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Research ArticleOncology

Interim PET Evaluation in Diffuse Large B-Cell Lymphoma Using Published Recommendations: Comparison of the Deauville 5-Point Scale and the ΔSUVmax Method

Jan Rekowski, Andreas Hüttmann, Christine Schmitz, Stefan P. Müller, Lars Kurch, Jörg Kotzerke, Christiane Franzius, Matthias Weckesser, Frank M. Bengel, Martin Freesmeyer, Andreas Hertel, Thomas Krohn, Jens Holzinger, Ingo Brink, Uwe Haberkorn, Fonyuy Nyuyki, Daniëlle M.E. van Assema, Lilli Geworski, Dirk Hasenclever, Karl-Heinz Jöckel and Ulrich Dührsen
Journal of Nuclear Medicine January 2021, 62 (1) 37-42; DOI: https://doi.org/10.2967/jnumed.120.244145
Jan Rekowski
1Institut für Medizinische Informatik, Biometrie, und Epidemiologie, Universitätsklinikum, Essen, Germany
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Andreas Hüttmann
2Klinik für Hämatologie, Universitätsklinikum, Essen, Germany
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Christine Schmitz
2Klinik für Hämatologie, Universitätsklinikum, Essen, Germany
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Stefan P. Müller
3Klinik für Nuklearmedizin, Universitätsklinikum, Essen, Germany
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Lars Kurch
4Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum, Leipzig, Germany
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Jörg Kotzerke
5Klinik für Nuklearmedizin, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
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Christiane Franzius
6Zentrum für moderne Diagnostik (Zemodi), Zentrum für Nuklearmedizin und PET/CT, Bremen, Germany
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Matthias Weckesser
7Klinik für Nuklearmedizin, Universitätsklinikum, Münster, Germany
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Frank M. Bengel
8Klinik für Nuklearmedizin, Medizinische Hochschule, Hannover, Germany
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Martin Freesmeyer
9Klinik für Nuklearmedizin, Universitätsklinikum, Jena, Germany
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Andreas Hertel
10Klinik für Diagnostische und Therapeutische Nuklearmedizin, Klinikum, Fulda, Germany
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Thomas Krohn
11Klinik für Nuklearmedizin, Universitätsklinikum, Aachen, Germany
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Jens Holzinger
12Institut für Diagnostische Radiologie, Neuroradiologie, und Nuklearmedizin, Johannes Wesling Klinikum, Minden, Germany
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Ingo Brink
13Klinik für nuklearmedizinische Diagnostik und Therapie, Ernst von Bergmann Klinikum, Potsdam, Germany
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Uwe Haberkorn
14Radiologische Klinik und Poliklinik, Universitätsklinikum, Heidelberg, Germany
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Fonyuy Nyuyki
15Klinik für Nuklearmedizin, Brüderkrankenhaus St. Josef, Paderborn, Germany
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Daniëlle M.E. van Assema
16Department of Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Lilli Geworski
17Stabsstelle Strahlenschutz und Abteilung Medizinische Physik, Medizinische Hochschule, Hannover, Germany; and
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Dirk Hasenclever
18Institut für Medizinische Informatik, Statistik, und Epidemiologie, Universität Leipzig, Leipzig, Germany
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Karl-Heinz Jöckel
1Institut für Medizinische Informatik, Biometrie, und Epidemiologie, Universitätsklinikum, Essen, Germany
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Ulrich Dührsen
2Klinik für Hämatologie, Universitätsklinikum, Essen, Germany
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Abstract

