TY - JOUR
TI - Positron emission tomography after response to rituximab-CHOP in primary mediastinal large B-cell lymphoma: impact on outcomes and radiotherapy strategies
AU - Vassilakopoulos, T.P.
AU - Papageorgiou, S.G.
AU - Angelopoulou, M.K.
AU - Chatziioannou, S.
AU - Prassopoulos, V.
AU - Karakatsanis, S.
AU - Arapaki, M.
AU - Mellios, Z.
AU - Sachanas, S.
AU - Kalpadakis, C.
AU - Katodritou, E.
AU - Leonidopoulou, T.
AU - Kotsianidis, I.
AU - Hatzimichael, E.
AU - Kotsopoulou, M.
AU - Dimou, M.
AU - Variamis, E.
AU - Boutsis, D.
AU - Terpos, E.
AU - Michali, E.
AU - Karianakis, G.
AU - Tsirkinidis, P.
AU - Vadikolia, C.
AU - Poziopoulos, C.
AU - Pigaditou, A.
AU - Vrakidou, E.
AU - Siakantaris, M.P.
AU - Kyrtsonis, M.-C.
AU - Symeonidis, A.
AU - Anargyrou, K.
AU - Papaioannou, M.
AU - Chatziharissi, E.
AU - Vervessou, E.
AU - Tsirogianni, M.
AU - Palassopoulou, M.
AU - Gainaru, G.
AU - Mainta, C.
AU - Tsirigotis, P.
AU - Assimakopoulou, T.
AU - Konstantinidou, P.
AU - Papadaki, H.
AU - Dimopoulos, M.-A.
AU - Pappa, V.
AU - Karmiris, T.
AU - Roussou, P.
AU - Datseris, I.
AU - Panayiotidis, P.
AU - Konstantopoulos, K.
AU - Pangalis, G.A.
AU - Rondogianni, P.
JO - Annals of Hematology
PY - 2021
VL - 100
TODO - 9
SP - 2279-2292
PB - Springer Science and Business Media Deutschland GmbH
SN - 0939-5555, 1432-0584
TODO - 10.1007/s00277-021-04421-2
TODO - cyclophosphamide plus doxorubicin plus prednisolone plus rituximab plus vincristine;  antineoplastic agent;  cyclophosphamide;  doxorubicin;  prednisone;  R-CHOP protocol;  rituximab;  vincristine, adolescent;  adult;  aged;  Article;  cancer prognosis;  cancer radiotherapy;  cancer recurrence;  female;  human;  large cell lymphoma;  major clinical study;  male;  mediastinum cancer;  positron emission tomography-computed tomography;  primary tumor;  radiation dose;  retrospective study;  treatment outcome;  diagnostic imaging;  diffuse large B cell lymphoma;  mediastinum tumor;  middle aged;  young adult, Adolescent;  Adult;  Aged;  Antineoplastic Combined Chemotherapy Protocols;  Cyclophosphamide;  Doxorubicin;  Female;  Humans;  Lymphoma, Large B-Cell, Diffuse;  Male;  Mediastinal Neoplasms;  Middle Aged;  Positron Emission Tomography Computed Tomography;  Prednisone;  Retrospective Studies;  Rituximab;  Treatment Outcome;  Vincristine;  Young Adult
TODO - 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.
ER -