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Prognostic Role of Interim 18-Fluorodeoxyglucose-PET in Diffuse Large B Cell Lymphoma: Experience from a Tertiary Care Centre in North India

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Abstract

This study was done to investigate the role of Interim 18-FDG-PET/CT (i-PET) in predicting the outcome of Diffuse Large B Cell Lymphoma (DLBCL) patients. The Lymphoma registry data base of the Department of Haematology was reviewed for all newly diagnosed DLBCL patients treated with R-CHOP-21 (n = 63). The PET-CT data of these patients at pre-defined time points (baseline, interim and end of treatment) was systematically collected. The predictive accuracy of i-PET-CT (done after 4 cycles R-CHOP-21 chemotherapy) was analysed to define their prognostic importance. 47 patients were eligible for final analysis in this study. According to Deauville’s criteria 15 patients (31%) were positive on i-PET. The positive predictive value (PPV) of i-PET by DS was 73.3%. At a median follow up of 21 months, DS based i-PET negative and positive cases showed significant differences in 2-year OS (81.2% vs 46.7%, p = 0.007) and PFS (75% vs 26.7%, p = 0.005). Combined analysis of i-PET (by DS) and IPI showed negative predictive value (NPV) of 92.3% in Low IPI while PPV of 76.9% in high IPI subgroup of DLBCL. On a multivariate analysis of all prognostic variables, i-PET was found to be independent prognostic marker predicting outcome in DLBCL patients. i-PET is an independent prognostic marker for outcome in DLBCL patients. Combined analysis of Interim PET along with IPI score at diagnosis improves the predictive accuracy of i-PET (both PPV & NPV) and may guide tailoring of therapy in these patients.

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Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author, Dr. Soniya Nityanand.

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Acknowledgements

The study was carried out in Sanjay Gandhi post Graduate Institute of Medical Sciences, Lucknow. We acknowledge the contribution of clinical hematologist Dr Rajesh Kashyap for recruitment of patients. We also acknowledge the significant contribution of haematopathologists, Dr Ruchi Gupta, Dr. Dinesh Chandra and Dr. Manish Kumar Singh. We also acknowledge all clinical & lab hematology senior residents, and nursing staff without whom this study was impossible.

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Authors and Affiliations

  1. Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, UP, 226014, India

    Sujeet Kumar, Anshul Gupta, Khaliqur Rahman,  Sanjeev, Reena Choudhary & Soniya Nityanand

  2. Department of Nuclear Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, UP, 226014, India

    Manish Ora

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  1. Sujeet Kumar
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Contributions

S.K., A.G. conceived the project and prepared the research methodology, R.C, M.O., collected data, K.R. interpreted histopathology results, A.G., S.N. interpreted results and wrote the manuscript.

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Correspondence to Soniya Nityanand.

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The authors declare that there is no conflict of interests regarding the publication of this paper.

Ethics Approval Statement

The study has been approved by Institution Ethics Committee (IEC No. 2017–189-IMP-113).

Patient Consent Statement

Written informed consent has been taken from all patients included in the study.

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Kumar, S., Gupta, A., Ora, M. et al. Prognostic Role of Interim 18-Fluorodeoxyglucose-PET in Diffuse Large B Cell Lymphoma: Experience from a Tertiary Care Centre in North India. Indian J Hematol Blood Transfus 38, 211–222 (2022). https://doi.org/10.1007/s12288-021-01441-w

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