The prognostic value of mid- and post-treatment [ 18 F]fluorodeoxyglucose (FDG) positron emission tomography (PET) in in
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ORIGINAL ARTICLE
The prognostic value of mid- and post-treatment [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) in indolent follicular lymphoma Zhou Lu • Michael Lin • Paul Downe Shanley Chong • Silvia Ling
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Received: 21 April 2014 / Accepted: 20 June 2014 / Published online: 10 July 2014 Ó The Japanese Society of Nuclear Medicine 2014
Abstract Background [18F]fluorodeoxyglucose positron emission tomography (PET) is a useful staging investigation for follicular lymphoma (FL). Recent studies have shown that positive post-treatment PET is also a strong predictor of inferior overall survival. Purpose To evaluate the predictive value of mid- and post-treatment PET in FL patients with respect to progression-free survival (PFS) and overall survival (OS). Methods We included 57 patients with indolent FL (grade 1, 2, and 3a) who received induction chemotherapy. Mid- and post-treatment PET results were correlated with PFS and OS retrospectively and analysed using Kaplan– Meier survival analysis and Cox regression. Results Post-treatment PET was predictive of OS (mean OS 95.2 vs. 45.0 months for PET-negative vs. PET-positive, p \ 0.001) and showed a trend towards significance for PFS (mean PFS 74.4 vs. 38.2 months for PET- vs. PET?, p = 0.083). 3-year PFS for post-treatment PETand PET? patients were 72 and 30 %, respectively. 3-year
Z. Lu M. Lin S. Chong University of New South Wales, Sydney, Australia M. Lin (&) Department of Nuclear Medicine and PET, Liverpool Hospital, Ground Floor, New Clinical Building, Liverpool, NSW 2170, Australia e-mail: [email protected] P. Downe S. Ling Department of Haematology, Liverpool Hospital, Liverpool, NSW, Australia S. Chong The Centre for Research, Evidence Management and Surveillance, Liverpool Hospital, Liverpool, NSW, Australia
OS were 96 and 60 %, respectively. Mid-treatment PET was not predictive of PFS (mean PFS 78.5 vs. 51.0 months for PET- vs. PET?, p = 0.35) nor OS (mean OS 89.9 vs. 76.6 months for PET- vs. PET?, p = 0.92). Conclusion Post-treatment PET is predictive of OS in indolent FL. It identifies patients who might benefit from more intensive follow-up, enrolment in clinical trials or second-line therapy. Mid-treatment PET scan results did not appear to predict long-term treatment outcomes. Keywords Survival
FDG PET PET/CT Follicular lymphoma
Introduction Follicular lymphoma (FL) is the second most common type of Non-Hodgkin’s Lymphoma (NHL) after diffuse large B cell lymphoma (DLBCL), accounting for 22 % of all cases [1]. It is a heterogeneous disease and treatment options include wait-and-watch, radiotherapy, chemotherapy, and autologous stem cell transplant. The World Health Organization (WHO) classifies FL into grades 1, 2, and 3 based on the number of centroblasts. Grade 3 is subdivided into 3a and 3b, depending on whether centrocytes are still present [2]. Grades 1-3a FL are indolent but incurable with similar clinical outcomes, whereas grade 3b is aggressive but potentially curable [3]. In recent years, metabolic im
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