TY - JOUR
T1 - Positron emission tomography–computed tomography predictors of progression after DA-R-EPOCH for PMBCL
AU - Pinnix, Chelsea C.
AU - Ng, Andrea K.
AU - Dabaja, Bouthaina S.
AU - Milgrom, Sarah A.
AU - Gunther, Jillian R.
AU - David Fuller, C.
AU - Smith, Grace L.
AU - Yehia, Zeinab Abou
AU - Qiao, Wei
AU - Wogan, Christine F.
AU - Akhtari, Mani
AU - Mawlawi, Osama
AU - Jeffrey Medeiros, L.
AU - Chuang, Hubert H.
AU - Martin-Doyle, William
AU - Armand, Philippe
AU - LaCasce, Ann S.
AU - Oki, Yasuhiro
AU - Fanale, Michelle
AU - Westin, Jason
AU - Neelapu, Sattva
AU - Nastoupil, Loretta
N1 - Publisher Copyright:
© 2018 by The American Society of Hematology.
PY - 2018/6/12
Y1 - 2018/6/12
N2 - Dose-adjusted rituximab plus etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-R-EPOCH) has produced good outcomes in primary mediastinal B-cell lymphoma (PMBCL), but predictors of resistance to this treatment are unclear. We investigated whether [18F]fluorodeoxyglucose positron emission tomography–computed tomography (PET-CT) findings could identify patients with PMBCL who would not respond completely to DA-R-EPOCH. We performed a retrospective analysis of 65 patients with newly diagnosed stage I to IV PMBCL treated at 2 tertiary cancer centers who had PET-CT scans available before and after frontline therapy with DA-R-EPOCH. Pretreatment variables assessed included metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Optimal cutoff points for progression-free survival (PFS) were determined by a machine learning approach. Univariate and multivariable models were constructed to assess associations between radiographic variables and PFS. At a median follow-up of 36.6 months (95% confidence interval, 28.1-45.1), 2-year PFS and overall survival rates for the 65 patients were 81.4% and 98.4%, respectively. Machine learning–derived thresholds for baseline MTV and TLG were associated with inferior PFS (elevated MTV: hazard ratio [HR], 11.5; P 5 .019; elevated TLG: HR, 8.99; P 5 .005); other pretreatment clinical factors, including International Prognostic Index and bulky (.10 cm) disease, were not. On multivariable analysis, only TLG retained statistical significance (P 5 .049). Univariate analysis of posttreatment variables revealed that residual CT tumor volume, maximum standardized uptake value, and Deauville score were associated with PFS; a Deauville score of 5 Remained significant on multivariable analysis (P 5 .006). A model combining baseline TLG and end-of-therapy Deauville score identified patients at increased risk of progression.
AB - Dose-adjusted rituximab plus etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-R-EPOCH) has produced good outcomes in primary mediastinal B-cell lymphoma (PMBCL), but predictors of resistance to this treatment are unclear. We investigated whether [18F]fluorodeoxyglucose positron emission tomography–computed tomography (PET-CT) findings could identify patients with PMBCL who would not respond completely to DA-R-EPOCH. We performed a retrospective analysis of 65 patients with newly diagnosed stage I to IV PMBCL treated at 2 tertiary cancer centers who had PET-CT scans available before and after frontline therapy with DA-R-EPOCH. Pretreatment variables assessed included metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Optimal cutoff points for progression-free survival (PFS) were determined by a machine learning approach. Univariate and multivariable models were constructed to assess associations between radiographic variables and PFS. At a median follow-up of 36.6 months (95% confidence interval, 28.1-45.1), 2-year PFS and overall survival rates for the 65 patients were 81.4% and 98.4%, respectively. Machine learning–derived thresholds for baseline MTV and TLG were associated with inferior PFS (elevated MTV: hazard ratio [HR], 11.5; P 5 .019; elevated TLG: HR, 8.99; P 5 .005); other pretreatment clinical factors, including International Prognostic Index and bulky (.10 cm) disease, were not. On multivariable analysis, only TLG retained statistical significance (P 5 .049). Univariate analysis of posttreatment variables revealed that residual CT tumor volume, maximum standardized uptake value, and Deauville score were associated with PFS; a Deauville score of 5 Remained significant on multivariable analysis (P 5 .006). A model combining baseline TLG and end-of-therapy Deauville score identified patients at increased risk of progression.
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U2 - 10.1182/bloodadvances.2018017681
DO - 10.1182/bloodadvances.2018017681
M3 - Article
C2 - 29895624
AN - SCOPUS:85060322499
SN - 2473-9529
VL - 2
SP - 1334
EP - 1343
JO - Blood Advances
JF - Blood Advances
IS - 11
ER -