Positron emission tomography after response to rituximab-CHOP in primary mediastinal large B-cell lymphoma: impact on outcomes and radiotherapy strategies.

Adolescent Adult Aged Antineoplastic Combined Chemotherapy Protocols / therapeutic use Cyclophosphamide / therapeutic use Doxorubicin / therapeutic use Female Humans Lymphoma, Large B-Cell, Diffuse / diagnostic imaging Male Mediastinal Neoplasms / diagnostic imaging Middle Aged Positron Emission Tomography Computed Tomography Prednisone / therapeutic use Retrospective Studies Rituximab / therapeutic use Treatment Outcome Vincristine / therapeutic use Young Adult

CHOP, Large B-cell lymphoma, PET, PET/CT, Primary mediastinal, Radiotherapy Rituximab,

Journal

Annals of hematology

ISSN: 1432-0584

Titre abrégé: Ann Hematol

Pays: Germany

ID NLM: 9107334

Informations de publication

Date de publication:
Sep 2021

Historique:

received: 17 11 2020

accepted: 11 01 2021

pubmed: 2 2 2021

medline: 21 8 2021

entrez: 1 2 2021

Statut: ppublish

Résumé

End-of-treatment (EoT) PET/CT is used as a guide to omit radiotherapy (RT) patients with primary mediastinal large B-cell lymphoma (PMBCL). We present the mature and extended results of a retrospective study evaluating the prognostic significance of EoT-PET/CT after adequate response to R-CHOP. Among 231 consecutive PMLBCL patients, 182 underwent EoT-PET/CT and were evaluated according to the Deauville 5-point scale (D5PS) criteria. Freedom from progression (FFP) was measured from the time of PET/CT examination. Among 182 patients, 72 (40%) had D5PS score 1 (D5PSS-1), 33 (18%) had 2, 28 (15%) had 3, 29 (16%) had 4, and 20 (11%) had 5. The 5-year FFP was 97, 94, 92, 82, and 44% for D5PSS-1, D5PSS-2, D5PSS-3, D5PSS-4, and D5PSS-5, respectively. Among 105 patients with unequivocally negative PET/CT (D5PSS-1/D5PSS-2), 49 (47%) received RT (median dose 3420 cGy) and 56 (53%) did not with relapses in 0/49 vs. 4/56 patients (2 mediastinum and 2 isolated CNS relapses).The 5-year FFP for those who received RT or not was 100% versus 96%, when isolated CNS relapses were censored (p = 0.159). Among D5PSS-3 patients (27/28 irradiated-median dose 3600 cGy), the 5-year FFP was 92%. The 5-year FFP for D5PSS-4 and D5PSS-5 was 82 and 44%; 44/49 patients received RT (median dose 4000 and 4400 cGy for D5PSS-4 and D5PSS-5). Our study supports the omission of RT in a sizeable fraction of PET/CT-negative patients and definitely discourages salvage chemotherapy and ASCT in patients with PMLBCL who conventionally respond to R-CHOP, solely based on PET/CT positivity in the absence of documented progressive or multifocal disease. The persistence of positive PET/CT with D5PSS < 5 after consolidative RT should not trigger the initiation of further salvage chemotherapy in the absence of conventionally defined PD.

Identifiants

DOI: 10.1007/s00277-021-04421-2 PMID: 33523289

pubmed: 33523289

doi: 10.1007/s00277-021-04421-2

pii: 10.1007/s00277-021-04421-2

doi:

Substances chimiques

R-CHOP protocol 0

Rituximab 4F4X42SYQ6

Vincristine 5J49Q6B70F

Doxorubicin 80168379AG

Cyclophosphamide 8N3DW7272P

Prednisone VB0R961HZT

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

2279-2292

Informations de copyright

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