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Prediction of outcome in pediatric Hodgkin lymphoma based on interpretation of 18FDG-PET/CT according to ΔSUVmax, Deauville 5-point scale and IHP criteria

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Abstract

Objective

Minimizing side effects by using response-adopted therapy strategies plays an important role in the management of pediatric Hodgkin lymphoma (HL); however, the criteria for the definition of adequate or inadequate response are controversial. The aim of this study is to compare different methods of interpretation of 18F-FDG-PET/CT (PET) in the prediction of disease outcome in order to determine the optimum method in this regard.

Methods

Baseline, interim and post-treatment PET scans of 72 children were interpreted according to revised International Harmonization Project criteria (IHP) and Deauville criteria. Cut-off values for changes in interim and post-treatment FDG uptake (ΔSUVmax) in the prediction of progression-free survival (PFS) were measured using ROC analysis. Quantitative and visual data were compared with each other in the prediction of PFS.

Results

Mean interim and post-treatment ΔSUVmax of the primary lesions were 77.4 ± 19.5 and 68.8 ± 30.4% and respective cut-off values were 82 and 73%. However, only post-treatment ΔSUVmax yielded statistically significant results in the prediction of 3-year PFS (p = 0.043). Interim ΔSUVmax was further analyzed according to the values reported in the literature (66 and 77%) yet statistically significant results were not reached (p = 0.604 and 0.431). For interim evaluation, IHP criteria was correlated to Deauville criteria (p = 0.002 and p = 0.001) and ΔSUVmax (p = 0.03), whereas for post-treatment evaluation, significant correlation with ΔSUVmax (p = 0.04) but marginally significant (p = 0.055 and p = 0.058) correlation with Deauville criteria were achieved. Overall, 1, 3 and 5-year PFS were 95.7 ± 0.2, 89.6 ± 0.4 and 80.8 ± 0.7%, respectively. All methods demonstrated comparable performance in the prediction of 3-year PFS; however, interim PET using Deauville criteria and post-treatment PET using IHP criteria were statistically significant. All methods demonstrated high negative-predictive value but substantially low positive-predictive value.

Conclusions

Deauville criteria are superior to other methods in the prediction of pediatric HL outcome using interim PET data. On the other hand, quantitative evaluation and visual evaluation by IHP can be used reliably at the end of the treatment. In this regard, we report the optimal cut-off value of SUVmax reduction as 73%.

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References

  1. Swerdlow AJ. Epidemiology of Hodgkin’s disease and non-Hodgkin’s lymphoma. Eur J Nucl Med Mol Imaging. 2003;30(Suppl 1):3–12.

    Article  Google Scholar 

  2. Jorgov L, Montravers F, Balogova S, Ragu C, Pacquement H, Leblanc T, et al. Paediatric and adolescent Hodgkin lymphoma: information derived from diffuse organ uptake of 18F-fluorodeoxyglucose on pre-treatment and on interim PET/CT. Eur J Nucl Med Mol Imaging. 2016;43(7):1220–30.

    Article  CAS  PubMed  Google Scholar 

  3. Cheson BD, Pfistner B, Juweid ME, Gascoyne RD, Specht L, Horning SJ, et al. Revised response criteria for malignant lymphoma. J Clin Oncol. 2007;25:579–86.

    Article  PubMed  Google Scholar 

  4. Kostakoglu L, Cheson BD. Current role of FDG PET/CT in lymphoma. Eur J Nucl Med Mol Imaging. 2014;41(5):1004–27.

    Article  PubMed  Google Scholar 

  5. Gallamini A, Patti C, Viviani S, Rossi A, Fiore F, Di Raimondo F, et al. Early chemotherapy intensification with BEACOPP in advanced stage Hodgkin lymphoma patients with an interim-PET positive after two ABVD courses. Br J Haematol. 2011;152(5):551–60.

    Article  PubMed  Google Scholar 

  6. Körholz D, Kluge R, Wickmann L, Hirsch W, Lüders H, Lotz I, et al. Importance of F18-fluorodeoxy-d-2-glucose positron emission tomography (FDGPET) for staging und therapy control of Hodgkin’s lymphoma in childhood and adolescence—consequences for the GPOH-HD 2003 protocol. Onkologie. 2003;26(5):489–93.

