| Literature DB >> 29750632 |
Ulrich Dührsen1, Stefan Müller1, Bernd Hertenstein1, Henrike Thomssen1, Jörg Kotzerke1, Rolf Mesters1, Wolfgang E Berdel1, Christiane Franzius1, Frank Kroschinsky1, Matthias Weckesser1, Dorothea Kofahl-Krause1, Frank M Bengel1, Jan Dürig1, Johannes Matschke1, Christine Schmitz1, Thorsten Pöppel1, Claudia Ose1, Marcus Brinkmann1, Paul La Rosée1, Martin Freesmeyer1, Andreas Hertel1, Heinz-Gert Höffkes1, Dirk Behringer1, Gabriele Prange-Krex1, Stefan Wilop1, Thomas Krohn1, Jens Holzinger1, Martin Griesshammer1, Aristoteles Giagounidis1, Aruna Raghavachar1, Georg Maschmeyer1, Ingo Brink1, Helga Bernhard1, Uwe Haberkorn1, Tobias Gaska1, Lars Kurch1, Daniëlle M E van Assema1, Wolfram Klapper1, Dieter Hoelzer1, Lilli Geworski1, Karl-Heinz Jöckel1, André Scherag1, Andreas Bockisch1, Jan Rekowski1, Andreas Hüttmann1.
Abstract
Purpose Interim positron emission tomography (PET) using the tracer, [18F]fluorodeoxyglucose, may predict outcomes in patients with aggressive non-Hodgkin lymphomas. We assessed whether PET can guide therapy in patients who are treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). Patients and Methods Newly diagnosed patients received two cycles of CHOP-plus rituximab (R-CHOP) in CD20-positive lymphomas-followed by a PET scan that was evaluated using the ΔSUVmax method. PET-positive patients were randomly assigned to receive six additional cycles of R-CHOP or six blocks of an intensive Burkitt's lymphoma protocol. PET-negative patients with CD20-positive lymphomas were randomly assigned or allocated to receive four additional cycles of R-CHOP or the same treatment with two additional doses rituximab. The primary end point was event-free survival time as assessed by log-rank test. Results Interim PET was positive in 108 (12.5%) and negative in 754 (87.5%) of 862 patients treated, with statistically significant differences in event-free survival and overall survival. Among PET-positive patients, 52 were randomly assigned to R-CHOP and 56 to the Burkitt protocol, with 2-year event-free survival rates of 42.0% (95% CI, 28.2% to 55.2%) and 31.6% (95% CI, 19.3% to 44.6%), respectively (hazard ratio, 1.501 [95% CI, 0.896 to 2.514]; P = .1229). The Burkitt protocol produced significantly more toxicity. Of 754 PET-negative patients, 255 underwent random assignment (129 to R-CHOP and 126 to R-CHOP with additional rituximab). Event-free survival rates were 76.4% (95% CI, 68.0% to 82.8%) and 73.5% (95% CI, 64.8% to 80.4%), respectively (hazard ratio, 1.048 [95% CI, 0.684 to 1.606]; P = .8305). Outcome prediction by PET was independent of the International Prognostic Index. Results in diffuse large B-cell lymphoma were similar to those in the total group. Conclusion Interim PET predicted survival in patients with aggressive lymphomas treated with R-CHOP. PET-based treatment intensification did not improve outcome.Entities:
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Year: 2018 PMID： 29750632 DOI： 10.1200/JCO.2017.76.8093
Source DB: PubMed Journal: J Clin Oncol ISSN： 0732-183X Impact factor: 44.544