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Pre-transplant 18F-fluorodeoxyglucose positron emission tomography-based survival model in patients with aggressive lymphoma undergoing high-dose chemotherapy and autologous SCT

Bone Marrow Transplantation volume 48, pages 551–556 (2013)Cite this article

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Abstract

18F-fluorodeoxyglucose positron emission tomography (FDG-PET) documented response after salvage chemotherapy has been reported to impact survival in patients with aggressive non-Hodgkin’s lymphoma, especially diffuse large B cell lymphoma (DLBCL) undergoing high dose chemotherapy and autologous SCT (HDC auto-SCT). We reviewed the impact of 19 different prognostic/predictive factors before salvage chemotherapy and post-salvage chemotherapy FDG-PET results in patients with aggressive lymphoma and developed an FDG-PET integrated model for post-HDC auto-SCT outcome. The Fine and Gray method for competing risk analysis and a regression model was used to assess the risk associated with different factors on outcome. Fifty-five patients had FDG-PET after salvage chemotherapy; male 65%, female 45%, relapsed 55%, refractory 45%, DLBCL 82%, T cell lymphoma 18%, median age at auto-SCT 40 years, median follow-up 42.4 months. Multivariate analysis identified only positive FDG-PET (P=0.04) and mediastinal involvement (P=0.05) with higher hazard rate of disease-specific death (model P=0.008) but only positive FDG-PET (P=0.01) for disease-specific events (persistent, progressive or relapsed disease). Cumulative incidence of disease-specific death for patients with 0, 1 and 2 risk factors was 5, 30 and 62%, respectively (P=0.01). Our model is significant and showed an increasing risk of failure with mediastinal involvement and post-salvage positive FDG-PET.

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Acknowledgements

We appreciate Ms Ruqaya Belkhedim, Mr Fayez Abu Zeid and Ms Fadia Mansour from BMT clinic, Mr Edgardo Colcol and Riad Youniss from Oncology Research Unit for their valuable contribution.

Author contributions: SA was the principal investigator, designed research, collected data, analyzed and interpreted data, wrote the manuscript. A Al-S and M Abu collected data, read PET scans and critically reviewed/provided input for manuscript; YA collected data, read CT scans and critically reviewed/T Elhassan performed statistical analysis and wrote statistical portion of the manuscript. M Abd, MD, HS, M Nabil-A, AD and AE collected data and critically reviewed/provided input for manuscript; IM designed research, collected data, interpreted data, helped in manuscript writing.

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Authors and Affiliations

  1. King Faisal Specialist Hospital and Research Center, Oncology Center, Riyadh, Saudi Arabia

    S Akhtar, M Dingle, M Abdelsalam, H Soudy, A Darwish, A Eltigani, T A M Elhassan, M Nabil-Ahmed & I Maghfoor

  2. Department of Medical Imaging Services, Section of Nuclear Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

    A S Al-Sugair & M Abouzied

  3. Department of Medical Imaging Services, Section of Abdominal Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

    Y AlKadhi

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  1. S Akhtar
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Correspondence to S Akhtar.

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Appendix

Appendix

1. Akhtar S, Al-Sugair A, Al Kadhi Y, Al-Zahrani A, Abdelsalam M, Bazarbashi S, Ajarim D, Maghfoor I. Prospective evaluation of 18F-fluorodeoxyglucose (FDG) positron emission tomography as a predictor of residual disease and subsequent relapse in patients with diffuse large cell lymphoma and Hodgkin’s lymphoma undergoing HDC and ASCT. Transplantation 2008; 4 (supplemental 1): S213, Abstract O 262. 34th Annual Meeting of the European Group for Blood and Marrow Transplantation. 30 March–02 April 2008, Florence, Italy.

2. Akhtar S, Al-Sugair A, Abuzaid M, Al Kadhi Y, Dingle M, Abdelsalam M, Soudy H, Darwish A, Altijani A, Nabil M, Maghfoor I. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) prior to high dose chemotherapy and autologous stem cell transplant predicts outcome after ASCT in patients with diffuse large cell lymphoma and Hodgkin’s lymphoma. Results of 110 patients. European Group for Blood and Marrow Transplantation 36th Annual Congress (EBMT) 2010, Vienna, Austria, 21–24 March 2010. Bone Marrow Transplantation 2010; (45)S2: S247, Abstract P819.

3. Akhtar S, Al-Sugair A, Abuzaid M, Al Kadhi Y, Dingle M, Abdelsalam M, Soudy H, Darwish A, Eltigani A, Nabil M, Maghfoor I. A new pre-transplant predictive model for event-free survival incorporating functional imaging using FDG-PET in lymphoma patients undergoing HDC and ASCT. European Hematology Association 15th Congress, 10–13 June 2010. Barcelona, Spain. Hematologica 2010; 95: S2; 208–209, Abstract 0510.

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Akhtar, S., Al-Sugair, A., Abouzied, M. et al. Pre-transplant 18F-fluorodeoxyglucose positron emission tomography-based survival model in patients with aggressive lymphoma undergoing high-dose chemotherapy and autologous SCT. Bone Marrow Transplant 48, 551–556 (2013). https://doi.org/10.1038/bmt.2012.168

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