PET-SCAN FOR RESPONSE ASSESSEMENT AFTER RITUXIMAB-DOSE-ADJUSTED-EPOCH (R-DA-EPOCH) IN PRIMARY MEDIASTINAL LARGE B-CELL LYMPHOMA (PMLBCL): CLINICAL AND PROGNOSTIC SIGNIFICANCE
Author(s): ,
Theodoros Vassilakopoulos
Affiliations:
Department of Hematology,National and Kapodistrian University of Athens, Laikon General Hospital,Athens,Greece
,
Chrysovalantou Chatzidimitriou
Affiliations:
Department of Hematology,National and Kapodistrian University of Athens, Laikon General Hospital,Athens,Greece
,
Zois Mellios
Affiliations:
Department of Hematology,Evangelismos General Hospital,Athens,Greece
,
Eugenia Verigou
Affiliations:
Department of Hematology,University of Patras,Patra,Greece
,
Sotiris Papageorgiou
Affiliations:
2nd Propedeutic Department of Internal Medicine,National and Kapodistrian University of Athens, Attikon Hospital,Athens,Greece
,
Hara Giatra
Affiliations:
Department of Hematology,Evangelismos General Hospital,Athens,Greece
,
Christina Kalpadakis
Affiliations:
Department of Hematology,University of Crete,Heraclion,Greece
,
Gabriela Gainaru
Affiliations:
Department of Hematology,National and Kapodistrian University of Athens, Laikon General Hospital,Athens,Greece
,
Stamatis Karatsanis
Affiliations:
3rd Department of Internal Medicine,National and Kapodistrian University of Athens, Sotiria Hospital,Athens,Greece
,
Vassilis Xanthopoulos
Affiliations:
Department of Hematology,Hygeia Hospital,Athens,Greece
,
Argyro Koumarianou
Affiliations:
Department of Hematology,Iaso General Hospital,Athens,Greece
,
Eirini Katodritou
Affiliations:
Department of Hematology,Theagenion Anticancer Hospital,Thessaloniki,Greece
,
Maria Tsirogianni
Affiliations:
Department of Hematology,Ag Savvas Anticancer Hospital,Athens,Greece
,
Maria Arapaki
Affiliations:
Department of Hematology,National and Kapodistrian University of Athens, Laikon General Hospital,Athens,Greece
,
Theofanis Giannikos
Affiliations:
Department of Hematology,National and Kapodistrian University of Athens, Laikon General Hospital,Athens,Greece
,
Maria Efstathopoulou
Affiliations:
Department of Hematology,National and Kapodistrian University of Athens, Laikon General Hospital,Athens,Greece
,
G Karanakis
Affiliations:
Department of Hematology,Hygeia Hospital,Athens,Greece
,
Argyris Simeonidis
Affiliations:
Department of Hematology,University of Patras,Patra,Greece
,
Dimitris Grentzelias
Affiliations:
Department of Hematology,Hygeia Hospital,Athens,Greece
,
Konstantinou Sakellariou
Affiliations:
Department of Hematology,Evangelismos General Hospital,Athens,Greece
,
Eleni Papadaki
Affiliations:
Department of Hematology,University of Crete,Heraclion,Greece
,
Eleni Plata
Affiliations:
Department of Hematology,National and Kapodistrian University of Athens, Laikon General Hospital,Athens,Greece
,
Maria Bakiri
Affiliations:
Department of Hematology,Evangelismos General Hospital,Athens,Greece
,
Ioannis Datseris
Affiliations:
Department of Nuclear Medicine,Evangelismos General Hospital,Athens,Greece
,
S Chatziioannou
Affiliations:
Department of Nuclear Medicine,Foundation for Biomedical Research of the Academy of Athens,Athens,Greece
,
Vassilis Prassopoulos
Affiliations:
Department of Nuclear Medicine,Hygeia Hospital,Athens,Greece
,
Kostas Konstantopoulos
Affiliations:
Department of Hematology,National and Kapodistrian University of Athens, Laikon General Hospital,Athens,Greece
,
Maria Angelopoulou
Affiliations:
Department of Hematology,National and Kapodistrian University of Athens, Laikon General Hospital,Athens,Greece
,
Karmiris Themistoklis
Affiliations:
Department of Hematology,Evangelismos General Hospital,Athens,Greece
Phoebe Rontogianni
Affiliations:
Department of Nuclear Medicine,Evangelismos General Hospital,Athens,Greece
EHA Library. Vassilakopoulos T. Jun 15, 2019; 266706; PS1089
Assoc. Prof. Theodoros Vassilakopoulos
Assoc. Prof. Theodoros Vassilakopoulos
Contributions
Abstract

