Clinical Research Papers:
Week one FLT-PET response predicts complete remission to R-CHOP and survival in DLBCL
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Ken Herrmann1,2,*, Andreas K. Buck1,2,*, Tibor Schuster3, Kathrin Abbrederis4, Christina Blümel2, Ivan Santi1, Martina Rudelius5,6, Hans-Jürgen Wester1, Christian Peschel4, Markus Schwaiger1, Tobias Dechow4,7 and Ulrich Keller4
1 Department of Nuclear Medicine, Technische Universität München, Munich, Germany
2 Department of Nuclear Medicine, Universitätsklinikum Würzburg, Würzburg, Germany
3 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
4 III. Medical Department, Technische Universität München, Munich, Germany
5 Institute of Pathology, Technische Universität München, Munich, Germany
6 Institute of Pathology, Universitätsklinikum Würzburg, Würzburg, Germany
7 Oncology Ravensburg, Ravensburg, Germany
* These Authors contributed equally to this work
Ulrich Keller, email:
Ken Herrmann, email:
Keywords: Lymphoma; DLBCL; Positron emission tomography; [18F]Fluorodeoxythymidine; FLT-PET
Received: March 28, 2014 Accepted: May 17, 2014 Published: May 19, 2014
Despite improved survival in the Rituximab (R) era, a considerable number of patients with diffuse large B-cell lymphoma (DLBCL) ultimately die from the disease. Functional imaging using [18F]fluorodeoxyglucose-PET is suggested for assessment of residual viable tumor very early during treatment but is compromised by non-specific tracer retention in inflammatory lesions. The PET tracer [18F]fluorodeoxythymidine (FLT) as surrogate marker of tumor proliferation may overcome this limitation. We present results of a prospective clinical study testing FLT-PET as superior and early predictor of response to chemotherapy and outcome in DLBCL. 54 patients underwent FLT-PET prior to and one week after the start of R-CHOP chemotherapy. Repetitive FLT-PET imaging was readily implemented into the diagnostic work-up. Our data demonstrate that the reduction of FLT standard uptake valuemean (SUVmean) and SUVmax one week after chemotherapy was significantly higher in patients achieving complete response (CR, n=48; non-CR, n=6; p<0.006). Martingale-residual and Cox proportional hazard analyses showed a significant monotonous decrease of mortality risk with increasing change in SUV. Consistent with these results, early FLT-PET response showed relevant discriminative ability in predicting CR. In conclusion, very early FLT-PET in the course of R-CHOP chemotherapy is feasible and enables identification of patients at risk for treatment failure.
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