1. Interim positron emission tomography scan associated with international prognostic index and germinal center B cell-like signature as prognostic index in diffuse large B-cell lymphoma.
- Author
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Lanic H, Mareschal S, Mechken F, Picquenot JM, Cornic M, Maingonnat C, Bertrand P, Clatot F, Bohers E, Stamatoullas A, Leprêtre S, Rainville V, Ruminy P, Bastard C, Tilly H, Becker S, Vera P, and Jardin F
- Subjects
- Adult, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols therapeutic use, B-Lymphocytes drug effects, B-Lymphocytes metabolism, Cyclophosphamide administration & dosage, Disease-Free Survival, Doxorubicin administration & dosage, Female, Gene Expression Profiling, Gene Expression Regulation, Neoplastic, Germinal Center drug effects, Germinal Center metabolism, Humans, Lymphoma, Large B-Cell, Diffuse drug therapy, Lymphoma, Large B-Cell, Diffuse genetics, Male, Middle Aged, Multivariate Analysis, Oligonucleotide Array Sequence Analysis, Outcome Assessment, Health Care statistics & numerical data, Prednisone administration & dosage, Prognosis, Proportional Hazards Models, Vincristine administration & dosage, Young Adult, B-Lymphocytes pathology, Germinal Center diagnostic imaging, Lymphoma, Large B-Cell, Diffuse diagnostic imaging, Positron-Emission Tomography methods
- Abstract
[(18)F]-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging is essential to optimize the initial staging and to predict the prognosis of diffuse large B-cell lymphoma (DLBCL). To assess the relationship between the germinal center B cell-like/activated B cell-like (GCB/ABC) classification and PET scan features in DLBCL, 57 cases treated with rituximab and a cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP)/CHOP-like regimen were analyzed. The expression profile of 18 GCB/ABC related genes and five genes coding for glucose transporters (GLUTs) was determined from frozen tissues using DASL (cDNA-mediated Annealing, Selection, Ligation and extension) technology. According to the gene expression profile (GEP), 30 cases of DLBCL were classified as GCB subtype (2-year progression-free survival [PFS] 76%) and 27 cases as ABC subtype (2-year PFS 51%, p = 0.03). Using a semiquantitative assessment of the decrease in standard uptake value (SUV) at interim PET performed after 3-4 cycles of chemotherapy, we defined fast (n = 36) and slow (n = 9) metabolic responders. In multivariate analysis, GCB/ABC subtype, age-adjusted international prognostic index (aaIPI) and slow/fast metabolic response were independent variables that predicted outcome. A score incorporating aaIPI, fast/slow metabolic response and GCB/ABC classification was used to define two groups with highly significantly distinct outcomes. Our study suggests that the combination of GEP, aaIPI and interim PET more accurately predicts DLBCL prognosis and is therefore suitable for tailoring therapeutic strategies.
- Published
- 2012
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