, Volume 22, Issue 4, pp 251-260
Date: 06 Jun 2008

Prognostic impact of pre-transplantation computed tomography and 67gallium scanning in chemosensitive diffuse large B cell lymphoma patients undergoing hematopoietic stem-cell transplantation

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Abstract

Objective

In the present study, we evaluated computed tomography (CT) and 67gallium scanning (67Ga scan) pre-transplant as prognostic factors for overall survival (OS) and event-free survival (EFS) in patients with diffuse large B cell lymphoma, undergoing high-dose chemotherapy and stem-cell transplantation.

Patients and methods

Forty-two patients were included. Of these, 9 (21%) had both positive CT and 67Ga scans, 17 (41%) negative results with both techniques, and 16 (38%) positive CT/negative 67Ga scan. Whole-body planar imaging and single-photon emission computed tomography (SPECT) were performed 72 h after an intravenous administration of 67Ga citrate measuring between 7 mCi and 10 mCi (259–370 MBq).

Results

Patients with positive CT/positive 67Ga scan had a significantly worse EFS and OS at 5 years than those with negative 67Ga scan regardless of whether it was associated with a positive or a negative CT scan (29% and 16% vs. 81% and 93% vs. 88% and 100%, respectively, P < 0.001). After a median follow-up of 43 months (range 4–130 months), no differences were observed between patients with negative CT/negative 67Ga scan and those with positive CT/negative 67Ga scan, with an EFS and OS at 5 years of 88% versus 81% and 100% versus 93%, respectively. In multivariate analysis, the presence of a pre-transplant positive CT/67Ga scans adversely influenced both EFS and OS [HR 8, 95% confidence interval (CI) (1.4–38), P = 0.03 and HR 2; 95% CI (1.3–8), P = 0.02, respectively].

Conclusions

67Ga scan helps to identify, in the pre-transplant evaluation, two groups with a different outcome: one group of patients with positive CT and negative 67Ga scans pre-transplant, who showed a favorable outcome with a low rate of relapse, and the other group of patients with both positive CT and 67Ga scans pre-transplant, who showed a poor prognosis and did not benefit from autologous stem-cell transplantation. They should have been offered other therapeutic strategies.