Application of interim PET-CT in first-line treatment decision-making for lymphoma

Abstract

Recent advances in lymphoma treatment have significantly improved the survival of patients; however, the current approaches also have varying side effects. To overcome these, it is critical to implement individualized treatment according to the patient's condition. Therefore, the early identification of high-risk groups and targeted treatment are important strategies for prolonging the survival time and improving the quality of life of patients. Interim positron emission tomography-computed tomography (PET-CT) has a high prognostic value, which can reflect chemosensitivity and identify patients for whom treatment may fail under this regimen. To date, many prospective clinical studies on interim PET (iPET)‍-adapted therapy have been conducted. In this review, we focus on the treatment strategies entailed in these studies, as well as the means and timing of iPET assessment, with the aim of exploring the efficacy and existing issues regarding iPET-adapted treatment. It is expected that the improved use of PET-CT examination can facilitate treatment decision-making to identify precise treatment options.

Keywords: Interim PET (iPET)‍-adapted therapy; Lymphoma; Positron emission tomography-computed tomography (PET-CT).

Fig. 1. Therapies based on iPET in early-stage Hodgkin's lymphoma. PET-CT: positron emission tomography-computed tomography; iPET: interim PET; ABVD: doxorubicin, bleomycin, vinblastine, and dacarbazine; NFT: no further treatment; RT: radiotherapy; IFRT: involved field radiation therapy; U: unfavorable cohort; F: favorable cohort; INRT: involved node radiation therapy; BEACOPP: bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone; eBEACOPP: escalated BEACOPP; PR: partial response; SD: stable disease; PD: progression disease.

Fig. 2. Therapies based on iPET in advanced-stage Hodgkin's lymphoma. PET-CT: positron emission tomography-computed tomography; iPET: interim PET; ABVD: doxorubicin, bleomycin, vinblastine, and dacarbazine; BEACOPP: bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone; eBEACOPP: escalated BEACOPP; BEACOPP-14: an accelerated version of BEACOPP that involves growth-factor support; R-eBEACOPP: eBEACOPP combined with rituximab; AVD: doxorubicin, vinblastine, and dacarbazine; RT: radiotherapy; NFT: no further treatment; VABEM: vindesine, doxorubicin, carmustine, etoposide, and methylprednisolone.

Fig. 3. Therapies based on iPET in non-Hodgkin's lymphoma (NHL). PET-CT: positron emission tomography-computed tomography; iPET: interim PET; CHOP: cyclophosphamide, doxorubicin, vincristine, and prednisone; R: rituximab; O: opdivo; IFRT: involved field radiation therapy; ICE: ifosfamide, carboplatin, and etoposide; HDT: high-dose therapy; ASCT: autologous stem cell transplantation; CD20⁺: cluster of differentiation 20-positive; IPI: international prognostic index; aaIPI: age-adjusted IPI; ACVBP: doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone; MTX: methotrexate; BEAM: carmustine, etoposide, cytarabine, and melphalan; VP: etoposide; IFO: ifosfamide; Arac: cytarabine; LDH: lactate dehydrogenase; β2-MG: β2-microglobulin; IFE: ifosfamide and etoposide; R-megaCHOP: rituximab 375 mg/m² on Day 1, cyclophosphamide 1500 mg/m² on Day 1, doxorubicin 65 mg/m² on Day 1, vincristine 1.4 mg/m² on Day 1, and prednisone 60 mg/m² on Days 1‍–‍5; RT: radiotherapy; Burkitt: the Burkitt protocol consisting of high-dose methotrexate, cytarabine, hyperfractionated cyclophosphamide and ifosfamide, split-dose doxorubicin and etoposide, vincristine, vindesine, and dexamethasone.