SAKK38/07 study: integration of baseline metabolic heterogeneity and metabolic tumor volume in DLBCL prognostic model.
- Ceriani L Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland.
- Gritti G Hematology Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
- Cascione L Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, Switzerland.
- Pirosa MC Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
- Polino A Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
- Ruberto T Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland.
- Stathis A Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
- Bruno A Department of Nuclear Medicine, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
- Moccia AA Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
- Giovanella L Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland.
- Hayoz S Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland.
- Schär S Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland.
- Dirnhofer S Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Switzerland.
- Rambaldi A Hematology Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
- Martinelli G European Institute of Oncology, Milan, Italy.
- Mamot C Cantonal Hospital Aarau, Aarau, Switzerland; and.
- Zucca E Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, Switzerland.
- 2020-03-21
Published in:
- Blood advances. - 2020
English
Several functional parameters from baseline (18)F-fluorodeoxyglucose positron emission tomography (PET)/computed tomography have been proposed as promising biomarkers of treatment efficacy in diffuse large B-cell lymphoma (DLBCL). We tested their ability to predict outcome in 2 cohorts of DLBCL patients receiving conventional immunochemotherapy (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone [R-CHOP] regimen), either every 14 (R-CHOP14) or 21 days (R-CHOP21). Baseline PET analysis was performed in 141 patients with DLBCL treated with R-CHOP14 in the prospective SAKK38/07 study (NCT00544219) of the Swiss Group for Clinical Cancer Research (testing set). Reproducibility was examined in a validation set of 113 patients treated with R-CHOP21. In the SAKK38/07 cohort, progression-free survival (PFS) at 5 years was 83% for patients with low metabolic tumor volume (MTV) and 59% for those with high MTV (hazard ratio [HR], 3.4; 95% confidence interval [CI], 1.6-7.0; P = .0005), whereas overall survival (OS) was 91% and 64%, respectively (HR, 4.4; 95% CI, 1.9-10; P = .0001). MTV was the most powerful predictor of outcome also in the validation set. Elevated metabolic heterogeneity (MH) significantly predicted poorer outcomes in the subgroups of patients with elevated MTV. A model integrating MTV and MH identified high-risk patients with shorter PFS (testing set: HR, 5.6; 95% CI, 1.8-17; P < .0001; validation set: HR, 5.6; 95% CI, 1.7-18; P = .0002) and shorter OS (testing set: HR, 9.5; 95% CI, 1.7-52; P < .0001; validation set: HR, 7.6; 95% CI, 2.0-28; P = .0003). This finding was confirmed by an unsupervised regression tree analysis indicating that prognostic models based on MTV and MH may allow early identification of refractory patients who might benefit from treatment intensification. This trial was registered at www.clinicaltrials.gov as #NCT00544219.
- Language
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- English
- Open access status
- gold
- Identifiers
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- DOI 10.1182/bloodadvances.2019001201
- PMID 32196557
- Persistent URL
- https://sonar.ch/global/documents/14624
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