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Post-Transplant Events

The role of FDG-PET imaging and involved field radiotherapy in relapsed or refractory diffuse large B-cell lymphoma

Bone Marrow Transplantation volume 43, pages 941–948 (2009)Cite this article

Abstract

We examined the role of fluorodeoxyglucose-positron emission tomography (FDG-PET) and the addition of involved field radiotherapy (IFRT) as potential modifiers of salvage therapy. From January 2000 to June 2007, 83 patients with chemosensitive relapsed or primary refractory diffuse large B-cell lymphoma (DLBCL) underwent FDG-PET scans following second-line chemotherapy before high-dose therapy with autologous stem cell rescue (HDT/ASCR). We evaluated the prognostic value of having a negative FDG-PET scan before HDT/ASCR and whether IFRT improved the outcomes. Median follow-up was 45 months, and the 3-year PFS, disease-specific survival (DSS) and OS were 72, 80 and 78%, respectively. Multivariate analysis revealed that a positive FDG-PET scan had worse PFS (hazard ratio=(HR) 3.4; P=0.014), DSS (HR=7.7; P=0.001) and OS (HR=5.4; P=0.001), and that patients not receiving IFRT had worse PFS (HR=2.7; P=0.03) and DSS (HR=2.8, P=0.059). Patients who received IFRT had better local control with fewer relapses within prior involved sites compared with those that did not receive IFRT (P=0.006). These outcomes confirm the important prognostic value of FDG-PET scans before undergoing HDT/ASCR. It also suggests that the role of IFRT should be evaluated further.

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Acknowledgements

This study was supported from the Lymphoma Foundation and the Sports Foundation against Cancer. BSH, MD, was a Dr Mortimer Lacher 2007 Lymphoma Fellow at the Memorial Sloan-Kettering Cancer Center. We thank Carol Pearce, MFA, writer/editor with the MSKCC Department of Medicine Editorial Unit, for reviewing this manuscript.

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Authors and Affiliations

  1. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    B S Hoppe & J Yahalom

  2. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    C H Moskowitz, J C Maragulia, R D Rice, P A Hamlin & A D Zelenetz

  3. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Z Zhang & A S Reiner

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Presented at the American Society for Hematology (ASH) 2007 meeting in Atlanta, GA and American Society for Therapeutic Radiology and Oncology (ASTRO) 2008 meeting in Boston, MA, USA.

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Hoppe, B., Moskowitz, C., Zhang, Z. et al. The role of FDG-PET imaging and involved field radiotherapy in relapsed or refractory diffuse large B-cell lymphoma. Bone Marrow Transplant 43, 941–948 (2009). https://doi.org/10.1038/bmt.2008.408

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