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 Ziessman, Amanda L. Blackford, Steven N. Goodman, Caroline A. Fidyk, Kathryn M. Rogers, F Javier Bolanos Meade, Michael J Borowitz, Richard F Ambinder, Richard J Jones, Lode Swinnen

Research output: Contribution to journalArticle

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 : journal of the American Society for Blood and Marrow Transplantation
Volume15
Issue number2
DOIs
StatePublished - Feb 2009

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Positron-Emission Tomography
Non-Hodgkin's Lymphoma
Disease-Free Survival
Therapeutics
Stem Cell Transplantation
Drug Therapy
Intention to Treat Analysis
Fluorodeoxyglucose F18
B-Cell Lymphoma
Platinum
Survival Rate
Confidence Intervals

Keywords

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

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

@article{b9f69cbd468446929a95d089e3ba043b,
title = "Phase II Study of Risk-Adapted Therapy of Newly Diagnosed, Aggressive Non-Hodgkin Lymphoma Based on Midtreatment FDG-PET Scanning",
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.",
keywords = "Autologous stem cell transplantation, Lymphoma, Positron emission tomography (PET), Prognosis",
author = "Kasamon, {Yvette L.} and Wahl, {Richard L.} and Harvey Ziessman and Blackford, {Amanda L.} and Goodman, {Steven N.} and Fidyk, {Caroline A.} and Rogers, {Kathryn M.} and {Bolanos Meade}, {F Javier} and Borowitz, {Michael J} and Ambinder, {Richard F} and Jones, {Richard J} and Lode Swinnen",
year = "2009",
month = "2",
doi = "10.1016/j.bbmt.2008.11.026",
language = "English (US)",
volume = "15",
pages = "242--248",
journal = "Biology of Blood and Marrow Transplantation",
issn = "1083-8791",
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T1 - Phase II Study of Risk-Adapted Therapy of Newly Diagnosed, Aggressive Non-Hodgkin Lymphoma Based on Midtreatment FDG-PET Scanning

AU - Kasamon, Yvette L.

AU - Wahl, Richard L.

AU - Ziessman, Harvey

AU - Blackford, Amanda L.

AU - Goodman, Steven N.

AU - Fidyk, Caroline A.

AU - Rogers, Kathryn M.

AU - Bolanos Meade, F Javier

AU - Borowitz, Michael J

AU - Ambinder, Richard F

AU - Jones, Richard J

AU - Swinnen, Lode

PY - 2009/2

Y1 - 2009/2

N2 - 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.

AB - 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.

KW - Autologous stem cell transplantation

KW - Lymphoma

KW - Positron emission tomography (PET)

KW - Prognosis

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