Research Papers:
Prognostic value of early 18F-FDG PET scanning evaluation in immunocompetent primary CNS lymphoma patients
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Abstract
Rudy Birsen1,2, Estelle Blanc3, Lise Willems1,2, Barbara Burroni1,4, Marielle Legoff1,2, Emmanuelle Le Ray1,2, Sylvain Pilorge2, Sawsen Salah1,5, Aude Quentin6, Benedicte Deau1,2, Patricia Franchi1,2, Marguerite Vignon1,2, Laurence Mabille3, Charles Nguyen3, Yioula Kirova7, Pascale Varlet1,8, Myriam Edjlali1,9, Edouard Dezamis1,10, Khê Hoang-Xuan11, Carole Soussain12, Caroline Houillier11, Diane Damotte1,4, Johan Pallud1,10, Didier Bouscary1,2 and Jerome Tamburini1,2
1Paris Descartes University, Sorbonne Paris Cité, Paris, France
2Hematology Department, Cochin Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
3Department of Nuclear Medicine, Marie Lannelongue Hospital, Le Plessis Robinson, France
4Pathology Department, Cochin Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
5Ophtalmology Department, Cochin Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
6Jean Jaurès Hospital, Paris, France
7Radiotherapy Department, Curie Institute, Paris, France
8Department of Neuropathology, Sainte-Anne Hospital, Paris, France
9Department of NeuroImaging, Sainte-Anne Hospital, Paris, France
10Department of Neurosurgery, Sainte-Anne Hospital, Paris, France
11Department of Neurology 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique–Hôpitaux de Paris, Sorbonne Universités UPMC Universités Paris VI, IHU, ICM, Paris, France
12Hematology Department, René Huguenin-Institut Curie Hospital, Saint Cloud, France
Correspondence to:
Jerome Tamburini, email: [email protected]
Keywords: primary CNS lymphoma; PET scanner
Received: December 17, 2017 Accepted: February 25, 2018 Published: March 30, 2018
ABSTRACT
Primary central nervous system lymphoma (PCNSL) is a rare topographic variant of diffuse large B-cell lymphoma (DLBCL). While prognostic scales are useful in clinical trials, no dynamic prognostic marker is available in this disease. We report here the prognostic value of early metabolic response by 18F-FDG PET scanner (PET) in 25 newly diagnosed immunocompetent PCNSL patients. Induction treatment consisted of four cycles of Rituximab, Methotrexate and Temozolamide (RMT). Based on patient's general condition, consolidation by high-dose Etoposide and Aracytine was given to responding patients. Brain MRI and PET were performed at diagnosis, after two and four cycles of RMT, and after treatment completion. Two-year progression-free (PFS) and overall survival (OS) were 62% and 74%, respectively for the whole cohort. Best responses after RMT induction were 18 (72%) complete response (CR)/CR undetermined (CRu), 4 (16%) partial response, 1 (4%) progressive disease and 2 (8%) stable disease. Response evaluation was concordant between MRI and PET at the end of induction therapy. Nineteen patients (76%) had a negative PET2. Predictive positive and negative values of PET2 on end-of-treatment (ETR) CR were 66.67% and 94.74%, respectively. We observed a significant association between PET2 negativity and ETR (p = 0.001) and longer PFS (p = 0.02), while having no impact on OS (p = 0.32). Two years PFS was 72% and 33% for PET2– and PET2+ patients, respectively (p < 0.02). PET2 evaluation may help to early define a subgroup of CR PCNSL patients with a favorable outcome.
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PII: 24706