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Molecular Imaging and Biology
Published in: Molecular Imaging and Biology 6/2019

Open Access 01-12-2019 | Lymphoma | Research Article

Pre-Therapeutic Total Lesion Glycolysis on [18F]FDG-PET Enables Prognostication of 2-Year Progression-Free Survival in MALT Lymphoma Patients Treated with CD20-Antibody-Based Immunotherapy

Authors: Marius E. Mayerhoefer, Anton Staudenherz, Barbara Kiesewetter, Michael Weber, Ingrid Simonitsch-Klupp, Peter Gibbs, Werner Dolak, Julius Lukas, Markus Raderer

Published in: Molecular Imaging and Biology | Issue 6/2019

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Abstract

Purpose

Standardized uptake values (SUV), total metabolic tumor volumes (TMTV), and total lesion glycolysis (TLG) based on positron emission tomography with 2-deoxy-2-[18F]fluoro-d-glucose ([18F]FDG/positron emission tomography (PET) are established outcome predictors in FDG-avid lymphomas. We therefore investigated whether these biomarkers also have prognostic value in extranodal marginal zone B cell lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma), with a focus on patients treated with anti-CD20 antibody-based immunotherapy.

Procedures

Pre-therapeutic [18F]FDG/PET scans of 61 treatment-naïve MALT lymphoma patients, including 35 scheduled for anti-CD20 antibody-based immunotherapy, were included in this retrospective study. SUVmean, SUVmax, TMTV, and TLG were measured and tested for 2-year progression-free survival (PFS) prognostication, using Cox regression analyses. Receiver operating characteristic curves were used to determine optimal cutoffs for prognostic [18F]FDG/PET parameters, and Kaplan–Meier estimates with log rank tests were performed.

Results

After 2 years, progression had occurred in 12/61 patients (CD20-anitbody group 6/35). TLG emerged as the only significant prognostic factor for 2-year PFS in the multivariate analyses with forward selection, both in entire cohort (hazard ratio HR, 1.001; 95 % CI, 1.001–1.002; P < 0.0001) and in the CD20-antibody group (HR, 1.001; 95 % CI, 1.001–1.002; P = 0.001). However, in the entire population, where 8/26 patients with a TLG > 90 (30.8 %) vs. 4/35 patients with a TLG ≤ 90 (11.4 %) showed progression within the 2-year observation period, TLG-based separation of risk groups failed (HR, 0.35; 95 % CI, 0.10–1.15; P = 0.069); whereas in the CD20-antibody group, where 6/16 patients with a TLG > 90 (37.5 %) vs. 0/19 patients with a TLG ≤ 90 (0.0 %) showed progression, risk group separation was successful (HR, 0.010; 95 % CI, 0.0001–8.068; P = 0.003).

Conclusions

TLG may improve early risk stratification of MALT lymphoma patients treated with CD20-antibody-based immunotherapy.
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Metadata
Title
Pre-Therapeutic Total Lesion Glycolysis on [18F]FDG-PET Enables Prognostication of 2-Year Progression-Free Survival in MALT Lymphoma Patients Treated with CD20-Antibody-Based Immunotherapy
Authors
Marius E. Mayerhoefer
Anton Staudenherz
Barbara Kiesewetter
Michael Weber
Ingrid Simonitsch-Klupp
Peter Gibbs
Werner Dolak
Julius Lukas
Markus Raderer
Publication date
01-12-2019
Publisher
Springer International Publishing
Published in
Molecular Imaging and Biology / Issue 6/2019
Print ISSN: 1536-1632
Electronic ISSN: 1860-2002
DOI
https://doi.org/10.1007/s11307-019-01329-2

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