POSITIVITY OF WHOLE BODY POSITRON EMISSION TOMOGRAPHY (PET) BEFORE AUTOLOGOUS STEM CELL TRANSPLANTATION HAS NEGATIVE PROGNOSTIC IMPACT BUT IT DIFFERS ACCORDING TO LYMPHOMA SUBTYPE AND LINE OF ASCT.
(Abstract release date: 05/19/16)
EHA Library. Pohlreich D. 06/09/16; 133050; E1501
Prof. David Pohlreich
Contributions
Contributions
Abstract
Abstract: E1501
Type: Eposter Presentation
Background
Pre-transplant PET is considered as an important prognostic variable. Positive PET is usually linked with worse prognosis. There is however limited information if there are any differences in PET impact according to line in which is ASCT performed as well as different lymphoma subtypes.
Aims
To analyze the impact of the pre-transplant PET on post-transplant outcome of patients with lymphoma according to lymphoma subtypes and the line of treatment.
Methods
Retrospective analyzes of patients who underwent ASCT between 2010 and 2014. Only pts. with pre-transplant PET were eligible for the analysis. PET had to be performed after the last cycle of chemotherapy before ASCT in interval less than 60 days. Patients who were PET negative and received one more cycle of chemotherapy due to logistic reasons were eligible. Visual PET evaluation was used in comparison to mediastinum and liver accumullation. All pts. signed the informed consent and agreed with data analysis.
Results
There were 350 pts. transplanted for lymphoma between 2005 and 2014. Pre-transplant PET was performed in 253 pts. Patients who were PET positive (PET+), but received additional chemotherapy before ASCT without PET reevaluation (n=20) were excluded from the study. In two patients PET findings were inconclusive and were excluded as well. Altogether 231 patients were evaluated, age at ASCT 53y (21-71), male/female 134/97, DLBCL 108/43% (68 in 1. line, 40 at relapse) FL 33/14 % (2 in 1. line, 31 at relapse), MCL 43/19% (41 in 1. line, 2 at relapse), HL 21/9% (1 primary progressive in 1. line, 20 at relapse) and others 26/11% (13 in 1. line, 13 at relapse).
Altogether 79 (34.2%) patients were PET positive (PET+) and 152 were PET negative (PET-). PET+ pts. had significantly higher death or relaps risk (HR 1.75, p 0.04). There was however only borderline impact of PET in 1st line ASCT (p 0.06) and significant in at relapse ASCT (p 0.002). It was mainly due to DLBCL, where was found significant risk for PET+ in the whole group (HR 2.35, p 0.02). No difference was observed in the 1st line ASCT (p ns) with PET negative predictive value (NPV) = 0.91 and PET positive predictive value (PPV) = 0.13. Patients with DLBCL and ASCT at relapse had significantly worse outcome (HR 2.42, p 0.037) with NPV 0.63 and PPV 0.47. The majority of MCL pts (41) underwent 1st line ASCT. There was significanty worse outcome for PET + (HR 157.3, p < 0,0001) with NPV 0.88 and PPV 0.43. There was limited number of FL (31) and HL (20) patients resp. transplanted for relapse and there was found only trend for worse outcome of PET+ pts for HL (HR 3.7, p 0.11, NPV 0.76, PPV 0.42) and no difference in FL subgroup (HR 0.64, p 0.49, NPV 0.75, PPV 0.14).
Conclusion
We have confirmed prognostic value of pretransplant PET. We have however found that there are differences in lymphoma subtypes (1st line ASCT for DLBCL vs MCL), and differences according to the line of ASCT (1st line ASCT vs at relapse ASCT DLBCL) with differences in NPV (high in 1s line ASCT DLBCL and MCL vs low at relapse ASCT for all subtypes) and PPV (low in 1st line ASCT for DLBCL). Lymphoma subtype as well as line of treatment should be considered in the PET finding interpretation before possible treatment change based on pretransplant PET.
Session topic: E-poster
Keyword(s): Lymphoma, PET, Transplant
Type: Eposter Presentation
Background
Pre-transplant PET is considered as an important prognostic variable. Positive PET is usually linked with worse prognosis. There is however limited information if there are any differences in PET impact according to line in which is ASCT performed as well as different lymphoma subtypes.
Aims
To analyze the impact of the pre-transplant PET on post-transplant outcome of patients with lymphoma according to lymphoma subtypes and the line of treatment.
Methods
Retrospective analyzes of patients who underwent ASCT between 2010 and 2014. Only pts. with pre-transplant PET were eligible for the analysis. PET had to be performed after the last cycle of chemotherapy before ASCT in interval less than 60 days. Patients who were PET negative and received one more cycle of chemotherapy due to logistic reasons were eligible. Visual PET evaluation was used in comparison to mediastinum and liver accumullation. All pts. signed the informed consent and agreed with data analysis.
