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. 2018 Mar 30;9(24):16822-16831.
doi: 10.18632/oncotarget.24706.

Prognostic value of early 18F-FDG PET scanning evaluation in immunocompetent primary CNS lymphoma patients

Rudy Birsen  1   2 , Estelle Blanc  3 , Lise Willems  1   2 , Barbara Burroni  1   4 , Marielle Legoff  1   2 , Emmanuelle Le Ray  1   2 , Sylvain Pilorge  2 , Sawsen Salah  1   5 , Aude Quentin  6 , Benedicte Deau  1   2 , Patricia Franchi  1   2 , Marguerite Vignon  1   2 , Laurence Mabille  3 , Charles Nguyen  3 , Yioula Kirova  7 , Pascale Varlet  1   8 , Myriam Edjlali  1   9 , Edouard Dezamis  1   10 , Khê Hoang-Xuan  11 , Carole Soussain  12 , Caroline Houillier  11 , Diane Damotte  1   4 , Johan Pallud  1   10 , Didier Bouscary  1   2 , Jerome Tamburini  1   2
Affiliations

Prognostic value of early 18F-FDG PET scanning evaluation in immunocompetent primary CNS lymphoma patients

Rudy Birsen et al. Oncotarget. .

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.

Keywords: PET scanner; primary CNS lymphoma.

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Conflict of interest statement

CONFLICTS OF INTEREST The author(s) indicated no potential conflicts of interest.

Figures

Figure 1
Figure 1. Survival based on PET2 evaluation
Progression-free survival (PFS, A) and overall survival (OS, B) of the 25 patients who had a PET2 evaluation, based on PET positivity (PET+, n = 6) or negativity (PET–, n = 19).
Figure 2
Figure 2. Response and outcome based on PET2 evaluation
Twenty-five patients had a PET2 evaluation. Nineteen were negative and 6 positive. Correlation to post-C2 (MRI2) and end-of-treatment (MRIe) MRI evaluation is provided. CRu: complete response unconfirmed; PR: partial response; SD: stable disease; PD: progressive disease; NE: not evaluable; CR: complete response; ORR: overall response rate; death*: death from lymphoma-unrelated cause.
Figure 3
Figure 3
Three illustrative cases of PET images showing negative (A) and positive (B) PET2. PETd: PET at diagnosis; PET2: PET after 2 RMT cycles.
See this image and copyright information in PMC

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