OtherClinical Investigations

PET Predicts Prognosis After 1 Cycle of Chemotherapy in Aggressive Lymphoma and Hodgkin’s Disease

Lale Kostakoglu, Morton Coleman, John P. Leonard, Ichiei Kuji, Holly Zoe and Stanley J. Goldsmith
Journal of Nuclear Medicine August 2002, 43 (8) 1018-1027;

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    In entire group of patients who underwent 18F-FDG PET after first cycle of chemotherapy (30 patients), Kaplan-Meier estimate of PFS for 15 patients with positive 18F-FDG PET results is compared with that for 15 patients with negative 18F-FDG PET results after first cycle of chemotherapy. Statistically significant difference in PFS was found between positive and negative 18F-FDG PET results (P < 0.001).

  • FIGURE 2.
    FIGURE 2.

    In group of patients who underwent both early and late 18F-FDG PET (23 patients), Kaplan-Meier estimate of PFS for 6 patients with positive 18F-FDG PET results is compared with that for 17 patients with negative 18F-FDG PET results at completion of chemotherapy. Statistically significant difference in PFS was found between positive and negative 18F-FDG PET results (P = 0.001).

  • FIGURE 3.
    FIGURE 3.

    A 35-y-old man with bulky HD underwent 18F-FDG PET before (A), after first cycle of (B), and at completion of (C) chemotherapy. Pretherapy 18F-FDG PET images reveal radiotracer uptake in anterior mediastinum involving both hilar regions and extending into left supraclavicular region. Patient underwent chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine. 18F-FDG PET after first cycle of chemotherapy reveals residual disease in right anterior mediastinum, whereas 18F-FDG PET at completion of chemotherapy shows no evidence of residual lymphoma in corresponding regions. Disease relapsed in mediastinum after PFS of 6 mo. Images obtained after first cycle show physiologic uptake in salivary glands, oral mucosa, right shoulder (trapezius muscle), and heart.

  • FIGURE 4.
    FIGURE 4.

    A 45-y-old man with NHL underwent 18F-FDG PET before (A), after first cycle of (B), and at completion of (C) chemotherapy. Pretherapy 18F-FDG PET images reveal radiotracer uptake in nasopharynx and left cervical lymph nodes. Patient underwent chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone. Both after first cycle and at completion of chemotherapy, 18F-FDG PET reveals no evidence of residual disease. Disease was still in remission after PFS of 18 mo. All images show physiologic uptake in heart.

  • FIGURE 5.
    FIGURE 5.

    In group of patients who underwent both early and late 18F-FDG PET (23 patients), Kaplan-Meier estimate of PFS for 10 patients with positive 18F-FDG PET results is compared with that for 13 patients with negative 18F-FDG PET results after first cycle of chemotherapy. Statistically significant difference in PFS was found between positive and negative 18F-FDG PET results (P < 0.001).

Tables

  • TABLE 1

    Patient Characteristics

    CharacteristicAll patients (n = 30)Patients examined twice* (n = 23)
    Age (y)
     Mean ± SD52.3 ± 16.050.1 ± 14.0
     Range26–7726–77
    Sex
     Male1612
     Female1411
    Histologic diagnosis
     NHL (n = 17)
      Diffuse large B-cell lymphoma1310
      Follicular large cell lymphoma22
      Lymphoblastic lymphoma21
     HD (n = 13)1310
    No. of patients examined
     At initial staging1713
     At relapse1310

    • ↵* These patients had 18F-FDG PET studies both after first cycle and at completion of therapy.

  • TABLE 2

    Characteristics of Patients with Relapse and with Poor Prognostic Features vs. Comparative 18F-FDG PET Results

    Patient no.Age (y)HistologyAnn Arbor stageTumor sizeAfter 1 cycleAfter completionOutcomePFS (mo)
    1>60DLCLIIIBBulky+− (FN)Relapse18
    2>60DLCLIIANonbulky+− (FN)Relapse10
    3<60DLCLIIBBulky+− (FN)Relapse6
    4>60FLCIIIABulky−−Remission24
    5<60HDIIBBulky+ (FP)+ (FP)Remission18
    6<60HDIIABulky−−Remission20
    7>60DLCLIIABulky−−Remission19
    8>60FLCIVNonbulky−−Remission20
    9DLCL+− (FN)Relapse7
    10DLCL++NFOD0
    11HD− (FN)+Relapse4
    12LL++NFOD0
    13HD+− (FN)Relapse5
    14DLCL++NFOD0
    15DLCL− (FN)− (FN)Relapse6
    16DLCL−−Remission18
    17HD++NFOD0
    18DLCL−−Remission18

    • After 1 cycle = 18F-FDG PET after first cycle of chemotherapy; After completion = 18F-FDG PET after completion of chemotherapy; DLCL = diffuse large cell lymphoma; FN = false-negative; FLC = follicular large cell lymphoma; FP = false-positive; NFOD = never free of disease; LL = lymphoblastic lymphoma.

      Patients 1–8 had poor prognostic features at initial staging; patients 9–18 were included in study at relapse.

  • TABLE 3

    18F-FDG PET After 1 Cycle of Chemotherapy

    Category18F-FDG PET +18F-FDG PET −
    Relapse132
    Remission213
    Total1515
    Median PFS* (mo)0Not reached

    • ↵* Statistically significant difference between negative and positive 18F-FDG PET results (P < 0.0001).

    • Sensitivity = 87%; specificity = 87%; negative predictive value = 87%; positive predictive value = 87%; accuracy = 87%.

  • TABLE 4

    18F-FDG PET After 1 Cycle vs. After Completion of Chemotherapy

    CategoryAfter 1 cycleAfter completion
    18F-FDG PET +18F-FDG PET −18F-FDG PET +18F-FDG PET −
    Relapse9256
    Remission111111
    Total1013617
    Median PFS (mo)5Not reached0Not reached
  • TABLE 5

    Overall Comparative Analysis

    IndexAll patients* (n = 23)Patients with poor prognosis† (n = 18)
    After 1 cycle (%)After completion (%)After 1 cycle (%)After completion (%)
    Sensitivity8245.58245.5
    Specificity92928686
    Negative predictive value85657550
    Positive predictive value90839083
    Accuracy87708361

    • ↵* These patients had data available for 18F-FDG PET performed after first and last cycles.

    • ↵† These patients were entered in study at relapse before salvage therapy or had poor prognostic features at initial staging.

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