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?
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