The value of interim 18F-FDG PET/CT (iPET)–guided treatment decisions in patients with diffuse large B-cell lymphoma (DLBCL) has been the subject of much debate. This investigation focuses on a comparison of the Deauville score and the change-in-SUVmax (ΔSUVmax) approach—2 methods to assess early metabolic response to standard chemotherapy in DLBCL. Methods: Of 609 DLBCL patients participating in the PET-Guided Therapy of Aggressive Non-Hodgkin Lymphomas trial, iPET scans of 596 patients originally evaluated using the ΔSUVmax method were available for post hoc assessment of the Deauville score. A commonly used definition of an unfavorable iPET result according to the Deauville score is an uptake greater than that of the liver, whereas an unfavorable iPET scan with regard to the ΔSUVmax approach is characterized as a relative reduction of the SUVmax between baseline and iPET staging of less than or equal to 66%. We investigated the 2 methods’ correlation and concordance by Spearman rank correlation coefficient and the agreement in classification, respectively. We further used Kaplan–Meier curves and Cox regression to assess differences in survival between patient subgroups defined by the prespecified cutoffs. Time-dependent receiver-operating-characteristic curve analysis provided information on the methods’ respective discrimination performance. Results: Deauville score and ΔSUVmax approach differed in their iPET-based prognosis. The ΔSUVmax approach outperformed the Deauville score in terms of discrimination performance—most likely because of a high number of false-positive decisions by the Deauville score. Cutoff-independent discrimination performance remained low for both methods, but cutoff-related analyses showed promising results. Both favored the ΔSUVmax approach, for example, for the segregation by iPET response, where the event-free survival hazard ratio was 3.14 (95% confidence interval, 2.22–4.46) for ΔSUVmax and 1.70 (95% confidence interval, 1.29–2.24) for the Deauville score. Conclusion: When considering treatment intensification, the currently used Deauville score cutoff of an uptake above that of the liver seems to be inappropriate and associated with potential harm for DLBCL patients. The ΔSUVmax criterion of a relative reduction in SUVmax of less than or equal to 66% should be considered as an alternative.

  • diffuse large B-cell lymphoma
  • early metabolic response to therapy
  • interim PET
  • Deauville score
  • deltaSUVmax approach

Footnotes

  • Published online May 8, 2020.

  • © 2021 by the Society of Nuclear Medicine and Molecular Imaging.
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Journal of Nuclear Medicine: 62 (1)
Journal of Nuclear Medicine
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January 1, 2021
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Interim PET Evaluation in Diffuse Large B-Cell Lymphoma Using Published Recommendations: Comparison of the Deauville 5-Point Scale and the ΔSUVmax Method
Jan Rekowski, Andreas Hüttmann, Christine Schmitz, Stefan P. Müller, Lars Kurch, Jörg Kotzerke, Christiane Franzius, Matthias Weckesser, Frank M. Bengel, Martin Freesmeyer, Andreas Hertel, Thomas Krohn, Jens Holzinger, Ingo Brink, Uwe Haberkorn, Fonyuy Nyuyki, Daniëlle M.E. van Assema, Lilli Geworski, Dirk Hasenclever, Karl-Heinz Jöckel, Ulrich Dührsen
Journal of Nuclear Medicine Jan 2021, 62 (1) 37-42; DOI: 10.2967/jnumed.120.244145

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Interim PET Evaluation in Diffuse Large B-Cell Lymphoma Using Published Recommendations: Comparison of the Deauville 5-Point Scale and the ΔSUVmax Method
Jan Rekowski, Andreas Hüttmann, Christine Schmitz, Stefan P. Müller, Lars Kurch, Jörg Kotzerke, Christiane Franzius, Matthias Weckesser, Frank M. Bengel, Martin Freesmeyer, Andreas Hertel, Thomas Krohn, Jens Holzinger, Ingo Brink, Uwe Haberkorn, Fonyuy Nyuyki, Daniëlle M.E. van Assema, Lilli Geworski, Dirk Hasenclever, Karl-Heinz Jöckel, Ulrich Dührsen
Journal of Nuclear Medicine Jan 2021, 62 (1) 37-42; DOI: 10.2967/jnumed.120.244145
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Keywords

  • diffuse large B-cell lymphoma
  • early metabolic response to therapy
  • interim PET
  • Deauville score
  • deltaSUVmax approach
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