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Achievement a Negative 18-FDG/PET Status at the End of Procedure by Tailored Treatment According Pre-Transplantation Pet Status in Lymphomas Improve 5 Years-OS and EFS.

2008; Elsevier BV; Volume: 112; Issue: 11 Linguagem: Inglês

10.1182/blood.v112.11.2193.2193

1528-0020

Dominique Bordessoule, Benôıt Marin, Stéphane Girault, Fredericka Bompart, Julie Abraham, Natacha Dmytruck, Arnaud Jaccard, Jacques Monteil, Pascal Turlure,

Medical Imaging Techniques and Applications

Abstract In patients (pts) with non Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) with poor prognosis factors, pre-transplantation (ASCT) 18-fluorodeoxyglucose (FDG)-positron-emission tomography (PET) status is important for evaluation of response and predicting the outcome. A positive pre-ASCT PET (+PET) indicated a high risk (HR) of relapse which was increased by a positive post-ASCT PET. For these patients additional therapy (salvage therapies prior ASCT, targeted radiotherapy, second transplant or new treatment approaches) will be required (Spaepen K 2001, Filmont JE 2003; Svoboda J 2006, Mounier, 2007). In a french regional network, we try to obtain a negative metabolic status with additive « targeted-therapy », before or after the ASCT, in the hope to improve the clinical outcome for these HR NHL/HD. Objective: The study assessed the impact of tailored therapy according to pre-transplantation FDG-PET status on pts outcome after high-dose chemotherapy and ASCT. Patients & Methods: We performed a retrospective analysis of pts included according three criteria: 1) histologically proven malignant lymphoma (NHL/HD) with a metabolic active disease in PET imaging 2) planned to receive an ASCT for HR factors according international recommendations (de novo initial aaIPI III/IV or not in CR after front line chemotherapy or in early and unfavorable relapse; 3) having a PET prospectively performed prior and after ASCT on a CDET replaced in 2005 by a PET/CT (Siemens). The metabolic imaging interpretation had been performed by 2 experienced nuclear physicans first blinded to clinical and CT scan then discussed in multidisciplinary team. + PET defined as any focal or diffuse area of increased activity in a location suspect for residual disease and -PET if any metabolic activity according revised Cheson criteria. Survival analysis were performed using Kaplan-Meier method for event free survival (EFS), overall survival (OS). Results: For 95 consecutive pts treated from 05/1999 to 12/2006 18 HD and 77 NHL, an ASCT has been planned either in initial HR prognostic score (n=39), primary refractory disease (n=31), or in relapse (n=25). First line therapy were mainly ABVD for HD and ACVBP/CHOP +/− Rituximab for NHL. A pre-ASCT -PET was obtained in 52 pts (55%) and 43 pts (45%) remained pre-ASCT +PET. Additional salvage chemotherapy (MINE or DHAP(+/−R) most frequently) obtained a - PET status from pre-ASCT +PET in 9/43 pts (21%) prior the ASCT. ASCT has been performed for all these HR pts with a conditioning regimen mainly BICNU-Etoposide-Aracytine-Melphalan (BEAM). After ASCT, 22/43 pre-ASCT +PET pts were converted in a post-ASCT -PET status. Residual disease of post-ASCT +PET pts was treated by targeted radiation (n=11) or by a second transplant (n=2). One pre-ASCT -PET converted to positive (1/52). At the end of procedure, we obtained a –PET status in 88 pts (92%), persistant + PET in 7 pts (7%) (3 PR/4 PD). With a median follow-up of 4.14 years (range 0.61–9.48) since diagnosis, 15/43pts (35%) pre-ASCT +PET and 14/52pts (26%) pre-HDT/ASCT -PET pts relapsed. Mortality was 23% (22/95pts range -PET : 11/52 (21%) and +/−PET 11/43 (25%) respectively and 4/7 (57%) resistant +/+PET). In –PET and in +/−PET median OS and EFS were not reached, 5yOS was 79% and 73% (p=0.7) and 5 y-EFS 62% and 54% respectively (p=0.2). In residual post-ASCT+PET, median OS was 4,5 months. Conclusion: PET-guided consolidative therapy prior or post ASCT in patients with HR lymphoma is routinely feasible and could obtain a negative status in 92% of pts at the end of procedure and reduce relapses with encouraging results in terms of OS and EFS with a 5-y median follow-up. Next step is now on-going: including pts in multicentric PETdesigned trials to confirm prospectively the crucial role of the metabolic imaging to determine which is the best tailoring therapy.