Results
There were 350 pts. transplanted for lymphoma between 2005 and 2014. Pre-transplant PET was performed in 253 pts. Patients who were PET positive (PET+), but received additional chemotherapy before ASCT without PET reevaluation (n=20) were excluded from the study. In two patients PET findings were inconclusive and were excluded as well. Altogether 231 patients were evaluated, age at ASCT 53y (21-71), male/female 134/97, DLBCL 108/43% (68 in 1. line, 40 at relapse) FL 33/14 % (2 in 1. line, 31 at relapse), MCL 43/19% (41 in 1. line, 2 at relapse), HL 21/9% (1 primary progressive in 1. line, 20 at relapse) and others 26/11% (13 in 1. line, 13 at relapse).
Altogether 79 (34.2%) patients were PET positive (PET+) and 152 were PET negative (PET-). PET+ pts. had significantly higher death or relaps risk (HR 1.75, p 0.04). There was however only borderline impact of PET in 1st line ASCT (p 0.06) and significant in at relapse ASCT (p 0.002). It was mainly due to DLBCL, where was found significant risk for PET+ in the whole group (HR 2.35, p 0.02). No difference was observed in the 1st line ASCT (p ns) with PET negative predictive value (NPV) = 0.91 and PET positive predictive value (PPV) = 0.13. Patients with DLBCL and ASCT at relapse had significantly worse outcome (HR 2.42, p 0.037) with NPV 0.63 and PPV 0.47. The majority of MCL pts (41) underwent 1st line ASCT. There was significanty worse outcome for PET + (HR 157.3, p < 0,0001) with NPV 0.88 and PPV 0.43. There was limited number of FL (31) and HL (20) patients resp. transplanted for relapse and there was found only trend for worse outcome of PET+ pts for HL (HR 3.7, p 0.11, NPV 0.76, PPV 0.42) and no difference in FL subgroup (HR 0.64, p 0.49, NPV 0.75, PPV 0.14).
Conclusion
We have confirmed prognostic value of pretransplant PET. We have however found that there are differences in lymphoma subtypes (1st line ASCT for DLBCL vs MCL), and differences according to the line of ASCT (1st line ASCT vs at relapse ASCT DLBCL) with differences in NPV (high in 1s line ASCT DLBCL and MCL vs low at relapse ASCT for all subtypes) and PPV (low in 1st line ASCT for DLBCL). Lymphoma subtype as well as line of treatment should be considered in the PET finding interpretation before possible treatment change based on pretransplant PET.
Session topic: E-poster
Keyword(s): Lymphoma, PET, Transplant
Abstract: E1501
Type: Eposter Presentation
Background
Pre-transplant PET is considered as an important prognostic variable. Positive PET is usually linked with worse prognosis. There is however limited information if there are any differences in PET impact according to line in which is ASCT performed as well as different lymphoma subtypes.
Aims
To analyze the impact of the pre-transplant PET on post-transplant outcome of patients with lymphoma according to lymphoma subtypes and the line of treatment.
Methods
Retrospective analyzes of patients who underwent ASCT between 2010 and 2014. Only pts. with pre-transplant PET were eligible for the analysis. PET had to be performed after the last cycle of chemotherapy before ASCT in interval less than 60 days. Patients who were PET negative and received one more cycle of chemotherapy due to logistic reasons were eligible. Visual PET evaluation was used in comparison to mediastinum and liver accumullation. All pts. signed the informed consent and agreed with data analysis.
Results
There were 350 pts. transplanted for lymphoma between 2005 and 2014. Pre-transplant PET was performed in 253 pts. Patients who were PET positive (PET+), but received additional chemotherapy before ASCT without PET reevaluation (n=20) were excluded from the study. In two patients PET findings were inconclusive and were excluded as well. Altogether 231 patients were evaluated, age at ASCT 53y (21-71), male/female 134/97, DLBCL 108/43% (68 in 1. line, 40 at relapse) FL 33/14 % (2 in 1. line, 31 at relapse), MCL 43/19% (41 in 1. line, 2 at relapse), HL 21/9% (1 primary progressive in 1. line, 20 at relapse) and others 26/11% (13 in 1. line, 13 at relapse).
