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Annals of Oncology Advance Access originally published online on December 11, 2008
Annals of Oncology 2009 20(3):503-507; doi:10.1093/annonc/mdn671
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© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

hematologic malignancies

Response assessment after an inductive CHOP or CHOP-like regimen with or without rituximab in 103 patients with diffuse large B-cell lymphoma: integrating 18fluorodeoxyglucose positron emission tomography to the International Workshop Criteria

J. Dupuis1, E. Itti2, A. Rahmouni3, F. Hemery4, C. Gisselbrecht5, C. Lin2, C. Copie-Bergman6, K. Belhadj1, T. El Gnaoui1, I. Gaillard1, F. Kuhnowski1, M. Meignan2 and C. Haioun1,*

1 Department of Clinical Hematology
2 Department of Nuclear Medicine
3 Department of Radiology
4 Department of Biostatistics, Université Paris 12, Créteil; Assistance Publique—Hôpitaux de Paris (AP-HP), Hôpital Henri Mondor, Créteil
5 Department of Hematology-Oncology, AP-HP, Hôpital Saint Louis, Paris, France
6 Inserm U841 (Equipe 9) and Pathology, Université Paris 12, Créteil; Assistance Publique—Hôpitaux de Paris (AP-HP), Hôpital Henri Mondor, Créteil

* Correspondence to: Dr C. Haioun, Service d'Hématologie Clinique, Hôpital H. Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France. Tel: +33-1-49-81-20-51; Fax: +33-1-49-81-20-67; E-mail: corinne.haioun{at}hmn.aphp.fr

Background: Revised response criteria for aggressive lymphomas have been proposed (Cheson, J Clin Oncol, 2007) stressing the role of 18fluorodeoxyglucose–positron emission tomography (PET) in posttreatment evaluation. The value of PET after four cycles compared with the International Workshop Criteria (IWC) remains to be established.

Patients and methods: In all, 103 patients with untreated diffuse large B-cell lymphoma were prospectively enrolled to evaluate the prognostic impact of PET after two and four cycles.

Results: Median age was 53 years (19–79), 68% male. The International Prognostic Index was low = 22%, low-intermediate = 19%, intermediate-high = 33% and high risk = 26%. Treatment consisted of cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) (30%) or dose-intensified CHOP (70%), with rituximab (49%) or without (51%). Ninety-nine patients were evaluated by PET and IWC at four cycles: 77 (78%) had a negative PET, while 22 (22%) remained positive. The 5-year event-free survival (EFS) was 36% for patients with a positive PET versus 80% with a negative examination, whatever the response [complete response (CR) versus partial response (PR)] according to IWC (P < 0.0001). Positive PET patients had a 5-year EFS of 58% if in CR/CR unconfirmed by IWC and 0% if not (P < 0.0001). The same observations could be made in patients treated with and without rituximab.

Conclusion: The integration of PET in treatment evaluation offers a powerful tool to predict outcome.

Key words: diffuse large B-cell lymphoma, 18fluorodeoxyglucose PET scan, response Criteria, rituximab

Received for publication September 5, 2008. Accepted for publication September 9, 2008.


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