Skip to main content
SpringerLink
Log in

Interim 18F-FGD PET/CT may not predict the outcome in primary central nervous system lymphoma patients treated with sequential treatment with methotrexate and cytarabine

  • Original Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

18F-fluoro-2-dexoy-D-glucose-positron emission tomography (PET)/computed tomography (CT) is a useful imaging technique for monitoring the treatment response in lymphoma cases. We investigated the value of interim brain PET/CT (I-PET/CT) for monitoring the response to intensive methotrexate-based chemotherapy in primary central nervous system lymphoma (PCNSL) patients with diffuse large B cell lymphoma (DLBCL). Of the 76 PCNSL patients treated with intensive methotrexate and cytarabine chemotherapy between September 2006 and December 2012, 66 patients with DLBCL were included in this study. The patient cohort of 66 individuals comprised 43 men and 23 women with a median age of 59 years (range, 17–75 years). During chemotherapy, 36 patients (54.5%) showed a negative metabolism on I-PET/CT, and 47 (71.2%) were negative on final (F) PET/CT. The baseline characteristics were similar between I-PET/CT-negative (n = 36) and I-PET/CT-positive patients (n = 30) except ECOG performance status. After a median follow-up of 27.5 months, there was no difference in the progression-free survival (PFS; P = 0.701) or overall survival (OS; P = 0.620) between the I-PET/CT-negative and I-PET/CT-positive groups. However, PFS in the F-PET/CT-negative group was significantly longer than that in the F-PET/CT-positive group (P < 0.001) without a significant difference in OS (P = 0.892). I-PET/CT may not predict the survival outcome of PCNSL patients with DLBCL treated with intensive methotrexate and cytarabine chemotherapy. Prospective trials are required to fully evaluate the role of I-PET/CT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Rubenstein J, Ferreri AJ, Pittaluga S (2008) Primary lymphoma of the central nervous system: epidemiology, pathology and current approaches to diagnosis, prognosis and treatment. Leukemia & lymphoma 49(Suppl 1):43–51. doi:10.1080/10428190802311441

    Article  CAS  Google Scholar 

  2. Huh J (2012) Epidemiologic overview of malignant lymphoma. Korean J Hematol 47(2):92–104

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ferreri AJ, Blay JY, Reni M, Pasini F, Spina M, Ambrosetti A, Calderoni A, Rossi A, Vavassori V, Conconi A, Devizzi L, Berger F, Ponzoni M, Borisch B, Tinguely M, Cerati M, Milani M, Orvieto E, Sanchez J, Chevreau C, Dell'Oro S, Zucca E, Cavalli F (2003) Prognostic scoring system for primary CNS lymphomas: the International Extranodal Lymphoma Study Group experience. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 21(2):266–272

    Article  Google Scholar 

  4. Abrey LE, Ben-Porat L, Panageas KS, Yahalom J, Berkey B, Curran W, Schultz C, Leibel S, Nelson D, Mehta M, DeAngelis LM (2006) Primary central nervous system lymphoma: the Memorial Sloan-Kettering Cancer Center prognostic model. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 24(36):5711–5715. doi:10.1200/jco.2006.08.2941

    Article  Google Scholar 

  5. Terasawa T, Lau J, Bardet S, Couturier O, Hotta T, Hutchings M, Nihashi T, Nagai H (2009) Fluorine-18-fluorodeoxyglucose positron emission tomography for interim response assessment of advanced-stage Hodgkin's lymphoma and diffuse large B-cell lymphoma: a systematic review. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 27(11):1906–1914. doi:10.1200/jco.2008.16.0861

    Article  Google Scholar 

  6. Terasawa T, Dahabreh IJ, Nihashi T (2010) Fluorine-18-fluorodeoxyglucose positron emission tomography in response assessment before high-dose chemotherapy for lymphoma: a systematic review and meta-analysis. Oncologist 15(7):750–759. doi:10.1634/theoncologist.2010-0054

