Prognostic value of 18F-fluorodeoxyglucose positron emission tomography using Deauville criteria in diffuse large B cell lymphoma treated with autologous hematopoietic stem cell transplantation

Zhitao Ying; Lan Mi; Nina Zhou; Xuejuan Wang; Zhi Yang; Yuqin Song; Xiaopei Wang; Wen Zheng; Ningjing Lin; Meifeng Tu; Yan Xie; Lingyan Ping; Chen Zhang; Weiping Liu; Lijuan Deng; Jun Zhu

doi:10.21147/j.issn.1000-9604.2019.01.11

Prognostic value of ¹⁸F-fluorodeoxyglucose positron emission tomography using Deauville criteria in diffuse large B cell lymphoma treated with autologous hematopoietic stem cell transplantation

Chin J Cancer Res. 2019 Feb;31(1):162-170. doi: 10.21147/j.issn.1000-9604.2019.01.11.

Authors

Zhitao Ying¹, Lan Mi², Nina Zhou³, Xuejuan Wang³, Zhi Yang³, Yuqin Song¹, Xiaopei Wang¹, Wen Zheng¹, Ningjing Lin¹, Meifeng Tu¹, Yan Xie¹, Lingyan Ping¹, Chen Zhang¹, Weiping Liu¹, Lijuan Deng¹, Jun Zhu¹

Affiliations

¹ Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China.
² Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing 100142, China.
³ Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing 100142, China.

PMID: 30996574
PMCID: PMC6433590
DOI: 10.21147/j.issn.1000-9604.2019.01.11

Abstract

Objective: High-dose chemotherapy (HDC) followed by autologous hematopoietic stem cell transplantation (auto-HSCT) plays an important role in improving outcomes of diffuse large B cell lymphoma (DLBCL) patients. ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/computed tomography (CT) has been widely accepted in response assessment and prediction of prognosis in DLBCL. Here, we report the value of ¹⁸F-FDG PET/CT pre- and post-HSCT in predicting outcomes of patients with DLBCL.

Methods: DLBCL patients who had PET/CT scan before and after HSCT were included. PET results were interpreted based upon Deauville criteria. The prognostic value of ¹⁸F-FDG PET/CT in auto-HSCT was evaluated.

Results: Eighty-four patients were enrolled. In univariate analysis, pre- and post-HSCT PET findings were correlated with 3-year progression-free survival (PFS) [hazard ratio (HR)=4.391, P=0.001; HR=7.607, P<0.001] and overall survival (OS) (HR=4.792, P=0.008; HR=26.138, P<0.001). Patients receiving upfront auto-HSCT after first-line treatment had better outcomes than relapsed/refractory DLBCL patients (3-year PFS, P<0.001; 3-year OS, P<0.001). In the relapsed/refractory patients, pre- and post-HSCT PET findings were also associated with 3-year PFS (P=0.003vs. P<0.001) and OS (P=0.027vs. P<0.001). A significant correlation was observed between clinical response to chemotherapy before auto-HSCT and outcomes of patients in the entire cohort (3-year PFS, P<0.001; 3-year OS, P<0.001) and in the subgroup of 21 patients with positive pre-HSCT PET (3-year PFS, P=0.084; 3-year OS, P=0.240). A significant association between survival and post-HSCT PET findings was observed in multivariate analysis (HR=5.168, P<0.001).

Conclusions: PET results before and after HSCT are useful prognostic factors for DLBCL patients receiving HSCT. Patients who responded to chemotherapy, even those with positive pre-HSCT PET, are appropriate candidates for auto-HSCT.

Keywords: Positron emission tomography; autologous hematopoietic stem cell transplantation; computed tomography; diffuse large B cell lymphoma; high-dose chemotherapy.