Predictive value of early 18F‐fluoro‐deoxyglucose positron emission tomography in chemosensitive relapsed lymphoma

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Abstract
Summary. 18F‐fluoro‐deoxyglucose (FDG) positron emission tomography (PET) might be a better tool than computerized tomography (CT) in predicting long‐term treatment outcome in patients with relapsed chemosensitive lymphoma who are candidates for autologous stem cell transplantation (ASCT). We studied patients with recurrent or persistent aggressive non‐Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD), who were treated with three courses of second‐line induction chemotherapy [DHAP–VIM (dexamethasone, cytarabine, cisplatin followed by etoposide, iphosphamide and methotrexate)‐DHAP], followed by myeloablative therapy and ASCT if chemosensitive. FDG‐PET was performed in parallel to conventional diagnostic methods before starting, and after two courses of, second‐line therapy. Of 68 relapsed lymphoma patients, 46 chemosensitive patients (33 NHL and 13 HD) were included, of whom 39 were transplanted. After DHAP‐VIM, the second PET scan was normalized in 15/46 patients; progression‐free survival at 2 years was 62% for PET‐negative patients versus 32% for PET‐positive patients (P = 0·048). The relative risk for progressive disease in patients with < 90% intensity reduction was 2·85 (95% confidence interval 1·15–7·05, P = 0·018). Early FDG‐PET may help to predict the long‐term treatment outcome of ASCT in chemosensitive patients with relapsed lymphoma and identify those patients who need extra or alternative treatment. Disappearance or > 90% reduction of intensity of abnormal FDG uptake after two courses of reinduction therapy was correlated with a favourable outcome.

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