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End of induction [18F]FDG PET is prognostic for progression-free survival and overall survival in follicular lymphoma patients enrolled in the FOLL12 trial.
Guerra, Luca; Chauvie, Stephane; Fallanca, Federico; Bergesio, Fabrizio; Marcheselli, Luigi; Durmo, Rexhep; Peano, Simona; Franceschetto, Antonella; Monaco, Lavinia; Barbieri, Emiliano; Ladetto, Marco; Musuraca, Gerardo; Tosi, Patrizia; Bianchi, Benedetta; Bolis, Silvia Anna Maria; Pavone, Vincenzo; Chiarenza, Annalisa; Arcari, Annalisa; Califano, Catello; Bari, Alessia; Massaia, Massimo; Conconi, Annarita; Musto, Pellegrino; Mannina, Donato; Roti, Giovanni; Galimberti, Sara; Gini, Guido; Falcinelli, Flavio; Vitolo, Umberto; Usai, Sara Veronica; Stefani, Piero Maria; Ibatici, Adalberto; Liberati, Anna Marina; Pennese, Elsa; Perrone, Tommasina; Versari, Annibale; Luminari, Stefano.
Afiliação
  • Guerra L; Nuclear Medicine, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy. luca.guerra@unimib.it.
  • Chauvie S; University of Milano Bicocca, Milan, Italy. luca.guerra@unimib.it.
  • Fallanca F; Medical Physics, Ospedale Santa Croce E Carle, Cuneo, Italy.
  • Bergesio F; Nuclear Medicine, IRCCS Ospedale San Raffaele, Milan, Italy.
  • Marcheselli L; Medical Physics, Ospedale Santa Croce E Carle, Cuneo, Italy.
  • Durmo R; Fondazione Italiana Linfomi, Modena, Italy.
  • Peano S; Nuclear Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
  • Franceschetto A; Nuclear Medicine Azienda Ospedaliera S. Croce E Carle, Cuneo, Italy.
  • Monaco L; Nuclear Medicine, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy.
  • Barbieri E; Nuclear Medicine, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy.
  • Ladetto M; Clinical and Experimental Medicine PhD Program, University of Modena E Reggio Emilia, Modena, Italy.
  • Musuraca G; Hematology Unit, Azienda Ospedaliera Di Alessandria, Alessandria, Italy.
  • Tosi P; Hematology and HSC Transplantation, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori Dino Amadori, Meldola, Italy.
  • Bianchi B; Hematology Unit, AUSL Della Romagna, Rimini, Italy.
  • Bolis SAM; Hematology Unit, Ospedale Di Circolo E Fondazione Macchi ASST Sette Laghi, Varese, Italy.
  • Pavone V; Hematology Unit, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy.
  • Chiarenza A; Hematology and Bone Marrow Transplantation, Ospedale C. Panico, Tricase, Italy.
  • Arcari A; Hematology and Bone Marrow Transplantation, AOU Policlinico S. Marco, Catania, Italy.
  • Califano C; Hematology Unit, Ospedale Guglielmo da Saliceto, Piacenza, Italy.
  • Bari A; Hematology Unit, Ospedale Andrea Tortora, Pagani, Italy.
  • Massaia M; Oncology Unit, Azienda Ospedaliero-Universitaria Policlinico, Modena, University of Modena and Reggio Emilia, Modena, Italy.
  • Conconi A; Hematology Unit, Ospedale Santa Croce E Carle, Cuneo, Italy.
  • Musto P; Hematology Unit, Ospedale Degli Infermi, Biella, Italy.
  • Mannina D; Hematology and Stem Cells Transplantation, IRCCS CROB, Rionero in Vulture, Italy.
  • Roti G; Hematology Unit, Azienda Ospedaliera Papardo, Messina, Italy.
  • Galimberti S; Hematology Unit, Azienda Ospedaliero-Universitaria Di Parma, Parma, Italy.
  • Gini G; Hematology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
  • Falcinelli F; Hematology Unit, Azienda Ospedaliero-Universitaria Delle Marche, Ancona, Italy.
  • Vitolo U; Hematology and Bone Marrow Transplantation, Azienda Ospedaliera Di Perugia, Perugia, Italy.
  • Usai SV; Hematology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy.
  • Stefani PM; Hematology and Bone Marrow Transplantation, Ospedale Brotzu, Cagliari, Italy.
  • Ibatici A; Hematology Unit, General Hospital Ca' Foncello, Treviso, Italy.
  • Liberati AM; Ematologia E Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
  • Pennese E; Università Degli Studi Di Perugia, A.O. Terni, Terni, Italy.
  • Perrone T; Hematology Unit, ASL Pescara, Pescara, Italy.
  • Versari A; Hematology and Stem Cells Transplantation, AOUC Policlinico, Bari, Italy.
  • Luminari S; Nuclear Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Eur J Nucl Med Mol Imaging ; 51(11): 3311-3321, 2024 Sep.
Article em En | MEDLINE | ID: mdl-38795120
ABSTRACT

