Predictive value of interim positron emission tomography in diffuse large B-cell lymphoma: a systematic review and meta-analysis

• Published in: European journal of nuclear medicine and molecular imaging Vol. 46; no. 1; pp. 65 - 79
• Main Authors: Burggraaff, Coreline N., de Jong, Antoinette, Hoekstra, Otto S., Hoetjes, Nikie J., Nievelstein, Rutger A. J., Jansma, Elise P., Heymans, Martijn W., de Vet, Henrica C. W., Zijlstra, Josée M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-01-2019; Springer Nature B.V
• Subjects: B-cell lymphoma; Cardiology; Chemotherapy; Diagnostic systems; Emission analysis; Fluorine isotopes; Fluorodeoxyglucose F18; Glucose; Humans; Imaging; Lymphocytes B; Lymphoma; Lymphoma, Large B-Cell, Diffuse - diagnostic imaging; Lymphoma, Large B-Cell, Diffuse - pathology; Medicine; Medicine & Public Health; Meta-analysis; Nuclear Medicine; Oncology; Original; Original Article; Orthopedics; Patients; Positron emission; Positron emission tomography; Positron-Emission Tomography - methods; Positron-Emission Tomography - standards; Predictions; Predictive Value of Tests; Radiology; Radiopharmaceuticals; Regression analysis; Side effects; Subgroups; Survival; Systematic review; Tomography; Positron-emission tomography; Systematic review; Aggressive non-Hodgkin’s lymphoma; Diffuse large B-cell lymphoma; Meta-analysis
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-018-4103-3

Purpose
Diffuse large B-cell lymphoma (DLBCL) represents the most common subtype of non-Hodgkin lymphoma. Most relapses occur in the first 2 years after diagnosis. Early response assessment with
18
F-fluoro-2-deoxy-D-glucose (
18
F-FDG) positron emission tomography (PET) may facilitate early change of treatment, thereby preventing ineffective treatment and unnecessary side effects. We aimed to assess the predictive value of visually-assessed interim
18
F-FDG PET on progression-free survival (PFS) or event-free survival (EFS) in DLBCL patients treated with first-line immuno-chemotherapy regimens.
Methods
For this systematic review and meta-analysis Pubmed, Embase, and the Cochrane Library were searched until July 11, 2017. Prospective and retrospective studies investigating qualitative interim PET response assessment without treatment adaptation based on the interim PET result were eligible. The primary outcome was two-year PFS or EFS. Prognostic and diagnostic measures were extracted and analysed with pooled hazard ratios and Hierarchical Summary Receiver Operator Characteristic Curves, respectively. Meta-regression was used to study covariate effects.
Results
The pooled hazard ratio for 18 studies comprising 2,255 patients was 3.13 (95%CI 2.52–3.89) with a 95% prediction interval of 1.68–5.83. In 19 studies with 2,366 patients, the negative predictive value for progression generally exceeded 80% (64–95), but sensitivity (33–87), specificity (49–94), and positive predictive values (20–74) ranged widely.
Conclusions
These findings showed that interim
18
F-FDG PET has predictive value in DLBCL patients. However, (subgroup) analyses were limited by lack of information and small sample sizes. Some diagnostic test characteristics were not satisfactory, especially the positive predictive value should be improved, before a successful risk stratified treatment approach can be implemented in clinical practice.