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[Abstract]

PURPOSE:

Our main objective was to prospectively determine the prognostic value of [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) after two cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone given every 14 days (R-CHOP-14) under standardized treatment and PET evaluation criteria.

PATIENTS AND METHODS:

Patients with any stage of diffuse large B-cell lymphoma were treated with six cycles of R-CHOP-14 followed by two cycles of rituximab. PET/CT examinations were performed at baseline, after two cycles (and after four cycles if the patient was PET-positive after two cycles), and at the end of treatment. PET/CT examinations were evaluated locally and by central review. The primary end point was event-free survival at 2 years (2-year EFS).

RESULTS:

Median age of the 138 evaluable patients was 58.5 years with a WHO performance status of 0, 1, or 2 in 56%, 36%, or 8% of the patients, respectively. By local assessment, 83 PET/CT scans (60%) were reported as positive and 55 (40%) as negative after two cycles of R-CHOP-14. Two-year EFS was significantly shorter for PET-positive compared with PET-negative patients (48% v 74%; P = .004). Overall survival at 2 years was not significantly different, with 88% for PET-positive versus 91% for PET-negative patients (P = .46). By using central review and the Deauville criteria, 2-year EFS was 41% versus 76% (P < .001) for patients who had interim PET/CT scans after two cycles of R-CHOP-14 and 24% versus 72% (P < .001) for patients who had PET/CT scans at the end of treatment.

CONCLUSION:

Our results confirmed that an interim PET/CT scan has limited prognostic value in patients with diffuse large B-cell lymphoma homogeneously treated with six cycles of R-CHOP-14 in a large prospective trial. At this point, interim PET/CT scanning is not ready for clinical use to guide treatment decisions in individual patients.

© 2015 by American Society of Clinical Oncology. 

[Author information]

Mamot C1, Klingbiel D2, Hitz F2, Renner C2, Pabst T2, Driessen C2, Mey U2, Pless M2, Bargetzi M2, Krasniqi F2, Gigli F2, Hany T2, Samarin A2, Biaggi C2, Rusterholz C2, Dirnhofer S2, Zucca E2, Martinelli G2.

1Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy. christoph.mamot@ksa.ch.

2Christoph Mamot and Mario Bargetzi, Cantonal Hospital Aarau, Aarau; Dirk Klingbiel, Christine Biaggi, and Corinne Rusterholz, Swiss Group for Clinical Cancer Research Coordinating Center; Thomas Pabst, Inselspital Bern, Bern; Felicitas Hitz and Christoph Driessen, Cantonal Hospital St. Gallen, St. Gallen; Christoph Renner, Hirslanden Zürich; Thomas Hany, Magnetic Resonance Imaging Roentgen Zürich; Andrei Samarin, University Hospital Zürich, Zürich; Ulrich Mey, Cantonal Hospital Graubuenden, Chur; Miklos Pless, Cantonal Hospital Winterthur, Winterthur; Fatime Krasniqi and Stephan Dirnhofer, University Hospital of Basel, Basel; Emanuele Zucca, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; and Federica Gigli and Giovanni Martinelli, European Institute of Oncology Milan, Milan, Italy.