Risk-Adapted Dose-Dense Immunochemotherapy Determined by Interim FDG-PET in Advanced-Stage Diffuse Large B-Cell Lymphoma
Risk-Adapted Dose-Dense Immunochemotherapy Determined by Interim FDG-PET in Advanced-Stage Diffuse Large B-Cell Lymphoma
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DOI：
10.1200/jco.2009.26.5942
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发表时间：
2010-04-10
影响因子：
45.3
通讯作者：
Zelenetz, Andrew D.
中科院分区：
文献类型：
--
作者：
Moskowitz, Craig H.;Schoeder, Heiko;Zelenetz, Andrew D.
目的 在弥漫性大 B 细胞淋巴瘤的研究中，在两到四个周期的化疗后进行的 [F-18] 氟脱氧葡萄糖 (FDG-PET) 正电子发射断层扫描显示了预后意义。然而，尽管中期 FDG-PET 扫描呈阳性，但一些接受免疫化疗的患者仍获得了良好的长期结果。为了阐明中期 FDG-PET 扫描的意义，我们前瞻性地研究了风险适应序贯免疫化疗计划中的中期 FDG 阳性疾病。 患者和方法 从 2002 年 3 月到 2006 年 11 月，纪念斯隆-凯特琳癌症中心的 98 名患者接受了四个周期的加速 R-CHOP 诱导治疗（利妥昔单抗 + 环磷酰胺、阿霉素、长春新碱和泼尼松）随后进行临时 FDG-PET 扫描。如果 FDG-PET 扫描呈阴性，患者接受三个周期的 ICE（异环磷酰胺、卡铂和依托泊苷）巩固治疗。如果发现残留 FDG 阳性病变，则对患者进行活检；如果活检呈阴性，他们还接受三个周期的 ICE。活检呈阳性的患者接受 ICE 治疗，然后进行自体干细胞移植。结果 在中位随访 44 个月时，总生存率和无进展生存率分别为 90% 和 79%。 97 名患者接受了中期 FDG-PET 扫描； 59 人的扫描结果为阴性，其中 51 人没有进展。 38 名 FDG-PET 阳性患者接受了重复活检； 33 例呈阴性，26 例在 ICE 巩固治疗后仍无进展。中期 FDG-PET 阳性/活检阴性患者的无进展生存期与中期 FDG-PET 扫描阴性的患者相同 (P = .27)。结论 中期或治疗后 FDG-PET 评估并不能预测这种剂量密集、序贯免疫化疗方案的结果。在临床试验之外，我们建议在改变治疗之前对异常的中期 FDG-PET 扫描进行活检确认。
Purpose In studies of diffuse large B-cell lymphoma, [positron emission tomography with [F-18]fluorodeoxyglucose (FDG-PET) performed after two to four cycles of chemotherapy has demonstrated prognostic significance. However, some patients treated with immunochemotherapy experience a favorable long-term outcome despite a positive interim FDG-PET scan. To clarify the significance of interim FDG-PET scans, we prospectively studied interim FDG-positive disease within a risk-adapted sequential immunochemotherapy program.Patients and Methods From March 2002 to November 2006, 98 patients at Memorial Sloan-Kettering Cancer Center received induction therapy with four cycles of accelerated R-CHOP (rituximab + cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by an interim FDG-PET scan. If the FDG-PET scan was negative, patients received three cycles of ICE (ifosfamide, carboplatin, and etoposide) consolidation therapy. If residual FDG-positive disease was seen, patients underwent biopsy; if the biopsy was negative, they also received three cycles of ICE. Patents with a positive biopsy received ICE followed by autologous stem-cell transplantation.Results At a median follow-up of 44 months, overall and progression-free survival were 90% and 79%, respectively. Ninety-seven patients underwent interim FDG-PET scans; 59 had a negative scan, 51 of whom are progression free. Thirty-eight patients with FDG-PET positive disease underwent repeat biopsy; 33 were negative, and 26 remain progression free after ICE consolidation therapy. Progression-free survival of interim FDG-PET-positive/biopsy-negative patients was identical to that in patients with a negative interim FDG-PET scan (P = .27).Conclusion Interim or post-treatment FDG-PET evaluation did not predict outcome with this dose-dense, sequential immunochemotherapy program. Outside of a clinical trial, we recommend biopsy confirmation of an abnormal interim FDG-PET scan before changing therapy.