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Different predictive values of interim 18F-FDG PET/CT in germinal center like and non-germinal center like diffuse large B-cell lymphoma

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Abstract

Purpose

Diffuse large B-cell lymphoma (DLBCL) is a pathologically heterogeneous disease with different prognoses according to its molecular profiles. Despite the broad usage of 18F-fluoro-2-dexoxy-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT), previous studies that have investigated the value of interim 18F-FDG PET/CT in DLBCL have given the controversial results. The purpose of this study was to evaluate the prognostic value of interim 18F-FDG PET/CT in DLBCL according to germinal center B cell-like (GCB) and non-GCB molecular profiling.

Methods

We enrolled 118 newly diagnosed DLBCL patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). Interim 18F-FDG PET/CT scans performed after 2 or 3 cycles of R-CHOP treatment were evaluated based on the Lugano response criteria. Patients were grouped as GCB or non-GCB molecular subtypes according to immunohistochemistry results of CD10, BCL6, and MUM1, based on Hans’ algorithm.

Results

In total 118 DLBCL patients, 35 % were classified as GCB, and 65 % were classified as non-GCB. Interim PET/CT was negative in 70 %, and positive in 30 %. During the median follow-up period of 23 months, the positive interim 18F-FDG PET/CT group showed significantly inferior progression free survival (PFS) compared to the negative interim 18F-FDG PET/CT group (P = 0.0004) in entire patients. A subgroup analysis according to molecular profiling demonstrated significant difference of PFS between the positive and negative interim 18F-FDG PET groups in GCB subtype of DLBCL (P = 0.0001), but there was no significant difference of PFS between the positive and negative interim 18F-FDG PET groups in non-GCB subtype of DLBCL.

Conclusions

Interim 18F-FDG PET/CT scanning had a significant predictive value for disease progression in patients with the GCB subtype of DLBCL treated with R-CHOP, but not in those with the non-GCB subtype. Therefore, molecular profiles of DLBCL should be considered for interim 18F-FDG PET/CT practice.

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Acknowledgments

The costs of publication of this article were defrayed in part by the payment of page charges. Therefore, and solely to indicate this fact, this article is hereby marked “advertisement” in accordance with 18 USC section 1734. This study was supported by grants from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (HI14C1072). No other potential conflict of interest relevant to this article was reported.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea

    Jihyun Kim, Won Woo Lee, Sang Eun Kim & Yoo Sung Song

  2. Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea

    Jeong-Ok Lee

  3. Department of Pathology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea

    Jin Ho Paik

  4. Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, Republic of Korea

    Sang Eun Kim

  5. Center for Nanomolecular Imaging and Innovative Drug Development, Advanced Institutes of Convergence Technology, 864-1 Iui-dong, Yeongtong-gu, Suwon, 443-270, Republic of Korea

    Sang Eun Kim

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The study was approved by an institutional review board and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Acquisition of the informed consents was waived by the institutional review board.

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Kim, J., Lee, JO., Paik, J.H. et al. Different predictive values of interim 18F-FDG PET/CT in germinal center like and non-germinal center like diffuse large B-cell lymphoma. Ann Nucl Med 31, 1–11 (2017). https://doi.org/10.1007/s12149-016-1123-6

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  • DOI: https://doi.org/10.1007/s12149-016-1123-6

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