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kasenda B, Haug V, Schorb E, Fritsch K, Finke J, Mix M, Hader C, Weber WA, Illerhaus G, Meyer PT (2013) 18F-FDG PET is an independent outcome predictor in primary central nervous system lymphoma. Journal of nuclear medicine : official publication, Society of Nuclear Medicine 54(2):184–191. doi:10.2967/jnumed.112.108654

    Article  CAS  Google Scholar 

  8. Ferreri AJ (2011) How I treat primary CNS lymphoma. Blood 118(3):510–522. doi:10.1182/blood-2011-03-321349

    Article  CAS  PubMed  Google Scholar 

  9. Abrey LE, Moskowitz CH, Mason WP, Crump M, Stewart D, Forsyth P, Paleologos N, Correa DD, Anderson ND, Caron D, Zelenetz A, Nimer SD, DeAngelis LM (2003) Intensive methotrexate and cytarabine followed by high-dose chemotherapy with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma: an intent-to-treat analysis. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 21(22):4151–4156. doi:10.1200/jco.2003.05.024

    Article  CAS  Google Scholar 

  10. Ferreri AJ, Reni M, Foppoli M, Martelli M, Pangalis GA, Frezzato M, Cabras MG, Fabbri A, Corazzelli G, Ilariucci F, Rossi G, Soffietti R, Stelitano C, Vallisa D, Zaja F, Zoppegno L, Aondio GM, Avvisati G, Balzarotti M, Brandes AA, Fajardo J, Gomez H, Guarini A, Pinotti G, Rigacci L, Uhlmann C, Picozzi P, Vezzulli P, Ponzoni M, Zucca E, Caligaris-Cappio F, Cavalli F (2009) High-dose cytarabine plus high-dose methotrexate versus high-dose methotrexate alone in patients with primary CNS lymphoma: a randomised phase 2 trial. Lancet 374(9700):1512–1520. doi:10.1016/s0140-6736(09)61416-1

    Article  CAS  PubMed  Google Scholar 

  11. Kawai N, Miyake K, Yamamoto Y, Nishiyama Y, Tamiya T (2013) 18F-FDG PET in the diagnosis and treatment of primary central nervous system lymphoma. Biomed Res Int 2013:247152. doi:10.1155/2013/247152

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mikhaeel NG, Hutchings M, Fields PA, O'Doherty MJ, Timothy AR (2005) FDG-PET after two to three cycles of chemotherapy predicts progression-free and overall survival in high-grade non-Hodgkin lymphoma. Annals of oncology : official journal of the European Society for Medical Oncology / ESMO 16(9):1514–1523. doi:10.1093/annonc/mdi272

    Article  CAS  Google Scholar 

  13. Abrey LE, Batchelor TT, Ferreri AJ, Gospodarowicz M, Pulczynski EJ, Zucca E, Smith JR, Korfel A, Soussain C, DeAngelis LM, Neuwelt EA, O'Neill BP, Thiel E, Shenkier T, Graus F, van den Bent M, Seymour JF, Poortmans P, Armitage JO, Cavalli F (2005) Report of an international workshop to standardize baseline evaluation and response criteria for primary CNS lymphoma. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 23(22):5034–5043. doi:10.1200/jco.2005.13.524

    Article  Google Scholar 

  14. Kawai N, Nishiyama Y, Miyake K, Tamiya T, Nagao S (2005) Evaluation of tumor FDG transport and metabolism in primary central nervous system lymphoma using [18F] fluorodeoxyglucose (FDG) positron emission tomography (PET) kinetic analysis. Ann Nucl Med 19(8):685–690

    Article  PubMed  Google Scholar 

  15. Palmedo H, Urbach H, Bender H, Schlegel U, Schmidt-Wolf IG, Matthies A, Linnebank M, Joe A, Bucerius J, Biersack HJ, Pels H (2006) FDG-PET in immunocompetent patients with primary central nervous system lymphoma: correlation with MRI and clinical follow-up. Eur J Nucl Med Mol Imaging 33(2):164–168. doi:10.1007/s00259-005-1917-6

    Article  CAS  PubMed  Google Scholar 

  16. Rubenstein JL, Gupta NK, Mannis GN, Lamarre AK, Treseler P (2013) How I treat CNS lymphomas. Blood 122(14):2318–2330. doi:10.1182/blood-2013-06-453084

