Prospective international cohort study demonstrates inability of interim PET to predict treatment failure in diffuse large B-cell lymphoma

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dc.contributor.authorÖzdağ, Hilal
dc.contributor.authorIDhttp://orcid.org/0000-0001-7940-2499tr_TR
dc.contributor.departmentBiyoteknoloji Enstitüsütr_TR
dc.contributor.otherKuzu, Işınsu
dc.date.accessioned2020-04-29T07:13:51Z
dc.date.available2020-04-29T07:13:51Z
dc.date.issued2014
dc.description.abstractThe International Atomic Energy Agency sponsored a large, multinational, prospective study to further define PET for risk stratification of diffuse large B-cell lymphoma and to test the hypothesis that international biological diversity or diversity of healthcare systems may influence the kinetics of treatment response as assessed by interim PET (I-PET). Methods: Cancer centers in Brazil, Chile, Hungary, India, Italy, the Philippines, South Korea, and Thailand followed a common protocol based on treatment with R-CHOP (cyclophosphamide, hydroxyadriamycin, vincristine, prednisolone with rituximab), with I-PET after 2-3 cycles of chemotherapy and at the end of chemotherapy scored visually. Results: Two-year survivals for all 327 patients (median follow-up, 35 mo) were 79% (95% confidence interval [CI], 74%-83%) for event-free survival (EFS) and 86% (95% CI, 81%-89%) for overall survival (OS). Two hundred ten patients (64%) were I-PET-negative, and 117 (36%) were I-PET-positive. Two-year EFS was 90% (95% CI, 85%-93%) for I-PET-negative and 58% (95% CI, 48%-66%) for I-PET-positive, with a hazard ratio of 5.31 (95% CI, 3.29-8.56). Two-year OS was 93% (95% CI, 88%-96%) for I-PET-negative and 72% (95% CI, 63%-80%) for I-PET-positive, with a hazard ratio of 3.86 (95% CI, 2.12-7.03). On sequential monitoring, 192 of 312 (62%) patients had complete response at both I-PET and end-of-chemotherapy PET, with an EFS of 97% (95% CI, 92%-98%); 110 of these with favorable clinical indicators had an EFS of 98% (95% CI, 92%-100%). In contrast, the 107 I-PET-positive cases segregated into 2 groups: 58 (54%) achieved PET-negative complete remission at the end of chemotherapy (EFS, 86%; 95% CI, 73%-93%); 46% remained PET-positive (EFS, 35%; 95% CI, 22%-48%). Heterogeneity analysis found no significant difference between countries for outcomes stratified by I-PET. Conclusion: This large international cohort delivers 3 novel findings: treatment response assessed by I-PET is comparable across disparate healthcare systems, secondly a negative I-PET findings together with good clinical status identifies a group with an EFS of 98%, and thirdly a single I-PET scan does not differentiate chemoresistant lymphoma from complete response and cannot be used to guide risk-adapted therapy. Copyright © 2014 by the Society of Nuclear Medicine and Molecular Imaging, Inc.tr_TR
dc.description.indexwos
dc.description.indexScopus
dc.identifier.endpage1944tr_TR
dc.identifier.startpage1936tr_TR
dc.identifier.urihttps://doi.org/10.2967/jnumed.114.145326tr_TR
dc.identifier.urihttp://hdl.handle.net/20.500.12575/71195
dc.language.isoentr_TR
dc.relation.isversionof10.2967/jnumed.114.145326tr_TR
dc.relation.journalJournal of Nuclear Medicinetr_TR
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıtr_TR
dc.subjectDiffuse large B-cell lymphomatr_TR
dc.subjectPositron emission tomographytr_TR
dc.subjectProspective observational studytr_TR
dc.subjectRisk stratificationtr_TR
dc.subjectRisk-adapted therapytr_TR
dc.titleProspective international cohort study demonstrates inability of interim PET to predict treatment failure in diffuse large B-cell lymphomatr_TR
dc.typeArticletr_TR

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