PET in DLBCLS. Jyrkkiö

10.10.2007 Oslo

Turku PET Centrehttp://pet.utu.fi

PET in DLBCL and HLRevised response criteria for malignant lymphoma

Cheson et al. JCO 2007;25:579 • Staging: recommended, but not

required• Early response: experimental, clinical

trials only• Post-treatment assessment: required

by the new revised response criteria

Early PET in Hodgkin’s lymphoma: response assessment

N=77

PET after 2 cycles negative (n=61, 79%) => 2 year FFS 95 %

PET after 2 cycles positive (n=16, 21%) => 2 year FFS 6 %

(Hutchings et al. Blood 2006;107:52)

Copyright ©2006 American Society of Hematology. Copyright restrictions may apply.

Hutchings, M. et al. Blood 2006;107:52-59

Figure 3. Kaplan-Meier survival curves depicting the progression-free survival of HL patients according to FDG-PET and CT results after 2 and 4 cycles of chemotherapy, and after

completion of chemotherapy

Copyright ©2006 American Society of Hematology. Copyright restrictions may apply.

Hutchings, M. et al. Blood 2006;107:52-59

Figure 1. PET and PET/CT images of 2 patients with stage III Hodgkin lymphoma

Hodgkinin taudin vastearvio kahden sytostaattikuurin jälkeen

FDG-PET

GPOH-HD 2003 Therapy study for Pediatric Hodgkin’s disease

EORTC protocol 20051 - H10

Can PET select patients with very good prognosis, who do not need radiotherapy?

HL ST I-II Favourable1. ABVDx2 => PET, any outcome=> ABVD x 1, RT 30 Gy2. ABVDx2

=> PET, negative => ABVDx2=> PET, positive => BEACOPPescx2, RT 30 Gy

HL ST I-II Unfavourable1. ABVDx2

=> PET any outcome => ABVDx2,RT 30 Gy2. ABVDx2

=>PET, negative => ABVDx2=>PET,positive => BEACOPPescx2, RT 30 Gy

Early PET in DLBCL: predicting patient outcome

• N=90• PET after 2 cycles: • early PET negative in 54 pts (60%) • early PET positive in 36 pts (40%)

Haioun et al. Blood 2005;106:1376

PET negN=54

PET posN=36

CR 83% 58%

2-y EFSp<0.001

82% 43%

2-y OSp=0.006

90% 61%

Haioun et al. Blood 2005;106:1376

Early PET:predicting patient outcome in DLBCL

Early PET for prediction of prognosis in DLBCL: SUV bsed assessment versus visual analysis

Lin et al. J Nucl Med 2007;48:1626-1632

• N=92• Visual analysis: • PET pos => 2-y EFS 51%• PET neg => 2-y EFS 79% (p=0.009)

Cutoff value of reduction of SUV (mid treatm/pre treatm)

• Optimal cutoff value 65,7%• SUV reduction <65,7% => 2-y EFS 21%• SUV reduction >65,7% => 2-y EFS 79%(p<0.0001)PPV of early PET for EFS could be improved

from 50 % with visual analysis to 81,3% when using SUVBWmax reduction

Lin et al. J Nucl Med 2007;48:1626-1632

Take home message:

• 17 pts of 34 pts with visually positive FDG uptake remained free of event for 2 yrs

• 50 % of PET positive pts overtreated if treated according to risk adaptive regimen?