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Positron emission tomography-computed tomography predictors of progression after DA-R-EPOCH for PMBCL.
- Source :
-
Blood advances [Blood Adv] 2018 Jun 12; Vol. 2 (11), pp. 1334-1343. - Publication Year :
- 2018
-
Abstract
- Dose-adjusted rituximab plus etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-R-EPOCH) has produced good outcomes in primary mediastinal B-cell lymphoma (PMBCL), but predictors of resistance to this treatment are unclear. We investigated whether [ <superscript>18</superscript> F]fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) findings could identify patients with PMBCL who would not respond completely to DA-R-EPOCH. We performed a retrospective analysis of 65 patients with newly diagnosed stage I to IV PMBCL treated at 2 tertiary cancer centers who had PET-CT scans available before and after frontline therapy with DA-R-EPOCH. Pretreatment variables assessed included metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Optimal cutoff points for progression-free survival (PFS) were determined by a machine learning approach. Univariate and multivariable models were constructed to assess associations between radiographic variables and PFS. At a median follow-up of 36.6 months (95% confidence interval, 28.1-45.1), 2-year PFS and overall survival rates for the 65 patients were 81.4% and 98.4%, respectively. Machine learning-derived thresholds for baseline MTV and TLG were associated with inferior PFS (elevated MTV: hazard ratio [HR], 11.5; P = .019; elevated TLG: HR, 8.99; P = .005); other pretreatment clinical factors, including International Prognostic Index and bulky (>10 cm) disease, were not. On multivariable analysis, only TLG retained statistical significance ( P = .049). Univariate analysis of posttreatment variables revealed that residual CT tumor volume, maximum standardized uptake value, and Deauville score were associated with PFS; a Deauville score of 5 remained significant on multivariable analysis ( P = .006). A model combining baseline TLG and end-of-therapy Deauville score identified patients at increased risk of progression.<br /> (© 2018 by The American Society of Hematology.)
- Subjects :
- Adult
Aged
Cyclophosphamide administration & dosage
Disease-Free Survival
Doxorubicin administration & dosage
Etoposide administration & dosage
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Survival Rate
Vincristine administration & dosage
Antineoplastic Combined Chemotherapy Protocols administration & dosage
Lymphoma, B-Cell diagnostic imaging
Lymphoma, B-Cell drug therapy
Lymphoma, B-Cell mortality
Mediastinal Neoplasms diagnostic imaging
Mediastinal Neoplasms drug therapy
Mediastinal Neoplasms mortality
Models, Biological
Positron-Emission Tomography
Tomography, X-Ray Computed
Subjects
Details
- Language :
- English
- ISSN :
- 2473-9537
- Volume :
- 2
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Blood advances
- Publication Type :
- Academic Journal
- Accession number :
- 29895624
- Full Text :
- https://doi.org/10.1182/bloodadvances.2018017681