Kategorie: Maligní lymfomy a leukémie
Téma: Non-Hodgkin lymphoma - Clinical
Číslo abstraktu: P333
Autoři: MUDr. Robert Pytlík, Ph.D.; MUDr. David Belada, Ph.D.; MUDr. David Šálek, Ph.D.; MUDr. Otakar Bělohlávek, CSc.; MUDr. Jozef Kubinyi, Ph.D., FEBNM; MUDr. Adéla Berková; Prof. MUDr. Marek Trněný, CSc.
18FDG-PET results at the end of treatment have independent prognostic value in aggressive B-cell lymphomas. The value of early or interim PET is unclear. Also, it is unclear whether eventual negative prognostic impact of positive early PET can be reversed with intensified consolidation treatment.
We have studied the impact of early PET after 2 to 3 cycles of intensified induction therapy on prognosis of patients 18-62 years old with diffuse large B-cell lymphomas (DLBCL) and primary mediastinal B-cell lymphomas (PMBL) with age-adjusted prognostic index (aaIPI) 2-3.
Patients were treated in 2002-2011 with 3 cycles of high-dose RCHOP (rituximab, 375 mg/m2, cyclophosphamide, 3 g/m2, doxorubicin, 75 mg/m2, vincristin, 2 mg and Prednison, 300 mg m2 + G-CSF), 3 cycles of RESHAP, and autologous transplantation (ASCT), with or without radiotherapy. PET was performed on 15th to 21st day of 2nd or 3rd cycle of high-dose RCHOP. Overall survival (OS), progression-free survival (PFS) and lymphomafree survival (LFS) was calculated according to Kaplan-Meier. Multivariable analysis for independent predictive factors was calculated according to Cox model.
91 patients with median age of 39 years (18-62) was treated. aaIPI was 2 in 56% of patients and 3 in 44% of patients. OS was 82±4 % at 3 years, PFS was 79±4 %, and LFS was 82±4 %. 36 patients (40 %) were early PET positive and 55 patients (60%) negative. Early PET negative patients had better 3-year LFS (90±4 % v. 70±8 %, P=0.03), and PFS (87±5 % v. 68±8 %, P=0.05) than early PET positive patients, but not better OS (88±5 % v. 73±8 %, P=0.21). Age less than 45 years and negative PET were the only independent variables for LFS and PFS on multivariate analysis.
Summary / Conclusion:
Intensive treatment in early PET positive patients with high-risk aggressive lymphomas at least partially overcomes the results of positive early PET, however, early PET negative patients still have better PFS and LFS.
This work was supported by grants IGA MZ ČR NT 13072-4 and MSMT PRVOUK P27/LF1/1.
Datum přednesení příspěvku: 14. 6. 2013