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  • [J Clin Oncol.] Baseline Metabolic Tumor Volume Predicts Outcome in High-Tumor-Burden Follicular Lymphoma: A Pooled Analysis of Three Multicenter Studies.

    University of Sydney/ Meignan M*

  • 출처
    J Clin Oncol.
  • 등재일
    2016 Aug 22
  • 저널이슈번호
    pii: JCO669440. [Epub ahead of print]
  • 내용

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    Abstract

    PURPOSE:

    Identifying patients at high risk of progression and early death among those with high-tumor-burden follicular lymphoma (FL) is unsatisfactory with current prognostic models. This study aimed to determine the prognostic impact of the total metabolic tumor volume (TMTV) measured at baseline with [18F]fluorodeoxyglucose/positron emission tomography-computed tomography ([18F]FDG/PET-CT) scans and its added value to these models.

     

    PATIENTS AND METHODS:

    A pooled analysis was performed by using patient data and centrally reviewed baseline PET-CT scans for 185 patients with FL who were receiving immunochemotherapy within three prospective trials. TMTV was computed by using the 41% maximum standardized uptake value thresholding method, and the optimal cutoff for survival prediction was determined.

     

    RESULTS:

    Median age was 55 years, 92% of patients had stage III to IV disease, 37% had a Follicular Lymphoma International Prognostic Index (FLIPI) score of 3 to 5, and 31% had a FLIPI2 score of 3 to 5. With a median follow-up of 64 months, overall 5-year progression-free survival (PFS) was 55% and overall survival (OS) was 92%. Median TMTV was 297 cm3 (quartile 1 through quartile 3, 135 to 567 cm3). The optimal cutoff identified was 510 cm3, with a markedly inferior survival in the 29% of patients with TMTV > 510 cm3. Five-year PFS was 33% versus 65% (hazard ratio [HR], 2.90; P < .001), and 5-year OS was 85% versus 95% (HR, 3.45; P = .010). On multivariable analysis, TMTV (HR, 2.3; P = .002) and FLIPI2 score (HR, 2.2; P = .002) were independent predictors of PFS. In combination, they identify three risk groups: high TMTV and intermediate-to-high FLIPI2 score with 5-year PFS of 20% (HR, 5.0; P < .001), high TMTV or intermediate-to-high FLIPI2 score with 5-year PFS of 46% (HR, 2.1; P = .007), and low TMTV and low FLIP2 with 5-year PFS of 69%.

     

    CONCLUSION:

    Baseline TMTV is a strong independent predictor of outcome in FL. In combination with FLIPI2 score, it identifies patients at high risk of early progression. It warrants further validation as a biomarker for development of first-line PET-adapted approaches in FL.

     

    Author information

    Meignan M1, Cottereau AS2, Versari A2, Chartier L2, Dupuis J2, Boussetta S2, Grassi I2, Casasnovas RO2, Haioun C2, Tilly H2, Tarantino V2, Dubreuil J2, Federico M2, Salles G2, Luminari S2, Trotman J2.

     

    1Michel Meignan, Anne Ségolène Cottereau, Jehan Dupuis, and Corinne Haioun, Université Paris-Est Créteil, Créteil; Loïc Chartier, Sami Boussetta, and Julien Dubreuil, Centre Hospitalier Lyon Sud; Gilles Salles, Université Claude Bernard Lyon 1, Pierre Bénite; René-Olivier Casasnovas, Centre Hospitalier Universitaire-Dijon, Dijon; Hervé Tilly, Université de Rouen, Rouen, France; Annibale Versari and Ilaria Grassi, Santa Maria Nuova Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico; Stefano Luminari, Arcispedale S. Maria Nuova IRCCS, University of Modena and Reggio Emilia, Reggio Emilia; Vittoria Tarantino and Massimo Federico, University of Modena and Reggio Emilia, Modena, Italy; and Judith Trotman, University of Sydney, Concord, New South Wales, Australia. michel.meignan@hmn.aphp.fr.

    2Michel Meignan, Anne Ségolène Cottereau, Jehan Dupuis, and Corinne Haioun, Université Paris-Est Créteil, Créteil; Loïc Chartier, Sami Boussetta, and Julien Dubreuil, Centre Hospitalier Lyon Sud; Gilles Salles, Université Claude Bernard Lyon 1, Pierre Bénite; René-Olivier Casasnovas, Centre Hospitalier Universitaire-Dijon, Dijon; Hervé Tilly, Université de Rouen, Rouen, France; Annibale Versari and Ilaria Grassi, Santa Maria Nuova Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico; Stefano Luminari, Arcispedale S. Maria Nuova IRCCS, University of Modena and Reggio Emilia, Reggio Emilia; Vittoria Tarantino and Massimo Federico, University of Modena and Reggio Emilia, Modena, Italy; and Judith Trotman, University of Sydney, Concord, New South Wales, Australia. 

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