Research ArticleClinical Investigation

Predictive Value of Initial 18F-FLT Uptake in Patients with Aggressive Non-Hodgkin Lymphoma Receiving R-CHOP Treatment

Ken Herrmann, Andreas K. Buck, Tibor Schuster, Alexandra Junger, Hinrich A.Wieder, Nicolas Graf, Ingo Ringshausen, Martina Rudelius, Hans-Jürgen Wester, Markus Schwaiger, Ulrich Keller and Tobias Dechow
Journal of Nuclear Medicine May 2011, 52 (5) 690-696; DOI: https://doi.org/10.2967/jnumed.110.084566

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Transaxial views of 18F-FLT PET, helical CT, and 18F-FDG PET for 2 patients with DLBCL. (A) A 41-y-old man with retromandibular lymphoma showing intense 18F-FDG and 18F-FLT uptake in projection of retromandibular lymph node. This stage IA patient revealed PD under therapy. (B) A 40-y-old woman (stage IVA) with histologically proven lymphoma in right iliac bone and sacrum. 18F-FDG PET shows intensely increased uptake in right ilium and sacrum. Corresponding 18F-FLT PET images allow detection of increased asymmetric uptake in right ilium and sacrum despite high physiologic 18F-FLT uptake in proliferating bone marrow. Transaxial views of helical CT display osteodestruction of right ilium. Restaging after end of therapy revealed CR.

  • FIGURE 2.
    FIGURE 2.

    Initial 18F-FLT uptake (SUVmean) in patients achieving CR vs. patients with PR or PD (P = 0.049; difference in median values, 2.5 [95% CI, 0.0–5.2]).

  • FIGURE 3.
    FIGURE 3.

    Initial 18F-FLT uptake (SUVmean) in patients with IPI score lower than or equal to 2, compared with patients with IPI score greater than 2 (P = 0.012; difference in medians, 2.1 (95% CI, 0.5–3.7) (top). Trend analysis of initial 18F-FLT uptake (SUVmean) with IPI risk groups (Spearman ρ, +0.44, P < 0.001) (bottom).

  • FIGURE 4.
    FIGURE 4.

    (A) Martingale residual analysis of IPI score and risk of death. Solid lines depict smoothing spline function, with simultaneous 95% confidence bands. Three patients with lymphoma-associated death had IPI scores of 2, 4, and 4. Corresponding estimated hazard ratio per 1-point increment of IPI score was 1.43 (95% CI, 0.81–2.52, P = 0.22). (B) Martingale residual plots of overall survival and initial 18F-FLT uptake. Solid lines depict smoothing spline function, with simultaneous 95% confidence bands. Corresponding estimated hazard ratio per 1-point increment of 18F-FLT SUVmean was 1.03 (95% CI, 0.83–1.27, P = 0.80). Initial 18F-FLT uptake was significantly higher in 3 patients with lymphoma-associated death (mean, 11.1; range, 9.7–13.7) than in those with non–lymphoma-associated deaths (mean, 6.6; range, 4.5–7.5; P = 0.036) and in whole study cohort (mean, 7.3; P = 0.034).

Tables

  • TABLE 1

    Histology of All Screened Lymphoma Patients (n = 70)

    Histologyn
    DLBCL64
    Follicular lymphoma grade I2
    Follicular lymphoma grade IIIB2
    Large cell anaplastic T-cell lymphoma2
  • TABLE 2

    Characteristics of Eligible Patients (n = 66)

    CharacteristicValuePercentage
    Age (y)
     Median63
     Range26–82
    Stage (n)
     I1827
     II1015
     III69
     IV3249
    IPI score (n)
     0/12436
     21726
     31421
     41015
     512
    Response (n)
     CR5583
     PR35
     PD46
     NA46
    18F-FLT uptake (SUVmean)
     Mean7.3
     SD3.3
     Median6.9
     Range1.0–18.2

    • Response could not be assessed in 4 patients (NA) because they had died early or were lost to follow-up. In 1 patient, IPI score could not be determined.

Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools
Bookmark this article

Jump to section