Interim Positron Emission Tomography During Frontline Chemoimmunotherapy for Follicular Lymphoma. Issue 2 (24th February 2023)

• Record Type: Journal Article
• Authors: Merryman, Reid W.; Michaud, Laure; Redd, Robert; Mondello, Patrizia; Park, Hyesun; Spilberg, Gabriela; Robertson, Matthew; Taranto, Eleanor; Ahmed, Gulrayz; Chase, Matthew; Jeter, Erin; Ahn, Inhye E.; Brown, Jennifer R.; Crombie, Jennifer; Davids, Matthew S.; Fisher, David C.; Jacobsen, Eric; Jacobson, Caron A.; Kim, Austin I.; LaCasce, Ann S.; Ng, Samuel Y.; Odejide, Oreofe O.; Parry, Erin M.; Salles, Gilles; Zelenetz, Andrew D.; Armand, Philippe; Schöder, Heiko; Jacene, Heather
• Is Part Of: HemaSphere. Volume 7:Issue 2(2023)
• Page Start: e826
• Publication Date: 2023-02-24
• Subjects: Hematology -- Periodicals; 616.15005
• DOI: 10.1097/HS9.0000000000000826
• Languages: English
• ISSNs: 2572-9241

Abstract

Abstract : While most patients with follicular lymphoma (FL) have excellent outcomes with frontline chemoimmunotherapy (CIT), a subset of patients will experience early progression, which is associated with poor subsequent outcomes. Novel biomarkers are needed to identify high-risk patients earlier. We hypothesized that interim positron emission tomography (PET) would predict progression-free survival (PFS) in this population. We retrospectively identified 128 patients with grade 1–3A FL who had an interim PET after 2–4 cycles of frontline CIT at 2 academic centers. PET scans were analyzed using Deauville score (DS) and change in maximum standardized uptake value (ΔSUVmax). Interim PET DS was a significant predictor of PFS ( P < 0.003). Patients with a DS of 3 had outcomes similar to those of patients with a DS of 4, so were categorized as PET-positive for additional analyses. Interim PET remained a strong predictor of PFS (DS 3-5, hazard ratio [HR] 2.4, P = 0.006) in a multivariable analysis and was also an early predictor of both a positive end-of-treatment PET ( P < 0.001) and progression of disease within 24 months (POD24) ( P = 0.006). An optimal ΔSUVmax cutoff of 75% was selected using the bootstrap method. ΔSUVmax <75% was also a significant predictor of PFS on univariable and multivariable analyses (HR 2.8, P < 0.003). In a separate cohort of 50 patients with high-grade FL, interim PET interpreted using either DS ( P < 0.001) or ΔSUVmax75% ( P = 0.034) was also a significant predictor of inferior PFS. In conclusion, interim PET is an independent predictor of PFS and may be useful as a tool for response-adapted treatment strategies in FL.