    PubMed  Google Scholar 

  7. Kluge R, Körholz D. Role of FDG-PET in staging and therapy of children with Hodgkin lymphoma. Klin Padiatr. 2011;223(6):315–9.

    Article  CAS  PubMed  Google Scholar 

  8. Kostakoglu L, Gallamini A. Interim 18F-FDG PET in Hodgkin lymphoma: would PET-adapted clinical trials lead to a paradigm shift? J Nucl Med. 2013;54(7):1082–93.

    Article  CAS  PubMed  Google Scholar 

  9. Gallamini A, Rigacci L, Merli F, Nassi L, Bosi A, Capodanno I, et al. The predictive value of positron emission tomography scanning performed after two courses of standard therapy on treatment outcome in advanced stage Hodgkin’s disease. Haematologica. 2006;91(4):475–81.

    PubMed  Google Scholar 

  10. Juweid ME, Stroobants S, Hoekstra OS, Mottaghy FM, Dietlein M, Guermazi A, et al. Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J Clin Oncol. 2007;25(5):571–8.

    Article  PubMed  Google Scholar 

  11. Meignan M, Gallamini A, Haioun C. Report on the first international workshop on interim-PET-scan in lymphoma. Leuk Lymphoma. 2009;50(8):1257–60.

    Article  PubMed  Google Scholar 

  12. Gallamini A, Fiore F, Sorasio R, Meignan M. Interim positron emission tomography scan in Hodgkin lymphoma: definitions, interpretation rules, and clinical validation. Leuk Lymphoma. 2009;50(11):1761–4.

    Article  PubMed  Google Scholar 

  13. Rhodes MM, Delbeke D, Whitlock JA, et al. Utility of FDG-PET/CT in follow-up of children treated for Hodgkin and non-Hodgkin lymphoma. J Pediatr Hematol Oncol. 2006;28(5):300–6.

    Article  PubMed  Google Scholar 

  14. Cheng G, Servaes S, Zhuang H. Value of (18)F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography scan versus diagnostic contrast computed tomography in initial staging of pediatric patients with lymphoma. Leuk Lymphoma. 2013;54(4):737–42.

    Article  CAS  PubMed  Google Scholar 

  15. Hasenclever D, Kurch L, Mauz-Körholz C, et al. qPET—a quantitative extension of the Deauville scale to assess response in interim FDG-PET scans in lymphoma. Eur J Nucl Med Mol Imaging. 2014;41(7):1301–8.

    Article  PubMed  Google Scholar 

  16. Swerdlow SH, Campo E, Harris NL, et al. WHO classification of tumours of haematopoietic and lymphoid tissues. Lyon: IARC Press; 2008.

    Google Scholar 

  17. Stauss J, Franzius C, Pfluger T, et al. Guidelines for 18F-FDG PET and PET-CT imaging in paediatric oncology. Eur J Nucl Med Mol Imaging. 2008;35(8):1581–8.

    Article  CAS  PubMed  Google Scholar 

  18. Casasnovas RO, Meignan M, Berriolo-Riedinger A, et al. SUVmax reduction improves early prognosis value of interim positron emission tomography scans in diffuse large B-cell lymphoma. Blood. 2011;118(1):37–43.

    Article  CAS  PubMed  Google Scholar 

  19. Lin C, Itti E, Haioun C, Petegnief Y, et al. Early 18F-FDG PET for prediction of prognosis in patients with diffuse large B-cell lymphoma: SUV-based assessment versus visual analysis. J Nucl Med. 2007;48(10):1626–32.

    Article  PubMed  Google Scholar 

  20. 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. 2013;40(9):1312–20.

    Article  PubMed  Google Scholar 

  21. Cerci JJ, Pracchia LF, Linardi CC, et al. 18F-FDG PET after 2 cycles of ABVD predicts event-free survival in early and advanced Hodgkin lymphoma. J Nucl Med. 2010;51(9):1337–43.

