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Abstract
Background/Objectives This study aimed to evaluate whether very early interim 18F-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) after a single cycle of first-line chemotherapy predicts long-term survival outcome in patients with diffuse large B-cell lymphoma (DLBCL). Methods A total of 51 patients (31 males and 20 females; mean age 55 years) had four FDG PET/CT studies, at baseline and after one, three, and six cycles of chemotherapy (PET0, PET1, PET3, and PET6). Visually and quantitatively assessed PET parameters were analyzed for associations with long-term survival. Results The estimated 10-year progression-free survival (PFS) and overall survival (OS) was 48% and 61%, respectively. During a median follow-up of 63 months (range 9-134), 17 patients (33%) exhibited disease progression and 15 (29%) died. On PET1, all but one showed decreased FDG uptake, and all showed decreased metabolic tumor volume. None of the PET1 or PET3 parameters were associated with survival. The PET6 parameters retained independent predictive value for OS after adjustment for the International Prognostic Index. Negative PET6 was associated with longer PFS (mean 99 vs. 50 mo, p = 0.04) and OS (mean 107 vs. 57 mo, p = 0.02). Con-clusions The FDG PET/CT parameters obtained after a single cycle of chemotherapy were not associated with long-term survival in DLBCL, while negative end-of-therapy FDG PET/CT was associated with longer PFS and OS. Tumor regression very early into first-line chemotherapy was not as clinically relevant as the presence of viable tumor on FDG PET/CT at the end of therapy for predicting long-term outcomes.

Affiliations

Eun Ji Han 1, Hye Lim Park 2, Seung-Ah Yahng 3, Gi-June Min 4, Byung-Ock Choi 5, Gyeongsin Park 6, Joo Hyun O 7, Seok-Goo Cho 4; Catholic University Lymphoma Group
1Division of Nuclear Medicine, Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
2Division of Nuclear Medicine, Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
3Department of Hematology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
4Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
5Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
6Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
7Division of Nuclear Medicine, Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.