Combination of baseline FDG PET/CT total metabolic tumour volume and gene expression profile have a robust predictive value in patients with diffuse large B-cell lymphoma

• Published in: European journal of nuclear medicine and molecular imaging Vol. 45; no. 5; pp. 680 - 688
• Main Authors: Toledano, Mathieu Nessim, Desbordes, P., Banjar, A., Gardin, I., Vera, P., Ruminy, P., Jardin, F., Tilly, H., Becker, S.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2018; Springer Nature B.V; Springer Verlag (Germany) [1976-....]
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; B-cell lymphoma; Cardiology; Disease-Free Survival; Female; Fluorodeoxyglucose F18; Gene expression; Gene Expression Profiling; Genotype & phenotype; Humans; Imaging; Life Sciences; Lymphocytes B; Lymphoma; Lymphoma, Large B-Cell, Diffuse - diagnostic imaging; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large B-Cell, Diffuse - genetics; Male; Medical prognosis; Medicine; Medicine & Public Health; Metabolism; Middle Aged; Multivariate analysis; Neoplasm Recurrence, Local; Nuclear Medicine; Oncology; Original Article; Orthopedics; Patients; Phenotypes; Positron emission tomography; Positron Emission Tomography Computed Tomography; Prognosis; Radiology; Retrospective Studies; RNA-directed DNA polymerase; Survival; Transcriptome; Tumor Burden; Tumors; DLBCL; ABC/GCB; FDG PET/CT; Metabolic tumour volume; RT-MLPA
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-017-3907-x

Purpose
This study evaluated the predictive significance of total metabolic tumour volume (TMTV) measured on baseline FDG PET/CT and its value in addition to gene expression profiling using a new method of gene analysis (rapid reverse transcriptase multiplex ligation-dependent probe amplification assay, RT-MLPA) in patients with diffuse large B-cell lymphoma treated with R-CHOP or R-CHOP-like chemotherapies.
Methods
The analysis included 114 patients. TMTV was measured using a 41% SUVmax threshold and tumours were classified into GCB or ABC subtypes according to the RT-MLPA assay.
Results
The median follow-up was 40 months. the 5-year progression-free survival (PFS) was 54% and the 5-year overall survival (OS) was 62%. The optimal TMTV cut-off value was 261 cm
3
. In 59 patients with a high TMTV the 5-year PFS and OS were 37% and 39%, respectively, in comparison with 72% and 83%, respectively, in 55 patients with a low TMTV (
p
 = 0.0002 for PFS,
p
 < 0.0001 for OS). ABC status was significantly associated with a worse prognosis. TMTV combined with molecular data identified three groups with very different outcomes: (1) patients with a low TMTV whatever their phenotype (
n
 = 55), (2) patients with a high TMTV and GCB phenotype (
n
 = 33), and (3) patients with a high TMTV and ABC phenotype (
n
 = 26). In the three groups, 5-year PFS rates were 72%, 51% and 17% (
p
 < 0.0001), and 5-year OS rates were 83%, 55% and 17% (p < 0.0001), respectively. In multivariate analysis, TMTV, ABC/GCB phenotype and International Prognostic Index were independent predictive factors for both PFS and OS (
p
 < 0.05 for both).
Conclusions
This integrated risk model could lead to more accurate selection of patients that would allow better individualization of therapy.