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Abstract
Objective: Evaluation of therapeutic response in non-Hodgkin's lymphoma (NHL) patients with autologous stem cell transplantation (ASCT) is of great clinical significance. But the exact role of 18F-fluorodeoxyglucose (FDG) imaging in NHL associated with ASCT is unclear. This study assessed the predictive value of 18F-FDG hybrid PET/CT imaging for the clinical outcome such as progression-free survival (PFS) in patients with NHL prior to and after ASCT.
Methods: 18F-FDG hybrid PET/CT was performed in 31 patients (24 male and 7 female) with pathologically confirmed NHL prior to and after ASCT. Mean age was 43·1±13·8 years. No patients were lost to follow-up earlier than 1 year from ASCT. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 18F-FDG hybrid PET/CT before ASCT were compared to the results after ASCT. The results of pre- and post-ASCT FDG hybrid PET/CT findings were correlated to PFS using Kaplan–Meier survival analysis. Regression analyses were employed to test for independence of established prognostic factors.
Results: Sixteen of 31 patients (52%) progressed/relapsed or died after a median follow-up of 7 months, the remaining 15 patients (48%) were disease free after a median follow-up of 24 months. Both pre- and post-ASCT, 18F-FDG hybrid PET/CT findings showed high PPV, NPV and accuracy (85·7 versus 92·3%, 76·5 versus 77·8% and 80·6 versus 83·9%). Both pre- and post-ASCT, 18F-FDG hybrid PET/CT findings were strongly correlated with PFS (P<0·0005, significant). Of pre- ASCT FDG finding, the 1-year PFS rate for FDG-negative and FDG-positive patients was 88·2 and 28·6%. Of post-ASCT FDG finding, the 1-year PFS rate for FDG-negative patients and FDG-positive patients was 88·9 and 23·1%. The regression model showed that the predictive value of FDG imaging owed its significance to the very high hazard ratio between patients with positive FDG imaging and negative FDG imaging (P<0·005) both pre- and post-ASCT.
Conclusions: 18F-FDG hybrid PET/CT imaging prior to and following autologous stem cell transplantation in NHL contains predictive information on the long-term clinical outcome.