TY - JOUR T1 - Prognostic Value of Pre and Post-Transplant FDG-PET Imaging in Refractory or Relapsed Lymphomas treated with Autologous Stem Cell Transplantation JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 617 LP - 617 VL - 60 IS - supplement 1 AU - Ameya Puranik AU - Venkatesh Rangarajan AU - Nilendu Purandare AU - Sneha Shah AU - Archi Agrawal Y1 - 2019/05/01 UR - http://jnm.snmjournals.org/content/60/supplement_1/617.abstract N2 - 617Introduction: Conventionally,patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) show good response to first-line chemotherapy regimens, with complete remission (CR) rates ranging from 60% to 80%. However, there is a subset of patients which does not achieve CR or demonstrate recurrent disease; this harbingers poor prognosis. 18F-FDG PET/CT is the accepted standard for staging, response assessment and restaging in patients with high grade lymphoma. Persistence of metabolic activity on post-treatment PET/CT study is associated with a high recurrence rate, whereas a negative FDG-PET/CT study is predictive of a good outcome. Aim and Objective: Hence, the objective of the study was to determine the impact of pre-transplantation and post-transplantation FDG PET/CT on patient outcome. Materials and Methods: From January 1, 2007 to December 31, 2013, 64 patients with biopsy-proven lymphoma (47:17; M: F, median age - 23 years) were included. 43 patients had HD, while 21 showed NHL All patients underwent FDG PET/CT study before and after ASCT (on day 100)For the current study, medical files were reviewed and data collected on a standard form. Study was approved by the Institutional Review Board and Ethics Committee of the Institute.Treatment response was assessed according to the Deauville-5-point visual scale (DS). PET results with DS of 1, 2 or 3 were defined as negative. DS of 4 or 5 were considered positive. Statistical Analysis: Data were collected using IBM SPSS Statistics for Windows (Version 22.0; IBM Corp., New York, USA). Progression-free survival (PFS) was measured from the date of ASCT to the date of disease progression or recurrence. Overall survival (OS) was measured from date of ASCT to the date of death from any cause. Survival curves were calculated by using Kaplan-Meier survival analysis, and using log-rank test compared groups. Univariate and multivariate survival analyses were performed using Cox regression with the backwards-stepwise model. Results: Univariate Analysis for Progression-free survival: Pre-transplant FDG PET: 24 patients showed FDG uptake on pre-transplant FDG PET. Mean PFS for patients with positive FDG uptake was 23 months, whereas those with no uptake showed PFS of 35 months (p - 0.032). 3-year PFS for PET negative patients was 74.4% and for PET positive patients was 23.8%. Post-transplant (Day 100) FDG PET: 14 of the 64 patients showed positive FDG PET at day 100 post-transplant, whereas remaining 50 patients showed no uptake. Mean PFS patients with positive uptake was 15 months, for those with no uptake was 36 months (p - 0.032). 3-year PFS for PET negative group was 68%, and PET positive group was 21.4%. HD vs NHL: Patients with HD had improved outcome compared to NHL, with a p-value of 0.027 Stage of Disease: Stage-wise analysis yielded no statistically significant survival benefit, however when grouped into early stage (I and II) and advanced stage (III and IV), patients in early stage had higher PFS compared to advanced stage. Further, patients were categorized into four groups according to the PET status before and after ASCT: those who were negative before and after (-/-; n=34); positive before and negative after (+/-; n=16); positive before and after (+/+; n=8); and negative before and positive after (-/+, n=6). Patients with (+/+) and (-/-) studies showed significant impact on survival, whereas the other two pairs i.e (+/-) and (-/+), showed no impact on prognosis and outcome. Multi-variate analysis for Progression-free survival: In this setting, findings of post-transplant FDG PET at day 100 showed significant impact on the outcome. (P=0.001) Univariate Analysis for Overall Survival: Only parameter which impacted OS was type of lymphoma, with patients with HD have better outcome compared to NHL. Conclusions: Pre and post-transplant FDG PET has significant prognostic impact in patients with relapsed or refractory lymphoma undergoing transplantation. ER -