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Predictive Value of Interim and End-of-Therapy 18F-FDG PET/CT in Patients with Follicular Lymphoma

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Abstract

Purpose

18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is the standard imaging modality for response evaluation in FDG-avid lymphoma, but the prognostic value is not established in follicular lymphoma (FL). This study investigated the prognostic value of Deauville 5-point scale (D5PS) from paired interim PET/CT (PETInterim) and end-of-induction therapy PET/CT (PETEOI) in patients with FL.

Methods

FL staging and response assessment PET/CT images from 2013 to 2015 were retrospectively reviewed. PETInterim was performed 3 or 4 cycles after chemotherapy and PETEOI after 6 or 8 cycles. D5PS scores of 1, 2, and 3 were considered as negative (−), and scores 4 and 5 were considered as positive (+). Statistical analysis was done using Cox regression analysis, Kaplan–Meier survival analysis, and the log-rank test.

Results

Thirty-three patients with set of baseline, interim, and end-of-induction therapy PET/CT studies were included. Ten patients (30.3%) had progression. The median progression-free survival (PFS) was 38.8 months (range 3.5–72.7 months). On PETInterim, 23 patients were negative and 10 were positive. On PETEOI scans, 29 patients were negative, and 4 were positive. On multivariate analysis, PETEOI(−) was associated with longer PFS. PETInterim(+) and PETEOI(+) patients had a significantly shorter PFS than PETInterim(−) patients (39.9 months, 95% confidence interval [CI] 23.0–56.9, versus 55.5 months, 95% CI 49.7–61.2, p = 0.005) and PETEOI(−) patients (14.2 months, 95% CI 8.5–19.8, versus 60.5 months, 95% CI 52.1–69.0, p < 0.001).

Conclusion

For patients with FL, PETInterim and PETEOI response is predictive of PFS, and PETEOI(+) is an independent prognostic factor for progression of FL.

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Acknowledgements

The authors thank Martin Mawhinney for his assistance in data acquisition.

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Authors and Affiliations

  1. Division of Nuclear Medicine, Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Sun Ha Boo, Joo Hyun O, Soo Jin Kwon, Ie Ryung Yoo & Sung Hoon Kim

  2. Department of Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Gyeong Sin Park

  3. Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Byung Ock Choi

  4. Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Seung Eun Jung

  5. Department of Hematology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Seok-Goo Cho

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  1. Sun Ha Boo
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Correspondence to Joo Hyun O.

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Conflict of Interest

Sun Ha Boo, Joo Hyun O, Soo Jin Kwon, Ie Ryung Yoo, Sung Hoon Kim, Gyeongsin Park, Byung Ock Choi, Seung Eun Jung, Seok-Goo Cho declare that they have no conflict of interest. There is no source of funding.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

The Institutional Review Board of our institute approved this retrospective study, and the requirement to obtain informed consent was waived.

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Boo, S.H., O, J.H., Kwon, S.J. et al. Predictive Value of Interim and End-of-Therapy 18F-FDG PET/CT in Patients with Follicular Lymphoma. Nucl Med Mol Imaging 53, 263–269 (2019). https://doi.org/10.1007/s13139-019-00602-0

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