Altogether 79 (34.2%) patients were PET positive (PET+) and 152 were PET negative (PET-). PET+ pts. had significantly higher death or relaps risk (HR 1.75, p 0.04). There was however only borderline impact of PET in 1st line ASCT (p 0.06) and significant in at relapse ASCT (p 0.002). It was mainly due to DLBCL, where was found significant risk for PET+ in the whole group (HR 2.35, p 0.02). No difference was observed in the 1st line ASCT (p ns) with PET negative predictive value (NPV) = 0.91 and PET positive predictive value (PPV) = 0.13. Patients with DLBCL and ASCT at relapse had significantly worse outcome (HR 2.42, p 0.037) with NPV 0.63 and PPV 0.47. The majority of MCL pts (41) underwent 1st line ASCT. There was significanty worse outcome for PET + (HR 157.3, p < 0,0001) with NPV 0.88 and PPV 0.43. There was limited number of FL (31) and HL (20) patients resp. transplanted for relapse and there was found only trend for worse outcome of PET+ pts for HL (HR 3.7, p 0.11, NPV 0.76, PPV 0.42) and no difference in FL subgroup (HR 0.64, p 0.49, NPV 0.75, PPV 0.14).
Conclusion
We have confirmed prognostic value of pretransplant PET. We have however found that there are differences in lymphoma subtypes (1st line ASCT for DLBCL vs MCL), and differences according to the line of ASCT (1st line ASCT vs at relapse ASCT DLBCL) with differences in NPV (high in 1s line ASCT DLBCL and MCL vs low at relapse ASCT for all subtypes) and PPV (low in 1st line ASCT for DLBCL). Lymphoma subtype as well as line of treatment should be considered in the PET finding interpretation before possible treatment change based on pretransplant PET.
Session topic: E-poster
Keyword(s): Lymphoma, PET, Transplant
Type: Eposter Presentation
Background
Pre-transplant PET is considered as an important prognostic variable. Positive PET is usually linked with worse prognosis. There is however limited information if there are any differences in PET impact according to line in which is ASCT performed as well as different lymphoma subtypes.
Aims
To analyze the impact of the pre-transplant PET on post-transplant outcome of patients with lymphoma according to lymphoma subtypes and the line of treatment.
Methods
Retrospective analyzes of patients who underwent ASCT between 2010 and 2014. Only pts. with pre-transplant PET were eligible for the analysis. PET had to be performed after the last cycle of chemotherapy before ASCT in interval less than 60 days. Patients who were PET negative and received one more cycle of chemotherapy due to logistic reasons were eligible. Visual PET evaluation was used in comparison to mediastinum and liver accumullation. All pts. signed the informed consent and agreed with data analysis.
Results
There were 350 pts. transplanted for lymphoma between 2005 and 2014. Pre-transplant PET was performed in 253 pts. Patients who were PET positive (PET+), but received additional chemotherapy before ASCT without PET reevaluation (n=20) were excluded from the study. In two patients PET findings were inconclusive and were excluded as well. Altogether 231 patients were evaluated, age at ASCT 53y (21-71), male/female 134/97, DLBCL 108/43% (68 in 1. line, 40 at relapse) FL 33/14 % (2 in 1. line, 31 at relapse), MCL 43/19% (41 in 1. line, 2 at relapse), HL 21/9% (1 primary progressive in 1. line, 20 at relapse) and others 26/11% (13 in 1. line, 13 at relapse).
Altogether 79 (34.2%) patients were PET positive (PET+) and 152 were PET negative (PET-). PET+ pts. had significantly higher death or relaps risk (HR 1.75, p 0.04). There was however only borderline impact of PET in 1st line ASCT (p 0.06) and significant in at relapse ASCT (p 0.002). It was mainly due to DLBCL, where was found significant risk for PET+ in the whole group (HR 2.35, p 0.02). No difference was observed in the 1st line ASCT (p ns) with PET negative predictive value (NPV) = 0.91 and PET positive predictive value (PPV) = 0.13. Patients with DLBCL and ASCT at relapse had significantly worse outcome (HR 2.42, p 0.037) with NPV 0.63 and PPV 0.47. The majority of MCL pts (41) underwent 1st line ASCT. There was significanty worse outcome for PET + (HR 157.3, p < 0,0001) with NPV 0.88 and PPV 0.43. There was limited number of FL (31) and HL (20) patients resp. transplanted for relapse and there was found only trend for worse outcome of PET+ pts for HL (HR 3.7, p 0.11, NPV 0.76, PPV 0.42) and no difference in FL subgroup (HR 0.64, p 0.49, NPV 0.75, PPV 0.14).
Conclusion
We have confirmed prognostic value of pretransplant PET. We have however found that there are differences in lymphoma subtypes (1st line ASCT for DLBCL vs MCL), and differences according to the line of ASCT (1st line ASCT vs at relapse ASCT DLBCL) with differences in NPV (high in 1s line ASCT DLBCL and MCL vs low at relapse ASCT for all subtypes) and PPV (low in 1st line ASCT for DLBCL). Lymphoma subtype as well as line of treatment should be considered in the PET finding interpretation before possible treatment change based on pretransplant PET.
Session topic: E-poster
Keyword(s): Lymphoma, PET, Transplant
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