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Early evaluation of tumor response to 90Y-ibritumomab radioimmunotherapy in relapsed/refractory B cell non-Hodgkin lymphoma: what is the optimal timing for FDG-PET/CT?

  • Nuclear Medicine
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine the earliest optimal timing for assessment of early response following radioimmunotherapy in non-Hodgkin lymphoma patients using FDG-PET/CT.

Methods

FDG-PET/CT was performed prior to treatment (PET1), at 2 (PET2) weeks, and at 6 (PET3) weeks after 90Y-ibritumomab radioimmunotherapy in 55 patients. Response was evaluated based on the Deauville 5-point scale and Lugano criteria as well as semiquantitative analysis and compared with progression-free survival (PFS).

Results

PET 2 showed complete metabolic response (CMR), partial metabolic response (PMR), stable metabolic disease (SMD), and progressive metabolic disease (PMD) in 33, 13, 6, and 3 patients, respectively, while PET 3 in 41, 8, 3, and 3 patients, respectively. Mean SUVmax of 168 target lesions decreased over time (PET1, 2, 3; 5.58 ± 2.58, 1.87 ± 1.78, 1.75 ± 2.25, respectively). Progression or recurrence after a median of 12.6 months (range 2.6–72.0 months) was seen in 44 patients. Patients with CMR or metabolic response (CMR + PMR) on PET2 showed significantly longer PFS as compared to those who did not (p = 0.00028 and p = 0.029, respectively). A similar significant difference was observed based on PET3 (p = 0.00013 and p = 0.017, respectively). The same trend was observed when analyzing only the subgroup of patients with follicular lymphoma (N = 43/55) (p < 0.0001).

Conclusion

Use of FDG-PET/CT findings with Lugano criteria for assessing early response to radioimmunotherapy after 6 weeks allowed for accurate evaluation and prognostic stratification, though scanning after 2 weeks was too soon to precisely evaluate response.

Key Points

• The optimal timing of FDG-PET/CT to obtain a suitable tool for assessment of response after 90 Y-ibritumomab radioimmunotherapy of lymphoma has not yet been defined.

• Assessment after 6 weeks by FDG-PET/CT using the Lugano criteria accurately evaluates treatment response and prognosis.

• FDG-PET/CT performed 2 weeks after radioimmunotherapy is too early as it significantly misses objective responses.

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Abbreviations

CMR:

Complete metabolic response

FDG:

18F-fluorodeoxyglucose

FOV:

Field of view

MALT:

Mucosa-associated lymphoid tissue

PET/CT:

Positron emission tomography/computed tomography

PFS:

Progression-free survival

PMD:

Progressive metabolic disease

PMR:

Partial metabolic response

SMD:

Stable metabolic disease

SUVmax :

Maximum standardized uptake value

VOI:

Volume of interest

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Acknowledgements

We thank the editors of European Radiology and those who reviewed this article.

Funding

We declare no financial support.

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Authors and Affiliations

  1. Division of Nuclear Medicine and PET Center, Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan

    Kazuhiro Kitajima

  2. Division of Hematology, Department of Internal Medicine Department of Transfusion Medicine and Cellular Therapy, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan

    Masaya Okada, Kyoko Yoshihara, Tazuko Tokugawa, Akihiro Sawada, Satoshi Yoshihara & Yoshihiro Fujimori

  3. Department of Healthcare office, Daimaru Matsuzaka Department Store, Osaka, 530-8202, Japan

    Toru Kashiwagi

  4. Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan

    Koichiro Yamakado

Authors
  1. Kazuhiro Kitajima
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  2. Masaya Okada
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  3. Toru Kashiwagi
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  9. Koichiro Yamakado
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Corresponding author

Correspondence to Kazuhiro Kitajima.

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Guarantor

The scientific guarantor of this publication is Koichiro Yamakado.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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Informed consent was obtained from each patient after the procedure details were fully explained.

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• prospective

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• performed at one institution

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Kitajima, K., Okada, M., Kashiwagi, T. et al. Early evaluation of tumor response to 90Y-ibritumomab radioimmunotherapy in relapsed/refractory B cell non-Hodgkin lymphoma: what is the optimal timing for FDG-PET/CT?. Eur Radiol 29, 3935–3944 (2019). https://doi.org/10.1007/s00330-019-06134-7

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  • DOI: https://doi.org/10.1007/s00330-019-06134-7

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