Positron emission tomography-computed tomography (PET-CT) after induction therapy is highly predictive of patient outcome in follicular lymphoma: analysis of PET-CT in a subset of PRIMA trial participants.

Judith Trotman , Marion Fournier , Thierry Lamy (1, 2) , John Francis Seymour , Anne Sonet , Andrea Janikova , Ofer Shpilberg , Emmanuel Gyan (3) , Hervé Tilly (4, 5) , Jane Estell , Cecily Forsyth , Didier Decaudin (6, 7) , Bettina Fabiani (8) , Jean Gabarre (9) , Bruno Salles , Eric van den Neste , Danielle Canioni (10) , Etienne Garin (11, 12) , Michael Fulham , Thierry Vander Borght , Gilles Salles (13)

1 MiCa - Microenvironnement et cancer
2 Etablissement Français du Sang Bretagne
3 GICC UMR 6239 CNRS - Génétique, immunothérapie, chimie et cancer (GICC), UMR 6239 CNRS [2008-2011]
4 GPL - Groupe d'étude des proliférations lymphoïdes
5 Service d'Hématologie
6 Département de Recherche Translationnelle
7 Service d'Oncologie Médicale
8 CHU Saint-Antoine [AP-HP]
9 CHU Pitié-Salpêtrière [AP-HP]
10 Hôpital Necker - Enfants Malades [AP-HP]
11 Foie, métabolismes et cancer
12 Service de médecine nucléaire [Rennes]
13 Service d'Hematologie

PURPOSE: The utility of [(18)F]fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) in assessing response at the end of induction therapy is well documented in Hodgkin's and diffuse large B-cell lymphomas, but its role in follicular lymphoma (FL) remains undetermined. We investigated the prognostic significance of PET-CT performed after first-line therapy in patients with FL treated in the prospective Primary Rituximab and Maintenance (PRIMA) study. PATIENTS AND METHODS: Results of PET-CT scans performed after induction immunochemotherapy were recorded retrospectively. Patients went on to either observation or rituximab maintenance per protocol independent of the PET-CT result. Patient characteristics and outcomes were then evaluated. RESULTS: Of 122 PET-CT scans performed at the end of the induction immunochemotherapy, 32 (26%) were reported as positive by the local investigator. Initial demographic or disease characteristics did not differ between PET-CT-positive (PET-positive) and PET-CT-negative (PET-negative) patients. PET status correlated with conventional response criteria (P < .001). Patients remaining PET positive had a significantly (P < .001) inferior progression-free survival at 42 months of 32.9% (95% CI, 17.2% to 49.5%) compared with 70.7% (95% CI, 59.3% to 79.4%) in those who became PET negative. PET status, but not conventional response (complete response or complete response unconfirmed v partial response) according to IWC 1999, was an independent predictive factor for lymphoma progression. The risk of death was also increased in PET-positive patients (hazard ratio 7.0; P = .0011). CONCLUSION: [(18)F]FDG PET-CT status at the end of immunochemotherapy induction in patients with FL is strongly predictive of outcome and should be considered a meaningful clinical end point in future studies.

Domaines: Cancer

Judith Trotman, Marion Fournier, Thierry Lamy, John Francis Seymour, Anne Sonet, et al.. Positron emission tomography-computed tomography (PET-CT) after induction therapy is highly predictive of patient outcome in follicular lymphoma: analysis of PET-CT in a subset of PRIMA trial participants.. Journal of Clinical Oncology, 2011, 29 (23), pp.3194-200. ⟨10.1200/JCO.2011.35.0736⟩. ⟨hal-00741692⟩