC/InCor
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