PURPOSE:

To evaluate the reliability of the Deauville score (DS) in therapy response assessment and to define the prognostic value of the metabolic response of end of induction (EOI) [18F]FDG PET (PET) in follicular lymphoma patients.

METHODS:

Adult patients with untreated grade 1-3a FL/ stage II-IV enrolled in the multicentre, prospective, phase III FOLL12 trial (NCT02063685) were randomized to receive standard immunochemotherapy followed by rituximab maintenance (standard arm) versus standard immunochemotherapy followed by response-adapted post-induction management (experimental arm). Baseline and EOI PET were mandatory for the study. All PET scans were centralized on the WIDEN® platform and classified according to DS in a blind independent central review. DS1-3 was considered negative (CMR), whereas DS4-5 was considered positive (not CMR). The primary endpoint was PFS. The main secondary endpoint was overall survival (OS).

RESULTS:

Overall, 807 follicular lymphoma patients-52% women, 89% stage III-IV disease, 40% with a high-risk FLIPI-2 score (3-5)-were enrolled in the study; 729 (90.4%) baseline and EOI PET were available for the analysis. EOI PET was positive (DS4-5) in 88/729 (12.1%) cases. Overall inter-reviewer agreement on PET pos/neg result was 0.92, while agreement on positive and negative cases was 0.77 and 0.94, respectively. The median follow-up was 69 months; 247 events were registered in the 5-yr follow-up, with a 5-yr PFS of 67% (95%CI 63%-70%). The 5-yr PFS rate for PET neg (DS1-3) and PET pos (DS4-5) patients was 71% (95%CI 67%-75%) and 36% (95%CI 25%-46%), respectively, with HR 3.49 (95%CI 2.57-4.72). Five-year PFS was worse as DS increased, with 74% (70%-78%), 58% (48%-67%; HR 1.71; p = 0.001)] and 36% (25%-46%; HR 3.88; p < 0.001) in DS1-2, DS3 and DS4-5, respectively. EOI PET maintained its prognostic value in both the standard and experimental arms. In the whole population, 5-yr OS was 94% (95%CI 92%-96%), with 96% (95%CI 94-97) and 82% (95%CI 72%-89%) in EOI PET negative (DS1-3) and positive (DS4-5), respectively (HR 4.48; p < 0.001). When DS was associated with FLIPI-2, patients with DS3 or DS1-2 with high FLIPI-2 (3-5) experienced worse OS than patients with DS1-2 and low FLIPI-2 (1-2) (p = 0.003).

CONCLUSION:

This study shows that DS is a reliable prognostic tool to evaluate EOI PET in follicular lymphoma patients, with prognostic value maintained both in the standard and experimental arms, making metabolic imaging a robust tool to assess response in FL. Moreover, although preliminary, this study provides further information on DS3 patients, who are considered as CMR but show a less favourable PFS than DS1-2 patients.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Linfoma Folicular / Fluordesoxiglucose F18 / Tomografia por Emissão de Pósitrons Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Linfoma Folicular / Fluordesoxiglucose F18 / Tomografia por Emissão de Pósitrons Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2024 Tipo de documento: Article