Abstract: PS1089

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Background
PET-scan has been evaluated in PMLBCL regarding its prognostic significance under R-CHOP and R-MACOP-B chemotherapy . Patients with clearly positive scans, and especially those with SUVmax ≥5 and Deauville 5-point scale (D5PS) score 5, have inferior outcomes even after consolidative radiotherapy (RT) [1,2]. However, after more intensive chemotherapy, as R-da-EPOCH, the prognostic significance of PET/CT can be modulated, since most patients with positive scans achieve durable remissions without consolidative RT, pointing out to the possibility of false-positive results [3].

Aims
To assess the clinical and prognostic significance of end-of-treatment PET (EOT-PET) in patients with PMLBCL and to evaluate the outcome of patients without subsequent RT

Methods
Among 54 patients with PMLBCL treated with R-da-EPOCH in 11 Greek Centers, 45 were evaluated with EOT-PET-scan after 6 cycles. PET evaluation was pending in 5 patients, whereas no data were available in 4 patients at the time of the analysis.

Results
The median follow-up from treatment initiation was 17 months. Among 45 evaluable patients, 6 had an EOT-PET D5PS of 1 (13%), 9 had D5PS 2 (20%), 13 had D5PS 3 (29%), 12 had D5PS 4 (27%) and 5 had D5PS 5 (11%). Among the 12 patients with D5PS 4, when evaluated according to the “1,4” criterion: 8 were reviewed as D5PS score 4 (SUVmax of residual lesion >1.4xSUVmaxliver) and 4 were reclassified as D5PS score 3 (SUVmax of residual lesion <1.4xSUVmaxliver). Thus the frequency of D5PS score 4 was reduced from 27% to 14% (6/43) with that of D5PS score 3 increasing from 29% to 40% (17/43). Only one of the patients with D5PS scores 1-3 (28 or 62% of total) actually received RT (a patient with D5PS score 2). Among the 12 patients with D5PS score 4, 5 were irradiated (42%). The SUVmax for these 5 patients was 2.9, 3.8, 4.3, 4.5, and 6.0 (4/5 were D5PS score 4 according to the “1.4” criterion). Two of them achieved complete metabolic remission (D5PS 1 and 2), the 3rd continued to have D5PS score 4 after RT and 2 had no available follow-up scans post-RT. Overall, none of the 40 patients with D5PS score 1-4 developed disease progression despite the omission of consolidative RT in 34/40 (85%). In contrast, all 5 patients with D5PS score 5 either progressed or received salvage chemotherapy. Data on follow-up scans will be presented at the Meeting.

Conclusion
PET/CT is a valuable tool for response assessment in PMBCL after R-da-EPOCH, greatly facilitating clinical decision making regarding further consolidative RT. In a real-life setting, RT was safely omitted in the vast majority of patients with EOT-PET D5PS scores 1-4 without even a single case of treatment failure. Patients with D5PS score 5 are rare and their handling requires further study.

1.Vassilakopoulos TP et al.Leukemia. 2016 Jan;30(1):238-42

2.Martelli M et al. J Clin Oncol. 2014 Jun 10;32(17):1769-75

3.Melani C et al.Haematologica. 2018 Aug;103(8):1337-1344

Session topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical

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