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Positron emission tomography after response to rituximab-CHOP in primary mediastinal large B-cell lymphoma: impact on outcomes and radiotherapy strategies

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Vassilakopoulos T.P., Papageorgiou S.G., Angelopoulou M.K., Chatziioannou S., Prassopoulos V., Karakatsanis S., Arapaki M., Mellios Z., Sachanas S., Kalpadakis C., Katodritou E., Leonidopoulou T., Kotsianidis I., Hatzimichael E., Kotsopoulou M., Dimou M., Variamis E., Boutsis D., Terpos E., Michali E., Karianakis G., Tsirkinidis P., Vadikolia C., Poziopoulos C., Pigaditou A., Vrakidou E., Siakantaris M.P., Kyrtsonis M.-C., Symeonidis A., Anargyrou K., Papaioannou M., Chatziharissi E., Vervessou E., Tsirogianni M., Palassopoulou M., Gainaru G., Mainta C., Tsirigotis P., Assimakopoulou T., Konstantinidou P., Papadaki H., Dimopoulos M.-A., Pappa V., Karmiris T., Roussou P., Datseris I., Panayiotidis P., Konstantopoulos K., Pangalis G.A., Rondogianni P.
Date
2021
Language
en
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Abstract
End-of-treatment (EoT) PET/CT is used as a guide to omit radiotherapy (RT) patients with primary mediastinal large B-cell lymphoma (PMBCL). We present the mature and extended results of a retrospective study evaluating the prognostic significance of EoT-PET/CT after adequate response to R-CHOP. Among 231 consecutive PMLBCL patients, 182 underwent EoT-PET/CT and were evaluated according to the Deauville 5-point scale (D5PS) criteria. Freedom from progression (FFP) was measured from the time of PET/CT examination. Among 182 patients, 72 (40%) had D5PS score 1 (D5PSS-1), 33 (18%) had 2, 28 (15%) had 3, 29 (16%) had 4, and 20 (11%) had 5. The 5-year FFP was 97, 94, 92, 82, and 44% for D5PSS-1, D5PSS-2, D5PSS-3, D5PSS-4, and D5PSS-5, respectively. Among 105 patients with unequivocally negative PET/CT (D5PSS-1/D5PSS-2), 49 (47%) received RT (median dose 3420 cGy) and 56 (53%) did not with relapses in 0/49 vs. 4/56 patients (2 mediastinum and 2 isolated CNS relapses).The 5-year FFP for those who received RT or not was 100% versus 96%, when isolated CNS relapses were censored (p = 0.159). Among D5PSS-3 patients (27/28 irradiated-median dose 3600 cGy), the 5-year FFP was 92%. The 5-year FFP for D5PSS-4 and D5PSS-5 was 82 and 44%; 44/49 patients received RT (median dose 4000 and 4400 cGy for D5PSS-4 and D5PSS-5). Our study supports the omission of RT in a sizeable fraction of PET/CT-negative patients and definitely discourages salvage chemotherapy and ASCT in patients with PMLBCL who conventionally respond to R-CHOP, solely based on PET/CT positivity in the absence of documented progressive or multifocal disease. The persistence of positive PET/CT with D5PSS < 5 after consolidative RT should not trigger the initiation of further salvage chemotherapy in the absence of conventionally defined PD. © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.
URI
http://hdl.handle.net/11615/80489
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