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Abstract
Patients with diffuse large B-cell lymphoma (DLBCL) with a poor prognosis based upon advanced stage and elevated serum lactate dehydrogenase achieve a 3–4-year progression-free survival (PFS) of only 55%. The role of interim fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) to guide use of upfront high dose chemotherapy (HDCT) and autologous stem cell transplant (ASCT) for patients with poor prognosis DLBCL is unproven. A prospective phase II clinical trial was designed to evaluate the outcomes of HDCT/ASCT for patients with poor prognosis DLBCL aged 18–65 years who had unfavorable interim restaging PET scans. Of the 70 eligible patients, 36 had unfavorable and 34 favorable interim PET responses, with 3-year PFS rates of 65.2% and 52.7%, respectively. In conclusion, favorable interim PET response as defined in this study is not associated with improved PFS rates for patients with poor prognosis DLBCL treated with RCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). A phase III trial evaluating this PET-guided approach is not warranted.
Acknowledgements
The authors would like to thank our patients as well as the physicians who participated in this study, including Drs. Christian Fibich and Waleed Sabry, who enrolled and followed a study patient from Saskatoon, and Dr. David Blair Macdonald, Diagnostic Imaging, Ottawa. We also thank Peter Faris, PhD, for biostatistical consultation and sample size calculation.
Potential conflict of interest:
Disclosure forms provided by the authors are available with the full text of this article at www.informahealthcare.com/lal.
The study was financially supported in part by a grant from Hoffman La Roche, Canada (Mississauga, ON), but was independently monitored by Scimega Research Inc., Montreal, QC, Canada. All data were controlled and analyzed by the investigators.