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An international confirmatory study of the prognostic value of early PET/CT in diffuse large B-cell lymphoma: comparison between Deauville criteria and ΔSUVmax

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The role of interim PET/CT in guiding therapeutic strategies in diffuse large B-cell lymphoma (DLBCL) is debated, mainly because interpretation rules vary among centres. This study aimed to explore the reproducibility and confirm the prognostic value of early PET/CT using the Deauville criteria and ΔSUVmax.

Methods

This international confirmatory study retrospectively evaluated 114 patients with newly diagnosed DLBCL treated with a rituximab-containing regimen. All patients underwent 18F-FDG PET/CT at baseline (PET0) and after two cycles (PET2), with no therapy change based on the latter. Scans were interpreted by three observers using the Deauville five-point scale and ΔSUVmax between PET0 and PET2 was calculated. Interpretations were evaluated for interobserver agreement and for progression-free survival (PFS) prediction.

Results

Median follow-up was 39 months. Early PET/CT was predictive of outcome when interpreted with the Deauville criteria and ΔSUVmax. Using the five-point scale, the overall kappa value was 0.66 with the reference background set in the liver (score ≥4) and interobserver agreement was even better using a 66 % ΔSUVmax cut-off (κ = 0.83). Moreover, the prognostic value of interim PET was slightly inferior when using a Deauville score ≥4 than when using a 66 % ΔSUVmax cut-off: for the Deauville score the 3-year PFS estimate was 59 % (45–73 %) in PET2-positive patients vs. 81 % (71–91 %) in PET2-negative patients (P = 0.003); for the 66 % ΔSUVmax cut-off the 3-year PFS estimate was 44 % (23–65 %) in PET2-positive patients vs. 79 % (70–88 %) in PET2-negative patients (P = 0.0002).

Conclusion

Although the Deauville criteria are valid for assessing the prognostic value of early PET/CT in DLBCL, computation of the ΔSUVmax leads to better performance and interobserver reproducibility, and should be preferred when a baseline scan is available.

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Acknowledgments

We address special thanks to Romain Ricci, Jennifer Frye, Stéphane Chauvie and Anna Cavallo for their help with data collection. We are indebted to Jérôme Fortineau and Pierre Thervet, of Keosys France, who kindly provided the central review platform.

Author contributions

Conception and design: Emmanuel Itti, Michel Meignan, Corinne Haioun

Collection and assembly of data: All authors

Data analysis and interpretation: Emmanuel Itti, Michel Meignan, Alina Berriolo-Riedinger, Alberto Biggi, Corinne Haioun

Manuscript writing: All authors

Final approval of manuscript: All authors

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Henri Mondor Hospital and Paris-Est University, Créteil, France

    Emmanuel Itti & Michel Meignan

  2. Department of Nuclear Medicine, Georges-François Leclerc Center, Dijon, France

    Alina Berriolo-Riedinger

  3. Department of Nuclear Medicine, Santa Croce e Carle Hospital, Cuneo, Italy

    Alberto Biggi

  4. Department of Oncology, Siteman Cancer Center and Washington University School of Medicine, St. Louis, MO, USA

    Amanda F. Cashen

  5. Department of Nuclear Medicine, Henri Becquerel Center, Rouen, France

    Pierre Véra

  6. Department of Hematology, Henri Becquerel Center, Rouen, France

    Hervé Tilly

  7. Department of Nuclear Medicine, Siteman Cancer Center and Washington University School of Medicine, St. Louis, MO, USA

    Barry A. Siegel

  8. Department of Hematology, Santa Croce e Carle Hospital, Cuneo, Italy

    Andrea Gallamini

  9. Department of Hematology, Le Bocage Hospital, Dijon, France

    René-Olivier Casasnovas

  10. Lymphoid Malignancies Unit, Henri Mondor Hospital and Paris-Est University, Créteil, France

    Corinne Haioun

  11. Service de Médecine Nucléaire, EAC CNRS 7054, Hôpital Henri Mondor AP-HP, Paris-Est University, 51 Ave. du Mal de Lattre de Tassigny, F-94010, Créteil, France

    Emmanuel Itti

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  1. Emmanuel Itti
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Correspondence to Emmanuel Itti.

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Itti, E., Meignan, M., Berriolo-Riedinger, A. et al. An international confirmatory study of the prognostic value of early PET/CT in diffuse large B-cell lymphoma: comparison between Deauville criteria and ΔSUVmax. Eur J Nucl Med Mol Imaging 40, 1312–1320 (2013). https://doi.org/10.1007/s00259-013-2435-6

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  • DOI: https://doi.org/10.1007/s00259-013-2435-6

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