Aberrant patterns of PET response during treatment for DLBCL patients with MYC gene rearrangements

Author:

Eertink J. J.ORCID,Arens A. I. J.ORCID,Huijbregts J. E.ORCID,Celik F.ORCID,de Keizer B.ORCID,Stroobants S.ORCID,de Jong D.ORCID,Wiegers S. E.ORCID,Zwezerijnen G. J. C.ORCID,Burggraaff C. N.ORCID,Boellaard R.ORCID,de Vet H. C. W.ORCID,Hoekstra O. S.ORCID,Lugtenburg P. J.ORCID,Chamuleau M. E. D.ORCID,Zijlstra J. M.,

Abstract

Abstract Purpose MYC gene rearrangements in diffuse large B-cell lymphoma (DLBCL) patients are associated with poor prognosis. Our aim was to compare patterns of 2[18F]fluoro-2-deoxy-D-glucose positron emission tomography computed tomography (PET/CT) response in MYC + and MYC- DLBCL patients. Methods Interim PET/CT (I-PET) and end of treatment PET/CT (EoT-PET) scans of 81 MYC + and 129 MYC- DLBCL patients from 2 HOVON trials were reviewed using the Deauville 5-point scale (DS). DS1-3 was regarded as negative and DS4-5 as positive. Standardized uptake values (SUV) and metabolic tumor volume (MTV) were quantified at baseline, I-PET, and EoT-PET. Negative (NPV) and positive predictive values (PPV) were calculated using 2-year overall survival. Results MYC + DLBCL patients had significantly more positive EoT-PET scans than MYC- patients (32.5 vs 15.7%, p = 0.004). I-PET positivity rates were comparable (28.8 vs 23.8%). In MYC + patients 23.2% of the I-PET negative patients converted to positive at EoT-PET, vs only 2% for the MYC- patients (p = 0.002). Nine (34.6%) MYC + DLBCL showed initially uninvolved localizations at EoT-PET, compared to one (5.3%) MYC- patient. A total of 80.8% of EoT-PET positive MYC + patients showed both increased lesional SUV and MTV compared to I-PET. In MYC- patients, 31.6% showed increased SUV and 42.1% showed increased MTV. NPV of I-PET and EoT-PET was high for both MYC subgroups (81.8–94.1%). PPV was highest at EoT-PET for MYC + patients (61.5%). Conclusion MYC + DLBCL patients demonstrate aberrant PET response patterns compared to MYC- patients with more frequent progression during treatment after I-PET negative assessment and new lesions at sites that were not initially involved. Trial registration number and date of registration HOVON-84: EudraCT: 2006–005,174-42, retrospectively registered 01–08-2008. HOVON-130: EudraCT: 2014–002,654-39, registered 26–01-2015

Funder

KWF Kankerbestrijding

Publisher

Springer Science and Business Media LLC

Subject

Radiology, Nuclear Medicine and imaging,General Medicine,Radiology, Nuclear Medicine and imaging,General Medicine

Reference23 articles.

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