    Article  CAS  PubMed  Google Scholar 

  22. Gallamini A, Hutchings M, Rigacci L, Specht L, Merli F, Hansen M, et al. Early interim 18F-FDG positron emission tomography is prognostically superior to international prognostic score in advanced stage Hodgkin’s lymphoma: a report from a joint Italian-Danish study. J Clin Oncol. 2007;24:3746–52.

    Article  Google Scholar 

  23. Zinzani PL, Rigacci L, Stefoni V, Broccoli A, Puccini B, Castagnoli A, et al. Early interim18 F-FDG PET in Hodgkin’s lymphoma: evaluation on 304 patients. Eur J Nucl Med Mol Imaging. 2012;39(1):4–12.

    Article  PubMed  Google Scholar 

  24. Jerusalem G, Hustinx R, Beguin Y, Fillet G. Evaluation of therapy for lymphoma. Semin Nucl Med. 2005;35(3):186–96.

    Article  PubMed  Google Scholar 

  25. Hutchings M, Mikhaeel NG, Fields PA, Nunan T, Timothy AR. Prognostic value of interim FDG- PET after two or three cycles of chemotherapy in Hodgkin lymphoma. Ann Oncol. 2005;16(7):1160–8.

    Article  CAS  PubMed  Google Scholar 

  26. Furth C, Steffen IG, Amthauer H, Ruf J, Misch D, Schönberger S, et al. Early and late therapy response assessment with [18F]fluorodeoxyglucose positron tomography in pediatric Hodgkin’s lymphoma: analysis of a prospective multicenter trial. J Clin Oncol. 2009;27(26):4385–91.

    Article  PubMed  Google Scholar 

  27. Torizuka T, Nakamura F, Kanno T, Futatsubashi M, Yoshikawa E, Okada H, et al. Early therapy monitoring with FDG-PET in aggressive non-Hodgkin’s lymphoma and Hodgkin’s lymphoma. Eur J Nucl Med Mol Imaging. 2004;31(1):22–8.

    Article  PubMed  Google Scholar 

  28. Itti E, Lin C, Dupuis J, Paone G, Capacchione D, Rahmouni A, et al. Prognostic value of interim 18F-FDG PET in patients with diffuse large B-cell lymphoma: SUV-based assessment at 4 cycles of chemotherapy. J Nucl Med. 2009;50(4):527–33.

    Article  PubMed  Google Scholar 

  29. Barnes JA, LaCasce AS, Zukotynski K, Israel D, Feng Y, Neuberg D, et al. End-of-treatment but not interim PET scan predicts outcome in nonbulky limited stage Hodgkin’s lymphoma. Ann Oncol. 2011;22(4):910–5.

    Article  CAS  PubMed  Google Scholar 

  30. Pilkington Woll JP, García Vicente AM, Talavera Rubio MP, Palomar Muñoz AM, Jiménez Londoño G, León Martín A, et al. Quantitative and qualitative evaluation of the interim PET/CT in lymphoma treatment in the prediction of complete metabolic response. Rev Esp Med Nucl Imagen Mol. 2013;32(2):70–6.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Nuclear Medicine, Istanbul Faculty of Medicine, Millet cad. ÇAPA, 34093, Istanbul, Turkey

    Emine Göknur Isik, Serkan Kuyumcu, Yasemin Sanli & Seher Nilgün Unal

  2. Division of Pediatric Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey

    Rejin Kebudi

  3. Department of Pediatric Hematology and Oncology, Istanbul Medical Faculty, Istanbul, Turkey

    Zeynep Karakas & Fatma Betul Cakir

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  1. Emine Göknur Isik
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  2. Serkan Kuyumcu
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Correspondence to Serkan Kuyumcu.

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Isik, E.G., Kuyumcu, S., Kebudi, R. et al. Prediction of outcome in pediatric Hodgkin lymphoma based on interpretation of 18FDG-PET/CT according to ΔSUVmax, Deauville 5-point scale and IHP criteria. Ann Nucl Med 31, 660–668 (2017). https://doi.org/10.1007/s12149-017-1196-x

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  • DOI: https://doi.org/10.1007/s12149-017-1196-x

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