DOI: 10.1007/s00259-017-3907-xPages: 680-688

Combination of baseline FDG PET/CT total metabolic tumour volume and gene expression profile have a robust predictive value in patients with diffuse large B-cell lymphoma

1. Henri Becquerel Cancer Centre and Rouen University Hospital, Nuclear Medicine Department

2. University of Rouen, QuantIF-LITIS (EA 4108-FR CNRS 3638), Faculty of Medicine

3. Centre Henri Becquerel, INSERM U918

4. Centre Henri Becquerel, Hematology Department

Correspondence to:
Mathieu Nessim Toledano
Tel: +33 2.32.08.22.56
Email: mathieu.toledano@gmail.com

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Abstract

Purpose

This study evaluated the predictive significance of total metabolic tumour volume (TMTV) measured on baseline FDG PET/CT and its value in addition to gene expression profiling using a new method of gene analysis (rapid reverse transcriptase multiplex ligation-dependent probe amplification assay, RT-MLPA) in patients with diffuse large B-cell lymphoma treated with R-CHOP or R-CHOP-like chemotherapies.

Methods

The analysis included 114 patients. TMTV was measured using a 41% SUVmax threshold and tumours were classified into GCB or ABC subtypes according to the RT-MLPA assay.

Results

The median follow-up was 40 months. the 5-year progression-free survival (PFS) was 54% and the 5-year overall survival (OS) was 62%. The optimal TMTV cut-off value was 261 cm3. In 59 patients with a high TMTV the 5-year PFS and OS were 37% and 39%, respectively, in comparison with 72% and 83%, respectively, in 55 patients with a low TMTV (p = 0.0002 for PFS, p < 0.0001 for OS). ABC status was significantly associated with a worse prognosis. TMTV combined with molecular data identified three groups with very different outcomes: (1) patients with a low TMTV whatever their phenotype (n = 55), (2) patients with a high TMTV and GCB phenotype (n = 33), and (3) patients with a high TMTV and ABC phenotype (n = 26). In the three groups, 5-year PFS rates were 72%, 51% and 17% (p < 0.0001), and 5-year OS rates were 83%, 55% and 17% (p < 0.0001), respectively. In multivariate analysis, TMTV, ABC/GCB phenotype and International Prognostic Index were independent predictive factors for both PFS and OS (p < 0.05 for both).

Conclusions

This integrated risk model could lead to more accurate selection of patients that would allow better individualization of therapy.

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  • Accepted: Dec 3, 2017
  • Online: Jan 17, 2018

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