The effect of 18F-FDG PET/CT findings on prognosis in patients with diffuse large B cell lymphoma

Aims: 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), plays an important role in both staging at the time of diagnosis and follow-up of treatment response in lymphoma. Our aim was to investigate the effect of different quantitative metabolic parameters, which are not used in routine practice, on treatment response and overall survival (OS) in patients with diffuse large B-cell lymphoma. Methods: A total of 26 patients were included in our retrospective cohort study. Deauville 5-point scale (5-PS), and cut-off values for changes in maximum standardized uptake value (SUVmax), peak SUV (SUVpeak), metabolic tumor volume (MTV)(2.5-%41- PERCIST -aort) and total lesion glycolysis index (TLG) (2.5-%41- PERCIST-aort) effect of metabolic parameters on treatment response and OS was investigated. Results: Metabolic parameters did not predict treatment response, while TLGPERCIST (p=0.034), TLGAORT (p=0.040), MTV41 (p=0.040) and TLG41 (p=0.034) parameters were statistically significant for OS. Median OS (months) was statistically significant in TLGPERCIST groups (p=0.047). While the median OS (months) in the TLGPERCIST <4411.90 group was inaccessible, the median OS in the ≥4411.90 group was 32.00 (95%CI: 0.00-87.43) months. Median OS (months) was statistically significant in MTV41 groups (p=0.047). While median OS (months) was inaccessible in the MTV41<376.10 group, median OS in the ≥376.10 group was 32.00 (95%CI: 0.00-87.43) months. Conclusion: The MTV41 and TLGPERCIST appear to be the best parameter to predict OS in patients diagnosed with DLBCL by 18F-FDG PET/CT.

Keywords:

Diffuse large cell lymphoma, Metabolic tumor volume, Overall survival PET Response, Total lesion glycolysis,

