Risk-adapted dose-dense immunochemotherapy determined by interim FDG-PET in advanced-stage diffuse large B-cell lymphoma

Craig Moskowitz, Heiko Schöder, Julie Teruya-Feldstein, Camelia Sima, Alexia Iasonos, Carol S. Portlock, David Straus, Ariela Noy, Maria L. Palomba, Owen A. O'Connor, Steven Horwitz, Sarah A. Weaver, Jessica L. Meikle, Daniel A. Filippa, James F. Caravelli, Paul A. Hamlin, Andrew D. Zelenetz

Research output: Contribution to journalArticle

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Abstract

Purpose: In studies of diffuse large B-cell lymphoma, positron emission tomography with [18F]fluorodeoxyglucose (FDG-PET) performed after two to four cycles of chemotherapy has demonstrated prognostic significance. However, some patients treated with immunochemotherapy experience a favorable long-term outcome despite a positive interim FDG-PET scan. To clarify the significance of interim FDG-PET scans, we prospectively studied interim FDG-positive disease within a risk-adapted sequential immunochemotherapy program. Patients and Methods: From March 2002 to November 2006, 98 patients at Memorial Sloan-Kettering Cancer Center received induction therapy with four cycles of accelerated R-CHOP (rituximab + cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by an interim FDG-PET scan. If the FDG-PET scan was negative, patients received three cycles of ICE (ifosfamide, carboplatin, and etoposide) consolidation therapy. If residual FDG-positive disease was seen, patients underwent biopsy; if the biopsy was negative, they also received three cycles of ICE. Patients with a positive biopsy received ICE followed by autologous stem-cell transplantation. Results: At a median follow-up of 44 months, overall and progression-free survival were 90% and 79%, respectively. Ninety-seven patients underwent interim FDG-PET scans; 59 had a negative scan, 51 of whom are progression free. Thirty-eight patients with FDG-PET-positive disease underwent repeat biopsy; 33 were negative, and 26 remain progression free after ICE consolidation therapy. Progression-free survival of interim FDG-PET - positive/biopsy-negative patients was identical to that in patients with a negative interim FDG-PET scan (P = .27). Conclusion: Interim or post-treatment FDG-PET evaluation did not predict outcome with this dose-dense, sequential immunochemotherapy program. Outside of a clinical trial, we recommend biopsy confirmation of an abnormal interim FDG-PET scan before changing therapy.

Original languageEnglish (US)
Pages (from-to)1896-1903
Number of pages8
JournalJournal of Clinical Oncology
Volume28
Issue number11
DOIs
StatePublished - Apr 10 2010
Externally publishedYes

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Lymphoma, Large B-Cell, Diffuse
Positron-Emission Tomography
Ifosfamide
Carboplatin
Etoposide
Biopsy
Fluorodeoxyglucose F18
Disease-Free Survival
Therapeutics
Stem Cell Transplantation
Vincristine
Prednisone
Doxorubicin
Cyclophosphamide
Clinical Trials
Drug Therapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Risk-adapted dose-dense immunochemotherapy determined by interim FDG-PET in advanced-stage diffuse large B-cell lymphoma. / Moskowitz, Craig; Schöder, Heiko; Teruya-Feldstein, Julie; Sima, Camelia; Iasonos, Alexia; Portlock, Carol S.; Straus, David; Noy, Ariela; Palomba, Maria L.; O'Connor, Owen A.; Horwitz, Steven; Weaver, Sarah A.; Meikle, Jessica L.; Filippa, Daniel A.; Caravelli, James F.; Hamlin, Paul A.; Zelenetz, Andrew D.

In: Journal of Clinical Oncology, Vol. 28, No. 11, 10.04.2010, p. 1896-1903.

Research output: Contribution to journalArticle

Moskowitz, C, Schöder, H, Teruya-Feldstein, J, Sima, C, Iasonos, A, Portlock, CS, Straus, D, Noy, A, Palomba, ML, O'Connor, OA, Horwitz, S, Weaver, SA, Meikle, JL, Filippa, DA, Caravelli, JF, Hamlin, PA & Zelenetz, AD 2010, 'Risk-adapted dose-dense immunochemotherapy determined by interim FDG-PET in advanced-stage diffuse large B-cell lymphoma', Journal of Clinical Oncology, vol. 28, no. 11, pp. 1896-1903. https://doi.org/10.1200/JCO.2009.26.5942
Moskowitz, Craig ; Schöder, Heiko ; Teruya-Feldstein, Julie ; Sima, Camelia ; Iasonos, Alexia ; Portlock, Carol S. ; Straus, David ; Noy, Ariela ; Palomba, Maria L. ; O'Connor, Owen A. ; Horwitz, Steven ; Weaver, Sarah A. ; Meikle, Jessica L. ; Filippa, Daniel A. ; Caravelli, James F. ; Hamlin, Paul A. ; Zelenetz, Andrew D. / Risk-adapted dose-dense immunochemotherapy determined by interim FDG-PET in advanced-stage diffuse large B-cell lymphoma. In: Journal of Clinical Oncology. 2010 ; Vol. 28, No. 11. pp. 1896-1903.
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abstract = "Purpose: In studies of diffuse large B-cell lymphoma, positron emission tomography with [18F]fluorodeoxyglucose (FDG-PET) performed after two to four cycles of chemotherapy has demonstrated prognostic significance. However, some patients treated with immunochemotherapy experience a favorable long-term outcome despite a positive interim FDG-PET scan. To clarify the significance of interim FDG-PET scans, we prospectively studied interim FDG-positive disease within a risk-adapted sequential immunochemotherapy program. Patients and Methods: From March 2002 to November 2006, 98 patients at Memorial Sloan-Kettering Cancer Center received induction therapy with four cycles of accelerated R-CHOP (rituximab + cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by an interim FDG-PET scan. If the FDG-PET scan was negative, patients received three cycles of ICE (ifosfamide, carboplatin, and etoposide) consolidation therapy. If residual FDG-positive disease was seen, patients underwent biopsy; if the biopsy was negative, they also received three cycles of ICE. Patients with a positive biopsy received ICE followed by autologous stem-cell transplantation. Results: At a median follow-up of 44 months, overall and progression-free survival were 90{\%} and 79{\%}, respectively. Ninety-seven patients underwent interim FDG-PET scans; 59 had a negative scan, 51 of whom are progression free. Thirty-eight patients with FDG-PET-positive disease underwent repeat biopsy; 33 were negative, and 26 remain progression free after ICE consolidation therapy. Progression-free survival of interim FDG-PET - positive/biopsy-negative patients was identical to that in patients with a negative interim FDG-PET scan (P = .27). Conclusion: Interim or post-treatment FDG-PET evaluation did not predict outcome with this dose-dense, sequential immunochemotherapy program. Outside of a clinical trial, we recommend biopsy confirmation of an abnormal interim FDG-PET scan before changing therapy.",
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T1 - Risk-adapted dose-dense immunochemotherapy determined by interim FDG-PET in advanced-stage diffuse large B-cell lymphoma

