Deauville Score-Based Evaluation of Interim PET/CT in Follicular Lymphoma: A Prognostic Factor Systematic Review and Meta-Analysis

Follicular lymphoma (FL) is an indolent non-Hodgkin lymphoma subtype, posing challenges in prognostication. While interim PET/CT is a recognized response assessment tool in other lymphoma subtypes, its prognostic value for FL remains uncertain. This study aims to evaluate the significance of interim PET results, which were assessed using the Deauville Score. A systematic review and meta-analysis were conducted across several databases, including studies that evaluated interim PET during frontline chemoimmunotherapy, with outcomes adjusted for other prognostic factors. Data extraction and risk of bias were performed independently by two authors. Hazard ratios (HR) and 95% confidence intervals (CI) were pooled using random-effects models, with leave-one-out sensitivity analyses to further assess the results. Four studies involving 427 patients were included. The pooled HR for Progression-Free Survival (PFS) was 2.88 (95% CI: 1.83-4.52; I² = 55.5%; p <0.0001), indicating a significant association between positive PET results and poorer PFS. The pooled HR for overall survival (OS) was 3.32 (95% CI: 1.34-8.23; I² = 74.4%; p = 0.0097), reflecting a significant decrease in OS with positive PET results. Sensitivity analyses confirmed the significance of these findings. Thus, positive interim PET results are associated with worse outcomes in frontline-treated FL patients, suggesting their potential as a valuable prognostic tool.