Michel Meignan1, Anne Ségolène Cottereau1, Annibale Versari1, Loïc Chartier1, Jehan Dupuis1, Sami Boussetta1, Ilaria Grassi1, René-Olivier Casasnovas1, Corinne Haioun1, Hervé Tilly1, Vittoria Tarantino1, Julien Dubreuil1, Massimo Federico1, Gilles Salles1, Stefano Luminari1, Judith Trotman1. 1. Michel Meignan, Anne Ségolène Cottereau, Jehan Dupuis, and Corinne Haioun, Université Paris-Est Créteil, Créteil; Loïc Chartier, Sami Boussetta, and Julien Dubreuil, Centre Hospitalier Lyon Sud; Gilles Salles, Université Claude Bernard Lyon 1, Pierre Bénite; René-Olivier Casasnovas, Centre Hospitalier Universitaire-Dijon, Dijon; Hervé Tilly, Université de Rouen, Rouen, France; Annibale Versari and Ilaria Grassi, Santa Maria Nuova Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico; Stefano Luminari, Arcispedale S. Maria Nuova IRCCS, University of Modena and Reggio Emilia, Reggio Emilia; Vittoria Tarantino and Massimo Federico, University of Modena and Reggio Emilia, Modena, Italy; and Judith Trotman, University of Sydney, Concord, New South Wales, Australia.
Abstract
PURPOSE: Identifying patients at high risk of progression and early death among those with high-tumor-burden follicular lymphoma (FL) is unsatisfactory with current prognostic models. This study aimed to determine the prognostic impact of the total metabolic tumor volume (TMTV) measured at baseline with [18F]fluorodeoxyglucose/positron emission tomography-computed tomography ([18F]FDG/PET-CT) scans and its added value to these models. PATIENTS AND METHODS: A pooled analysis was performed by using patient data and centrally reviewed baseline PET-CT scans for 185 patients with FL who were receiving immunochemotherapy within three prospective trials. TMTV was computed by using the 41% maximum standardized uptake value thresholding method, and the optimal cutoff for survival prediction was determined. RESULTS: Median age was 55 years, 92% of patients had stage III to IV disease, 37% had a Follicular Lymphoma International Prognostic Index (FLIPI) score of 3 to 5, and 31% had a FLIPI2 score of 3 to 5. With a median follow-up of 64 months, overall 5-year progression-free survival (PFS) was 55% and overall survival (OS) was 92%. Median TMTV was 297 cm3 (quartile 1 through quartile 3, 135 to 567 cm3). The optimal cutoff identified was 510 cm3, with a markedly inferior survival in the 29% of patients with TMTV > 510 cm3. Five-year PFS was 33% versus 65% (hazard ratio [HR], 2.90; P < .001), and 5-year OS was 85% versus 95% (HR, 3.45; P = .010). On multivariable analysis, TMTV (HR, 2.3; P = .002) and FLIPI2 score (HR, 2.2; P = .002) were independent predictors of PFS. In combination, they identify three risk groups: high TMTV and intermediate-to-high FLIPI2 score with 5-year PFS of 20% (HR, 5.0; P < .001), high TMTV or intermediate-to-high FLIPI2 score with 5-year PFS of 46% (HR, 2.1; P = .007), and low TMTV and low FLIP2 with 5-year PFS of 69%. CONCLUSION: Baseline TMTV is a strong independent predictor of outcome in FL. In combination with FLIPI2 score, it identifies patients at high risk of early progression. It warrants further validation as a biomarker for development of first-line PET-adapted approaches in FL.
PURPOSE: Identifying patients at high risk of progression and early death among those with high-tumor-burden follicular lymphoma (FL) is unsatisfactory with current prognostic models. This study aimed to determine the prognostic impact of the total metabolic tumor volume (TMTV) measured at baseline with [18F]fluorodeoxyglucose/positron emission tomography-computed tomography ([18F]FDG/PET-CT) scans and its added value to these models. PATIENTS AND METHODS: A pooled analysis was performed by using patient data and centrally reviewed baseline PET-CT scans for 185 patients with FL who were receiving immunochemotherapy within three prospective trials. TMTV was computed by using the 41% maximum standardized uptake value thresholding method, and the optimal cutoff for survival prediction was determined. RESULTS: Median age was 55 years, 92% of patients had stage III to IV disease, 37% had a Follicular Lymphoma International Prognostic Index (FLIPI) score of 3 to 5, and 31% had a FLIPI2 score of 3 to 5. With a median follow-up of 64 months, overall 5-year progression-free survival (PFS) was 55% and overall survival (OS) was 92%. Median TMTV was 297 cm3 (quartile 1 through quartile 3, 135 to 567 cm3). The optimal cutoff identified was 510 cm3, with a markedly inferior survival in the 29% of patients with TMTV > 510 cm3. Five-year PFS was 33% versus 65% (hazard ratio [HR], 2.90; P < .001), and 5-year OS was 85% versus 95% (HR, 3.45; P = .010). On multivariable analysis, TMTV (HR, 2.3; P = .002) and FLIPI2 score (HR, 2.2; P = .002) were independent predictors of PFS. In combination, they identify three risk groups: high TMTV and intermediate-to-high FLIPI2 score with 5-year PFS of 20% (HR, 5.0; P < .001), high TMTV or intermediate-to-high FLIPI2 score with 5-year PFS of 46% (HR, 2.1; P = .007), and low TMTV and low FLIP2 with 5-year PFS of 69%. CONCLUSION: Baseline TMTV is a strong independent predictor of outcome in FL. In combination with FLIPI2 score, it identifies patients at high risk of early progression. It warrants further validation as a biomarker for development of first-line PET-adapted approaches in FL.
Authors: Marius E Mayerhoefer; Anton Staudenherz; Barbara Kiesewetter; Michael Weber; Ingrid Simonitsch-Klupp; Peter Gibbs; Werner Dolak; Julius Lukas; Markus Raderer Journal: Mol Imaging Biol Date: 2019-12 Impact factor: 3.488
Authors: Paula Lapa; Bárbara Oliveiros; Margarida Marques; Jorge Isidoro; Filipe Caseiro Alves; J M Nascimento Costa; Gracinda Costa; João Pedroso de Lima Journal: Eur J Nucl Med Mol Imaging Date: 2017-08-07 Impact factor: 9.236