AU - Moskowitz, Craig

AU - Schöder, Heiko

AU - Teruya-Feldstein, Julie

AU - Sima, Camelia

AU - Iasonos, Alexia

AU - Portlock, Carol S.

AU - Straus, David

AU - Noy, Ariela

AU - Palomba, Maria L.

AU - O'Connor, Owen A.

AU - Horwitz, Steven

AU - Weaver, Sarah A.

AU - Meikle, Jessica L.

AU - Filippa, Daniel A.

AU - Caravelli, James F.

AU - Hamlin, Paul A.

AU - Zelenetz, Andrew D.

PY - 2010/4/10

Y1 - 2010/4/10

N2 - Purpose: In studies of diffuse large B-cell lymphoma, positron emission tomography with [18F]fluorodeoxyglucose (FDG-PET) performed after two to four cycles of chemotherapy has demonstrated prognostic significance. However, some patients treated with immunochemotherapy experience a favorable long-term outcome despite a positive interim FDG-PET scan. To clarify the significance of interim FDG-PET scans, we prospectively studied interim FDG-positive disease within a risk-adapted sequential immunochemotherapy program. Patients and Methods: From March 2002 to November 2006, 98 patients at Memorial Sloan-Kettering Cancer Center received induction therapy with four cycles of accelerated R-CHOP (rituximab + cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by an interim FDG-PET scan. If the FDG-PET scan was negative, patients received three cycles of ICE (ifosfamide, carboplatin, and etoposide) consolidation therapy. If residual FDG-positive disease was seen, patients underwent biopsy; if the biopsy was negative, they also received three cycles of ICE. Patients with a positive biopsy received ICE followed by autologous stem-cell transplantation. Results: At a median follow-up of 44 months, overall and progression-free survival were 90% and 79%, respectively. Ninety-seven patients underwent interim FDG-PET scans; 59 had a negative scan, 51 of whom are progression free. Thirty-eight patients with FDG-PET-positive disease underwent repeat biopsy; 33 were negative, and 26 remain progression free after ICE consolidation therapy. Progression-free survival of interim FDG-PET - positive/biopsy-negative patients was identical to that in patients with a negative interim FDG-PET scan (P = .27). Conclusion: Interim or post-treatment FDG-PET evaluation did not predict outcome with this dose-dense, sequential immunochemotherapy program. Outside of a clinical trial, we recommend biopsy confirmation of an abnormal interim FDG-PET scan before changing therapy.

AB - Purpose: In studies of diffuse large B-cell lymphoma, positron emission tomography with [18F]fluorodeoxyglucose (FDG-PET) performed after two to four cycles of chemotherapy has demonstrated prognostic significance. However, some patients treated with immunochemotherapy experience a favorable long-term outcome despite a positive interim FDG-PET scan. To clarify the significance of interim FDG-PET scans, we prospectively studied interim FDG-positive disease within a risk-adapted sequential immunochemotherapy program. Patients and Methods: From March 2002 to November 2006, 98 patients at Memorial Sloan-Kettering Cancer Center received induction therapy with four cycles of accelerated R-CHOP (rituximab + cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by an interim FDG-PET scan. If the FDG-PET scan was negative, patients received three cycles of ICE (ifosfamide, carboplatin, and etoposide) consolidation therapy. If residual FDG-positive disease was seen, patients underwent biopsy; if the biopsy was negative, they also received three cycles of ICE. Patients with a positive biopsy received ICE followed by autologous stem-cell transplantation. Results: At a median follow-up of 44 months, overall and progression-free survival were 90% and 79%, respectively. Ninety-seven patients underwent interim FDG-PET scans; 59 had a negative scan, 51 of whom are progression free. Thirty-eight patients with FDG-PET-positive disease underwent repeat biopsy; 33 were negative, and 26 remain progression free after ICE consolidation therapy. Progression-free survival of interim FDG-PET - positive/biopsy-negative patients was identical to that in patients with a negative interim FDG-PET scan (P = .27). Conclusion: Interim or post-treatment FDG-PET evaluation did not predict outcome with this dose-dense, sequential immunochemotherapy program. Outside of a clinical trial, we recommend biopsy confirmation of an abnormal interim FDG-PET scan before changing therapy.

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