Phase II Study of Risk-Adapted Therapy of Newly Diagnosed, Aggressive Non-Hodgkin Lymphoma Based on Midtreatment FDG-PET Scanning

Yvette L. Kasamon, Richard L. Wahl, Harvey A. Ziessman, Amanda L. Blackford, Steven N. Goodman, Caroline A. Fidyk, Kathryn M. Rogers, Javier Bolaños-Meade, Michael J. Borowitz, Richard F. Ambinder, Richard J. Jones, Lode J. Swinnen

Research output: Contribution to journalArticlepeer-review

Abstract

In newly diagnosed aggressive non-Hodgkin lymphoma (NHL), a positive midtreatment fluorine-18 fluorodeoxyglucose positron emission tomography (PET) scan often carries a poor prognosis, with reported 2-year event-free survival (EFS) rates of 0% to 30% after standard therapy. To determine the outcome of early treatment intensification for midtreatment PET-positive disease, a phase II trial of risk-adapted therapy was conducted. Fifty-nine newly diagnosed patients, 98% with B cell lymphoma, had PET/CT performed after 2 or 3 cycles of first-line chemotherapy. Those with negative PET on semiquantitative visual interpretation completed standard therapy. Those with positive PET received platinum-based salvage chemotherapy, high-dose therapy, and autologous stem cell transplantation (ASCT). Midtreatment PET was positive in 33 (56%); 28 received ASCT with an actuarial 2-year EFS of 75% (95% confidence interval, 60%-93%). On intention-to-treat analysis, 2-year EFS was 67% (53%-86%) in all PET-positive patients and 89% (77%-100%) in PET-negative patients. No association was found between the International Prognostic Index category and the midtreatment PET result. The favorable outcome achieved here in historically poor-risk patients warrants further, more definitive investigation of treatment modification based on early PET scanning.

Original languageEnglish (US)
Pages (from-to)242-248
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume15
Issue number2
DOIs
StatePublished - Feb 2009

Keywords

  • Autologous stem cell transplantation
  • Lymphoma
  • Positron emission tomography (PET)
  • Prognosis

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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