The role of FDG-PET imaging and involved field radiotherapy in relapsed or refractory diffuse large B-cell lymphoma Journal Article

Authors: Hoppe, B. S.; Moskowitz, C. H.; Zhang, Z.; Maragulia, J. C.; Rice, R. D.; Reiner, A. S.; Hamlin, P. A.; Zelenetz, A. D.; Yahalom, J.
Article Title: The role of FDG-PET imaging and involved field radiotherapy in relapsed or refractory diffuse large B-cell lymphoma
Abstract: We examined the role of fluorodeoxyglucose-positron emission tomography (FDG-PET) and the addition of involved field radiotherapy (IFRT) as potential modifiers of salvage therapy. From January 2000 to June 2007, 83 patients with chemosensitive relapsed or primary refractory diffuse large B-cell lymphoma (DLBCL) underwent FDG-PET scans following second-line chemotherapy before high-dose therapy with autologous stem cell rescue (HDT/ASCR). We evaluated the prognostic value of having a negative FDG-PET scan before HDT/ASCR and whether IFRT improved the outcomes. Median follow-up was 45 months, and the 3-year PFS, disease-specific survival (DSS) and OS were 72, 80 and 78%, respectively. Multivariate analysis revealed that a positive FDG-PET scan had worse PFS (hazard ratio = (HR) 3.4; P = 0.014), DSS (HR = 7.7; P = 0.001) and OS (HR = 5.4; P = 0.001), and that patients not receiving IFRT had worse PFS (HR = 2.7; P = 0.03) and DSS (HR = 2.8, P = 0.059). Patients who received IFRT had better local control with fewer relapses within prior involved sites compared with those that did not receive IFRT (P = 0.006). These outcomes confirm the important prognostic value of FDG-PET scans before undergoing HDT/ASCR. It also suggests that the role of IFRT should be evaluated further.
Keywords: adolescent; adult; cancer survival; controlled study; treatment outcome; aged; middle aged; antibiotic agent; retrospective studies; major clinical study; prednisone; salvage therapy; cisplatin; doxorubicin; cancer growth; cancer radiotherapy; cytarabine; rituximab; outcome assessment; positron emission tomography; follow up; follow-up studies; carboplatin; etoposide; antineoplastic combined chemotherapy protocols; recurrence; antifungal agent; cyclophosphamide; dexamethasone; steroid; vincristine; retrospective study; cancer mortality; ifosfamide; lung embolism; liver metastasis; lung metastasis; myelodysplastic syndrome; disease progression; fluorodeoxyglucose f 18; fluorodeoxyglucose f18; positron-emission tomography; stem cell mobilization; sepsis; cancer relapse; multivariate analysis; large cell lymphoma; lymphoma, large b-cell, diffuse; cancer control; lung infection; pericardial effusion; congestive heart failure; autologous hematopoietic stem cell transplantation; bone marrow rescue; chronic kidney failure; involved field radiotherapy; lung infiltrate; radiation enteropathy; supraventricular tachycardia
Journal Title: Bone Marrow Transplantation
Volume: 43
Issue: 12
ISSN: 0268-3369
Publisher: Nature Publishing Group  
Date Published: 2009-06-01
Start Page: 941
End Page: 948
Language: English
DOI: 10.1038/bmt.2008.408
PUBMED: 19139730
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 3" - "Export Date: 30 November 2010" - "CODEN: BMTRE" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Anne S Reiner
    122 Reiner
  2. Zhigang Zhang
    244 Zhang
  3. Joachim Yahalom
    407 Yahalom
  4. Craig Moskowitz
    375 Moskowitz
  5. Bradford Scott Hoppe
    14 Hoppe
  6. Andrew D Zelenetz
    556 Zelenetz
  7. Paul Hamlin
    174 Hamlin
  8. Robert D Rice
    27 Rice