Baseline and interim PET-based outcome prediction in peripheral T-cell lymphoma: A subgroup analysis of the PETAL trial

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Christine Schmitz - , University of Duisburg-Essen (Author)
  • Jan Rekowski - , University of Duisburg-Essen (Author)
  • Stefan P. Müller - , University of Duisburg-Essen (Author)
  • Bernd Hertenstein - , Klinikum Bremen-Mitte (Author)
  • Christiane Franzius - , Zentrum für Nuklearmedizin und PET/CT (Author)
  • Arnold Ganser - , Hannover Medical School (MHH) (Author)
  • Frank M. Bengel - , Hannover Medical School (MHH) (Author)
  • Frank Kroschinsky - , Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden (Author)
  • Jörg Kotzerke - , Department of Nuclear Medicine, University Hospital Carl Gustav Carus Dresden (Author)
  • Paul La Rosée - , Friedrich Schiller University Jena (Author)
  • Martin Freesmeyer - , Friedrich Schiller University Jena (Author)
  • Heinz Gert Hoeffkes - , Klinikum Fulda gAG (Author)
  • Andreas Hertel - , Klinikum Fulda gAG (Author)
  • Dirk Behringer - , Augusta Hospitals Bochum Hattingen (Author)
  • Rolf Mesters - , University of Münster (Author)
  • Matthias Weckesser - , University of Münster (Author)
  • Stefan Mahlmann - , Westpfalz-Klinikum GmbH (Author)
  • Uwe Haberkorn - , Heidelberg University  (Author)
  • Uwe Martens - , SLK-Kliniken Heilbronn GmbH (Author)
  • Gabriele Prange-Krex - , Onkologische Gemeinschaftspraxis (Author)
  • Winfried Brenner - , Charité – Universitätsmedizin Berlin (Author)
  • Aristoteles Giagounidis - , Marien Hospital Düsseldorf (Author)
  • Regina Moeller - , Hämatologisch-onkologische Gemeinschaftspraxis Halle (Author)
  • Volker Runde - , Wilhelm-Anton-Hospital (Author)
  • Matthias Sandmann - , Cellitinnen-Krankenhaus St. Petrus (Author)
  • Hubertus Hautzel - , University Hospital Duesseldorf (Author)
  • Stefan Wilop - , RWTH Aachen University (Author)
  • Thomas Krohn - , RWTH Aachen University (Author)
  • Heinz Dürk - , Medical Center Bethel (Author)
  • Michael Heike - , Klinikum Dortmund gGmbH (Author)
  • Ferras Alashkar - , University of Duisburg-Essen (Author)
  • Marcus Brinkmann - , University of Duisburg-Essen (Author)
  • Guido Trenn - , Knappschaftskrankenhaus Bottrop GmbH (Author)
  • Dietmar Wacker - , Klinikum Vest (Author)
  • Christiane Kreisel-Büstgens - , Universitätsmedizin Mannheim (Author)
  • Helga Bernhard - , Heidelberg University  (Author)
  • Gerhard Heil - , Hospital Lüdenscheid (Author)
  • Rolf Larisch - , Hospital Lüdenscheid (Author)
  • Lars Kurch - , Leipzig University (Author)
  • Karl Heinz Jöckel - , University of Duisburg-Essen (Author)
  • Dieter Hoelzer - , ONKOLOGIKUM Frankfurt a.M. (Author)
  • Wolfram Klapper - , University Hospital Schleswig-Holstein Campus Kiel (Author)
  • Ronald Boellaard - , Vrije Universiteit Amsterdam (VU) (Author)
  • Ulrich Dührsen - , University of Duisburg-Essen (Author)
  • Andreas Hüttmann - , University of Duisburg-Essen (Author)

Abstract

The prospective randomized Positron Emission Tomography (PET)-Guided Therapy of Aggressive Non-Hodgkin Lymphomas (PETAL) trial was designed to test the ability of interim PET (iPET) to direct therapy. As reported previously, outcome remained unaffected by iPET-based treatment changes. In this subgroup analysis, we studied the prognostic value of baseline total metabolic tumor volume (TMTV) and iPET response in 76 patients with T-cell lymphoma. TMTV was measured using the 41% maximum standardized uptake value (SUV41max) and SUV4 thresholding methods. Interim PET was performed after two treatment cycles and evaluated using the ΔSUVmax approach and the Deauville scale. Because of significant differences in outcome, patients with anaplastic lymphoma kinase (ALK)-positive lymphoma were analyzed separately from patients with ALK-negative lymphoma. In the latter, TMTV was statistically significantly correlated with progression-free survival, with thresholds best dichotomizing the population, of 232 cm3 using SUV41max and 460 cm3 using SUV4. For iPET response, the respective thresholds were 46.9% SUVmax reduction and Deauville score 1-4 vs 5. The proportion of poor prognosis patients was 46% and 29% for TMTV by SUV41max and SUV4, and 29% and 25% for iPET response by ΔSUVmax and Deauville, respectively. At diagnosis, the hazard ratio (95% confidence interval) for poor prognosis vs good prognosis patients according to TMTV was 2.291 (1.135-4.624) for SUV41max and 3.206 (1.524-6.743) for SUV4. At iPET, it was 3.910 (1.891-8.087) for ΔSUVmax and 4.371 (2.079-9.187) for Deauville. On multivariable analysis, only TMTV and iPET response independently predicted survival. Patients with high baseline TMTV and poor iPET response (22% of the population) invariably progressed or died within the first year (hazard ratio, 9.031 [3.651-22.336]). Due to small numbers and events, PET did not predict survival in ALK-positive lymphoma. Baseline TMTV and iPET response are promising tools to select patients with ALK-negative T-cell lymphoma for early allogeneic transplantation or innovative therapies.

Details

Original languageEnglish
Pages (from-to)244-256
Number of pages13
JournalHematological oncology
Volume38
Issue number3
Publication statusPublished - 1 Aug 2020
Peer-reviewedYes

External IDs

PubMed 32067259

Keywords

Sustainable Development Goals

ASJC Scopus subject areas

Keywords

  • lymphoma, positron-emission tomography, prognosis, prospective studies, T-cell, tumor burden