Liposomal doxorubicin supercharge-containing front-line treatment in patients with advanced-stage diffuse large B-cell lymphoma or classical Hodgkin lymphoma: Preliminary results of a single-centre phase II study.

We evaluated the impact of liposomal doxorubicin (NPLD) supercharge-containing therapy on interim fluorodeoxyglucose positron emission tomography (interim-FDG-PET) responses in high-risk diffuse large B-cell lymphoma (DLBCL) or classical Hodgkin lymphoma (c-HL). In this phase II study (2016-2021), 81 adult patients with advanced-stage DLBCL (n = 53) and c-HL (n = 28) received front-line treatment with R-COMP-dose-intensified (DI) and MBVD-DI. R-COMP-DI consisted of 70 mg/m2 of NPLD plus standard rituximab, cyclophosphamide, vincristine and prednisone for three cycles (followed by three cycles with NPLD de-escalated at 50 mg/m2 ); MBVD-DI consisted of 35 mg/m2 of NPLD plus standard bleomycin, vinblastine and dacarbazine for two cycles (followed by four cycles with NPLD de-escalated at 25 mg/m2 ). Patients underwent R-COMP-DI and MBVD-DI with a median dose intensity of 91% and 94% respectively. At interim-FDG-PET, 72/81 patients (one failed to undergo interim-FDG-PET due to early death) had a Deauville score of ≤3. At end of treatment, 90% of patients reached complete responses. In all, 20 patients had Grade ≥3 adverse events, and four of them required hospitalisation. At a median 21-months of follow-up, the progression-free survival of the entire population was 77.3% (95% confidence interval 68%-88%). Our data suggest that the NPLD supercharge-driven strategy in high-risk DLBCL/c-HL may be a promising option to test in phase III trials, for improving negative interim-FDG-PET cases incidence.

Relationship between contractile reserve, Tl-201 uptake, and collateral angiographic circulation in collateral-dependent myocardium: implications regarding the evaluation of myocardial viability.

BACKGROUND: The aim of this study was to compare collateral angiographic circulation (CC), thallium 201 single photon emission computed tomography (SPECT), low-dose dobutamine echocardiography (LDDE), and their combination in identifying viable myocardium beyond a chronic occlusion. METHODS AND RESULTS: We studied 33 consecutive patients with a chronic occluded coronary artery and regional ventricular dysfunction who underwent dobutamine infusion (5-10 microg x kg(-1) x min(-1)), Tl-201 SPECT, and coronary revascularization (15 patients underwent coronary artery bypass grafting and 18 patients percutaneous transluminal coronary angioplasty). Echocardiography and Tl-201 SPECT at rest were repeated 90 +/- 48 days after revascularization. For viability assessment, Tl-201 SPECT showed the best sensitivity and accuracy (77% and 72%, respectively) compared with LDDE (64% and 63%, respectively) and CC (74% and 55%, P < .05 vs Tl-201 SPECT). Specificity was significantly better for both Tl-201 SPECT (65%) and LDDE (62%) compared with collateral circulation (27%, P < .001 vs Tl-201 SPECT and LDDE). Furthermore, combined Tl-201 SPECT and LDDE data improved specificity (from 88% to 92%) and positive predictive power (from 75% to 78%) but not global accuracy. A direct relationship between the number of viable segments and global functional recovery after revascularization was found only in the case of Tl-201 SPECT (r = 0.48, P = .04). CONCLUSIONS: This study demonstrates that CC has a very low specificity in the evaluation of viability in collateral-dependent myocardium and that LDDE has a very low sensitivity, whereas Tl-201 SPECT is the most reliable method, particularly in akinetic segments, and optimally identifies patients who will mostly benefit from revascularization in terms of ventricular functional improvement. No additional advantages in terms of accuracy were found when Tl-201 SPECT and LDDE data were combined.

Prediction of long-term effects of revascularization on regional and global left ventricular function by dobutamine echocardiography and rest Tl-201 imaging alone and in combination in patients with chronic coronary artery disease.

BACKGROUND: The aim of this study was to evaluate the accuracy of low-dose dobutamine echocardiography (DE) and resting thallium 201 single photon emission computed tomography (SPECT) alone and in combination for prediction of functional recovery at late follow-up (1 year) after revascularization. METHODS AND RESULTS: Twenty-six patients with coronary artery disease and ventricular dysfunction (ejection fraction, 42% +/- 9%) underwent DE and Tl-201 SPECT 14 +/- 9 (mean +/- SD) days before revascularization and repeated echocardiography 12 +/- 5 months thereafter. Discriminant analysis was applied to combine Tl-201 SPECT and DE data to classify dysfunctional segments as viable or nonviable. In 78 akinetic/dyskinetic revascularized segments, Tl-201 SPECT provided a sensitivity of 83% and a specificity of 55%, whereas DE showed a sensitivity of 60% and a specificity of 91%, for prediction of improvement in regional function at follow-up. The combination of data through use of discriminant analysis provided a sensitivity of 80% and a specificity of 86%, with an overall accuracy of 82%, significantly higher than DE (71%; P <.05) and Tl-201 SPECT (73%; P <.05) alone. Moreover, discriminant analysis identified 12 (75%) of 16 patients with and 8 (80%) of 10 patients without significant improvement in ejection fraction at follow-up, with an accuracy of 77%. CONCLUSIONS: The combination of Tl-201 SPECT and DE data provides higher accuracy than either technique alone for prediction of recovery of regional and global function after revascularization.