Positron Emission Tomography Guided Therapy of Aggressive Non-Hodgkin's Lymphomas (PETAL trial): Correlation between Clinical Variables and PET Parameters

Autor: Henrike Thomssen, Gabriele Prange-Krex, Rolf M. Mesters, Frank Kroschinsky, Stefan Müller, Ulrich Duehrsen, Aristoteles Giagounidis, Andreas Hüttmann, Andreas Bockisch
Rok vydání: 2009
Předmět:
Zdroj: Blood. 114:2695-2695
ISSN: 1528-0020
0006-4971
DOI: 10.1182/blood.v114.22.2695.2695
Popis: Abstract 2695 Poster Board II-671 Introduction: Positron emission tomography (PET) performed after a few cycles of chemotherapy (interim-PET) in aggressive lymphomas correlates with long-term outcome: While the majority of patients with a negative interim-PET scan enjoy long-lasting remissions, patients with persistent pathological glucose uptake almost invariably relapse. The multicenter PETAL trial was initiated in Germany in 2008 to resolve the question whether a change in treatment protocol may improve the outcome of patients with a positive interim-PET scan (ClinicalTrials.gov Identifier: NCT00554164). Patients and Methods: The PETAL trial is open for patients with newly diagnosed aggressive B cell or T cell non-Hodgkin's lymphomas between 18 and 80 years of age with a performance status of 0 to 3 according to the Eastern Cooperative Oncology Group scale and a positive PET scan before starting any lymphoma-directed therapy. Interim-PET is done after 2 cycles of the CHOP protocol (cyclophosphamide, doxorubicine, vincristine, prednisone; plus rituximab (R) in CD20-positive lymphomas) administered at a 14-day interval. Precautions were taken to minimize the risk of false-positive interim-PET results. First, the interval between the second (R-)CHOP cycle and the interim-PET scan is three weeks. Second, hematopoietic growth factors accelerating blood cell recovery are not allowed after the second cycle of chemotherapy. Third, quantitative standard uptake value (SUV)-based assessment rather than exclusive visual interpretation is used for interim-PET evaluation as described by Lin et al (J Nucl Med 48: 1626, 2007). Results: So far, a total of 266 patients have been recruited into the trial. A negative pre-treatment scan was observed in 18 patients, the majority of whom had complete lymphoma resection. 196 patients have reached interim-PET scanning, 168 with diffuse large B cell lymphoma (86%), 11 with grade 3a/b follicular lymphoma (6%), and 17 with peripheral T cell lymphoma (8%). Median SUVmax at staging did not differ across these three lymphoma subgroups. However, the SUVmax reduction at interim-PET was significantly lower in T-cell lymphomas as compared to B-cell lymphomas. Six patients (3%) with a low SUV at staging ( Conclusion: A combined strategy of SUV-based quantitative and visual qualitative interim-PET assessment is feasible in a multicenter randomized trial designed to guide treatment in lymphoma patients. In this largest series of interim-PET scanning in aggressive lymphoma reported so far, interim-PET response and the IPI risk score proved to be independent. With an as yet short follow-up period relapses were unevenly distributed between PET responders and non-responders. The PETAL trial will help define criteria for interim-PET scanning and response prediction. Recruitment into the trial continues. Disclosures: Hüttmann: Roche: Research Funding; Amgen: Research Funding. Duehrsen:Amgen: Research Funding; Roche: Research Funding.
Databáze: OpenAIRE
Externí odkaz: