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


  • Christine Schmitz - , Klinik für Hämatologie (Author)
  • Jan Rekowski - , Institute for Medical Informatics and Biometry (Author)
  • Stefan P Müller - , Klinik für Nuklearmedizin (Author)
  • Bernd Hertenstein - , Department of internal Medicine I (Author)
  • Christiane Franzius - , Zentrum für Moderne Diagnostik (Author)
  • Arnold Ganser - , Klinik für Hämatologie (Author)
  • Frank M Bengel - , Klinik für Nuklearmedizin (Author)
  • Frank Kroschinsky - , Department of internal Medicine I (Author)
  • Jörg Kotzerke - , Department of Nuclear Medicine (Author)
  • Paul La Rosée - , Klinik für Innere Medizin und Kardiologie (Author)
  • Martin Freesmeyer - , Klinik für Nuklearmedizin (Author)
  • Heinz-Gert Hoeffkes - , Tumorklinik (Author)
  • Andreas Hertel - , Klinik für Diagnostische und Therapeutische Nuklearmedizin (Author)
  • Dirk Behringer - , Klinik für Hämatologie (Author)
  • Rolf Mesters - , Department of internal Medicine I (Author)
  • Matthias Weckesser - , Klinik für Nuklearmedizin (Author)
  • Stefan Mahlmann - , Westpfalz-Klinikum GmbH (Author)
  • Uwe Haberkorn - , Radiologische Klinik und Poliklinik (Author)
  • Uwe Martens - , Klinik für Innere Medizin III: Hämatologie (Author)
  • Gabriele Prange-Krex - , Onkologische Gemeinschaftspraxis (Author)
  • Winfried Brenner - , Klinik für Nuklearmedizin (Author)
  • Aristoteles Giagounidis - , Marienhospital Wesel (Author)
  • Regina Moeller - , Hämatologisch-onkologische Gemeinschaftspraxis (Author)
  • Volker Runde - , Wilhelm-Anton-Hospital (Author)
  • Matthias Sandmann - , Klinik für Innere Medizin III - Hämatologie und Onkologie (Author)
  • Hubertus Hautzel - , Klinik für Nuklearmedizin (Author)
  • Stefan Wilop - , Klinik für Hämatologie (Author)
  • Thomas Krohn - , Klinik für Nuklearmedizin (Author)
  • Heinz Dürk - , Klinik für Hämatologie (Author)
  • Michael Heike - , Klinik für Innere Medizin mit Schwerpunkt Gastroenterologie (Author)
  • Ferras Alashkar - , Klinik für Hämatologie (Author)
  • Marcus Brinkmann - , Zentrum für Klinische Studien Essen (ZKSE) (Author)
  • Guido Trenn - , Klinik für Innere Medizin und Kardiologie (Author)
  • Dietmar Wacker - , Medizinische Klinik und Poliklinik III, Bereich Allgemeinmedizin (Author)
  • Christiane Kreisel-Büstgens - , Zentrum für Hämatologie und Onkologie (Author)
  • Helga Bernhard - , Department of internal Medicine I (Author)
  • Gerhard Heil - , Klinik für Hämatologie und Medizinische Onkologie (Author)
  • Rolf Larisch - , Klinik für Nuklearmedizin (Author)
  • Lars Kurch - , Ulm University Medical Center (Author)
  • Karl-Heinz Jöckel - , Institute for Medical Informatics and Biometry (Author)
  • Dieter Hoelzer - , ONKOLOGIKUM Frankfurt a.M. (Author)
  • Wolfram Klapper - , Charité – Universitätsmedizin Berlin (Author)
  • Ronald Boellaard - , Amsterdam University Medical Centers (UMC) (Author)
  • Ulrich Dührsen - , Klinik für Hämatologie (Author)
  • Andreas Hüttmann - , Klinik für Hämatologie (Author)


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.


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

External IDs

Scopus 85079702568



  • Adolescent, Adult, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Female, Fluorodeoxyglucose F18/metabolism, Follow-Up Studies, Humans, Lymphoma, T-Cell, Peripheral/diagnostic imaging, Male, Middle Aged, Positron-Emission Tomography/methods, Prognosis, Radiopharmaceuticals/metabolism, Survival Rate, Young Adult

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