J Nucl Med 2002 Aug;43(8):1018-27
PET predicts prognosis after 1 cycle of chemotherapy in aggressive lymphoma
and Hodgkin's disease.
Kostakoglu L, Coleman M, Leonard JP, Kuji I, Zoe H, Goldsmith SJ.
Early identification of chemotherapy-refractory lymphoma patients provides a
basis for alternative treatment strategies. Metabolic imaging with (18)F-FDG PET
offers functional tissue characterization that is useful for assessing response
to therapy. Our objective was to determine the predictive value of (18)F-FDG PET
early during chemotherapy (after 1 cycle) and at the completion of chemotherapy
for subsequent progression-free survival (PFS) in patients with aggressive
non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD). METHODS: (18)F-FDG PET
(dual-head coincidence camera with attenuation correction) was performed before
and after 1 cycle of chemotherapy on 30 patients (17 NHL, 13 HD; mean age, 52.3
+/- 16.0 y). For 23 of the 30 patients, (18)F-FDG PET data were also obtained
after the completion of chemotherapy. The patients had a median follow-up of 19
mo (range, 18-24 mo). Follow-up of PFS was compared between patients with
positive and negative (18)F-FDG PET results obtained after the first cycle of
chemotherapy and at the completion of chemotherapy. RESULTS: Positive (18)F-FDG
PET results obtained both after the first cycle and at the completion of therapy
were associated with a shorter PFS (median, 5 and 0 mo, respectively) than were
negative (18)F-FDG PET results (PFS medians not reached). A statistically
significant difference in PFS between positive and negative (18)F-FDG PET
results was obtained both after the first cycle and at the completion of
chemotherapy (P < or = 0.001). The PFS and (18)F-FDG PET results obtained
after the first cycle correlated better than those obtained after the completion
of chemotherapy (r(2) = 0.45 vs. 0.17). (18)F-FDG PET had more false-negative
results after the last cycle (6/17 cases, or 35%) than after the first cycle
(2/13 cases, or 15%). Thus, (18)F-FDG PET had greater sensitivity and positive
predictive values after the first cycle (82% vs. 45.5% and 90% vs. 83%,
respectively) than after the last cycle. CONCLUSION: (18)F-FDG PET after 1 cycle
of chemotherapy is predictive of 18-mo outcome in patients with aggressive NHL
and HD and may earlier identify patients who would benefit from more intensive
treatment programs.
