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Blood, 15 January 2007, Vol. 109, No. 2, pp. 486-491.
Prepublished online as a Blood First Edition Paper on September 26, 2006; DOI 10.1182/blood-2005-11-006957.
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Submitted November 16, 2005
Accepted August 20, 2006
Early FDG-PET assessment in combination with clinical
risk scores determines prognosis in relapsed lymphoma
Bart W. Schot, Josee M. Zijlstra, Wim J. Sluiter, Gustaaf W. van Imhoff, Jan Pruim, Willem Vaalburg, and Edo Vellenga*
Department of Hematology, University Medical Center Groningen, Groningen, Netherlands
Department of Hematology, VU University Medical Center, Amsterdam, Netherlands
Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, Netherlands
* Corresponding author; email: e.vellenga{at}int.azg.nl.
This study was set up to demonstrate whether prognostic classification based on the secondary age-adjusted international prognostic index (sAA-IPI) for relapsed aggressive Non-Hodgkin Lymphoma (NHL) or the prognostic score for relapsed Hodgkin's lymphoma (HL) can be improved by including the mid-treatment results of fluorine-18-fluorodeoxy-glucose positron emission tomography (FDG-PET). Clinical data of relapsed lymphoma patients who were treated with second-line chemotherapy (DHAP-VIM-DHAP) followed by autologous stem cell transplantation (ASCT) were collected and combined with the results of FDG-PET performed before and after two cycles of re-induction chemotherapy. PET responses after two courses were scored as complete remission (CR), responsive disease (PR) or no response (NR). A multivariate analysis was performed to design a predictive model.
101/117 included patients (78 aggressive NHL and 23 HL) could be analyzed according to protocol. Of these, 80 patients were chemo-sensitive and 77 were transplanted. Both secondary clinical risk score (p<0.001) and FDG-PET-response (p<0.001) were independent predictive factors for the total evaluable group of lymphoma patients and for NHL patients alone. The combined use of the clinical risk score and FDG-PET response after two chemotherapy courses identified at least four categories of patients with a failure free survival varying between 100%-5% post-transplantation (p<0.001). These data indicate that the secondary clinical risk score in conjunction with FDG-PET response provides a more accurate prognostic instrument for the outcome of second-line treatment in at least relapsed NHL patients.
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