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Yin X, Xu A, Fan F, et al.I ncidence andmortality trends and risk prediction nomogram for extranodal diffuse large B-cell lymphoma: an analysis ofthe surveillance, epidemiology, and end results database. Front Oncol. 2019;9:1198.
Kurz KS, Ott M, Kalmbach S, et al. Large B-Cell lymphomas in the 5th edition of the WHO-classification of haematolymphoid neoplasms-updated classification and new concepts. Cancers (Basel). 2023;15(8):2285.
Ziepert M, Hasenclever D, Kuhnt E, et al. Standard International prognostic index remains a valid predictor of outcome for patients with aggressive CD20+ B-cell lymphoma in the rituximab era. J Clin Oncol 2010;28(14):2373-2380.
Salles G, de Jong D, Xie W, et al. Prognostic significance of immunohistochemical biomarkers in diffuse large B-cell lymphoma: a study from the lunenburg lymphoma biomarker consortium. Blood. 2011;117(26):7070-7078.
Zhou Z, Sehn LH, Rademaker AW, et al. An enhanced International Prognostic Index (NCCN-IPI) for patients with diffuse large B-cell lymphoma treated in the rituximab era. Blood. 2014;123(6):837-842.
Bartlett NL, Wilson WH, Jung SH, et al. Dose-adjusted EPOCH-R compared with R-CHOP as frontline therapy for diffuse large B-cell lymphoma: clinical outcomes of the phase III Intergroup Trial Alliance/CALGB 50303. J Clin Oncol. 2019;37(21):1790-1799.
Gómez León N, Vega G, Rodríguez-Vigil Junco B, Suevos Ballesteros C. Evaluation of diffuse large B-cell lymphoma patients with 64-slice multidetector computed tomography versus 18FDG positron emission tomography/computed tomography in initial staging and restaging after treatment. Med Clin (Barc). 2018;151(7):255-264.
Spaepen K, Stroobants S, Dupont P, et al. Prognostic value of positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose ([18F]FDG) after first-line chemotherapy in non-Hodgkin's lymphoma: is [18F]FDG-PET a valid alternative to conventional diagnostic methods?. J Clin Oncol. 2001;19(2):414-419.
Zhang Y-Y, Chen W-Y, Cui Y-P, et al. Value of 18F-FDG PET/CT scan quantization parameters for prognostic evaluation of patientswith diffuse large B-cells lymphoma. Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2018;26(5):1249-1342.
Chang C-C, Cho S-F, Chuang Y-W, et al. Prognostic significance of total metabolic tumor volume on 18F-fluorodeoxyglucosepositron emission tomography/computed tomography in patients with diffuselarge B-cell lymphoma receiving rituximab-containing chemotherapy. Oncotar-get. 2017;8(59):99587–99600.
Kostakoglu L, Martelli M, Sehn LH, et al. Base-line PET-derived metabolic tumor volume metrics predict progression-free and overall survival in DLBCL after first-line treatment: results from the phase 3GOYA study. Blood. 2017;130(Suppl 1):824-824.
Tateishi U, Tatsumi M, Terauchi T, et al. Prognosticsignificance of metabolic tumor burden by positron emission tomogra-phy/computed tomography in patients with relapsed/refractory diffuse largeB-cell lymphoma. Cancer Sci. 2015;106(2):93-186.
Shipp MA. International non-Hodgkin's lymphoma prognostic factors project. A predictive model for aggressive non-Hodgkin's lymphoma. N Engl J Med. 1993;329(2):987-994.
Susanibar-Adaniya S, Barta SK. 2021 Update on Diffuse large B cell lymphoma: a review of current data and potential applications on risk stratification and management. Am J Hematol. 2021;96(5):617-629.
Cottereau AS, Meignan M, Nioche C, et al. Risk stratification in diffuse large B-cell lymphoma using lesion dissemination and metabolic tumor burden calculated from baseline PET/CT†. Ann Oncol. 2021;32(3):404-411.
Cottereau AS, Lanic H, Mareschal S, et al. Molecular profile and FDGPET/CT total metabolic tumor volume improve risk classification at diagnosis for patients with diffuse large B cell lymphoma. Clin Cancer Res. 2016;22(15):3801-3809.
Cottereau AS, Becker S, Broussais F, et al. Prognostic value of baseline total metabolic tumor volume (TMTV0) measured on FDG-PET/CT in patients with peripheral T-cell lymphoma (PTCL). Ann Oncol. 2016;27(4):719-724.
Meignan M, Cottereau AS, Versari A, et al. Baseline metabolic tumor volume predicts outcome in high-tumor-burden follicular lymphoma: a pooled analysis of three multicenter studies. J Clin Oncol. 2016;34(30):3618-3626.
Cottereau AS, Versari A, Loft A, et al. Prognostic value of baseline metabolic tumor volume in early-stage Hodgkin lymphoma in the standard arm of the H10 trial. Blood. 2018;131(13):1456-1463.
Mikhaeel NG, Smith D, Dunn JT, et al. Combination of baseline metabolic tumour volume and early response on PET/CT improves progression-free survival prediction in DLBCL. Eur J Nucl Med Mol Imaging. 2016;43(7):1209-1219.
Albano D, Dondi F, Mazzoletti A, Bellini P, Giubbini R, Bertagna F. Prognostic impact of pretreatment 2-[18F]-FDG PET/CT parameters in primary gastric DLBCL. Medicina (Kaunas). 2021;57(5):498.
Ilyas H, Mikhaeel NG, Dunn JT, et al. Defining the optimal method for measuring baseline metabolic tumour volume in diffuse large B cell lymphoma. Eur J Nucl Med Mol Imaging. 2018;45(7):1142-1154.
Adams HJ, de Klerk JM, Fijnheer R, et al. Prognostic superiority of the National Comprehensive Cancer Network International Prognostic Index over pretreatment whole-body volumetric-metabolic FDG-PET/CT metrics in diffuse large B-cell lymphoma. Eur J Haematol. 2015;94(6):532-539.