Imaging determinants of early progression in relapsed and refractory Hodgkin and diffuse large B cell lymphoma

Autor: Ravikanth Mankala, Oliver Bohnsack, Jayant Narang, Rudresh Jarecha, Shweta Narang, Manish Sharma, Surabhi Bajpai, Usha Lalchandani
Rok vydání: 2021
Předmět:
Zdroj: Journal of Clinical Oncology. 39:e19522-e19522
ISSN: 1527-7755
0732-183X
Popis: e19522 Background: Diffuse Large B-cell Lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma with over 18,000 new cases diagnosed each year in the United States and approximately 7-8 cases per 100.000 people globally. Hodgkin’s Lymphoma (HL) is less common accounting for approximately 9,000 new cases each year. However, their imaging manifestations overlap; with both the diseases demonstrating extensive lymph nodal and extra-nodal involvement along with intense uptake on 18FDG-PET. Novel targeted therapies have been developed to improve survival in patients with DLBCL and HL. The purpose of this study analysis was to determine if there was a correlation between the baseline tumor burden and early tumor progression based on imaging. Methods: This retrospective study involved the analysis of baseline imaging data (CT, MRI and PET) of 469 patients enrolled in multiple phase II/III clinical trials involving a diagnosis of DLBCL and HL. Image analysis was performed utilizing the IWG criteria Lugano 2014 modification. The staging of the baseline disease burden was performed as per the Revised Staging System for Primary Nodal Lymphomas. In addition to the staging, the sum of the product of perpendicular diameters of all target lesions (SPD), and spleen size at baseline were recorded. The time point of disease progression was also captured in this analysis for each patient. These baseline imaging parameters were compared among patients with early progression (≤6 months following onset of therapy). Results: Out of the 469 patients, 61.4% of patients (n = 288/469) demonstrated disease progression during treatment and/or follow up phase of the trial. In this cohort, 64.5% (n = 186/288) of patients showed early progression. Patients with advanced stage disease at baseline (Stage II bulky, III and IV) showed a higher rate of early progression compared to those with limited baseline disease burden (Stage I and II) (47.1% vs 32.9%). The occurrence of early progression was similar in patients with normal spleen size at baseline compared to those with an enlarged spleen at baseline (39.3% vs 41%). There was a trend towards higher baseline SPD in patients with early progression (3204mm2, +12.5%) and late progression (3185mm2, +12%) compared to patients who did not demonstrate progression during the trial phase (2804mm2, p = 0.23-0.45). Conclusions: Baseline disease staging is an important determinant of early progression in patients with DLBCL and HL. Baseline tumor burden is potentially a predictive marker of disease progression. Therefore, precise staging along with accurate recording of baseline tumor burden have important prognostic and subsequent therapeutic strategy implications for prospective decision making in the era of precision medicine. Further prospective studies may be needed to validate our results.
Databáze: OpenAIRE
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