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Choi MK, Kang ES, Kim DW, Ko YH, Seok H, Park JH, Pyo DH, Hoon Lim D, Kim SJ, Kim WS (2013) Treatment outcome of relapsed/refractory primary central nervous system diffuse large B-cell lymphoma: a single-center experience of autologous stem cell transplantation. Int J Hematol 98(3):346–354. doi:10.1007/s12185-013-1403-z

    Article  CAS  PubMed  Google Scholar 

  18. Citterio G, Ferreri AJ, Reni M (2013) Current uses of radiation therapy in patients with primary CNS lymphoma. Expert Rev Anticancer Ther 13(11):1327–1337. doi:10.1586/14737140.2013.851007

    Article  CAS  PubMed  Google Scholar 

  19. Yamanaka R (2009) Management of refractory or relapsed primary central nervous system lymphoma (review). Mol Med Rep 2(6):879–885. doi:10.3892/mmr_00000186

    Article  CAS  PubMed  Google Scholar 

  20. Haioun C, Itti E, Rahmouni A, Brice P, Rain JD, Belhadj K, Gaulard P, Garderet L, Lepage E, Reyes F, Meignan M (2005) [18F] fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in aggressive lymphoma: an early prognostic tool for predicting patient outcome. Blood 106(4):1376–1381. doi:10.1182/blood-2005-01-0272

    Article  CAS  PubMed  Google Scholar 

  21. Spaepen K, Stroobants S, Dupont P, Vandenberghe P, Thomas J, de Groot T, Balzarini J, De Wolf-Peeters C, Mortelmans L, Verhoef G (2002) Early restaging positron emission tomography with 18F-fluorodeoxyglucose predicts outcome in patients with aggressive non-Hodgkin's lymphoma. Annals of oncology : official journal of the European Society for Medical Oncology / ESMO 13(9):1356–1363

    Article  CAS  Google Scholar 

  22. Yoo C, Lee DH, Kim JE, Jo J, Yoon DH, Sohn BS, Kim SW, Lee JS, Suh C (2011) Limited role of interim PET/CT in patients with diffuse large B-cell lymphoma treated with R-CHOP. Ann Hematol 90(7):797–802. doi:10.1007/s00277-010-1135-6

    Article  CAS  PubMed  Google Scholar 

  23. Karantanis D, O'Eill BP, Subramaniam RM, Witte RJ, Mullan BP, Nathan MA, Lowe VJ, Peller PJ, Wiseman GA (2007) 18F-FDG PET/CT in primary central nervous system lymphoma in HIV-negative patients. Nucl Med Commun 28(11):834–841. doi:10.1097/MNM.0b013e328264ae7f

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by a grant (2017-198) from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea.

Author information

Authors and Affiliations

  1. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Jae-Cheol Jo, Dok Hyun Yoon, Shin Kim, Kyoungmin Lee, Eun Hee Kang, Jung Sun Park & Cheolwon Suh

  2. Department of Nuclear Medicine, University of Ulsan College of Medicine, Ulsan, South Korea

    Jin-Sook Ryu

  3. Department of Pathology, University of Ulsan College of Medicine, Ulsan, South Korea

    Jooryung Huh & Chan-Sik Park

  4. Department of Neurosurgery, University of Ulsan College of Medicine, Ulsan, South Korea

    Jong Hoon Kim

  5. Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Sang Wook Lee

  6. Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea

    Jae-Cheol Jo

Authors
  1. Jae-Cheol Jo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dok Hyun Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kyoungmin Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eun Hee Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jung Sun Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jin-Sook Ryu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jooryung Huh
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Chan-Sik Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jong Hoon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Sang Wook Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Cheolwon Suh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cheolwon Suh.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jo, JC., Yoon, D.H., Kim, S. et al. Interim 18F-FGD PET/CT may not predict the outcome in primary central nervous system lymphoma patients treated with sequential treatment with methotrexate and cytarabine. Ann Hematol 96, 1509–1515 (2017). https://doi.org/10.1007/s00277-017-3068-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-017-3068-9

Keywords

Search

Navigation