Download This Paper
Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.
Interim PET/CT Predicts Response in Pediatric Lymphoma Patients - Report of an IAEA Multicenter Prospective Study
20 Pages Posted: 28 Nov 2018
More...Abstract
Background: PET/CT is well established as method for prognostic stratification in adult Hodgkin (HL) and Non-Hodgkin lymphoma (NHL). In pediatric lymphoma, there is no uniform system of prognostic stratification. This study evaluates the prognosis of interim FDG-PET/CT in HL and NHL pediatric patients in a large multicenter population from low-middle, upper-middle and high income countries.
Methods: Eleven worldwide centers prospectively performed FDG-PET/CT studies on pediatric patients for staging and interim response evaluation. Clinical and PET/CT findings, events, and mortality data were collected. Expert panel performed central review of baseline and interim FDG-PET/CT examinations visually with Lugano classification (LC) and semi-quantitatively (including SUVmax and Delta SUVmax). LC scores of 1, 2, 3 and X were considered negative (LC-); LC scores 4 and 5 were considered positive (LC ). Prognostic analysis compared the 2-y event-free survival (EFS) rate to the PET2 results, and clinical data.
Findings: Whole-body FDG-PET/CT acquisitions were performed in 250 patients (183 males; mean age = 10 ± 4 years; 70% with Hodgkin lymphoma) with clinical stage I-IV represented. There were 9 deaths and 46 events during follow-up and 194 (78%) patients with LC- interim studies. LC studies were significantly and independently associated with increased overall mortality (HR=8.96; p 0.002) and more events (HR 5.80; p<0.001). At multivariate analysis neither Delta SUV nor SUVmax were predictor of events. LC studies were associated with more events in children with HL (HR=9.77; p<0.001) than in NHL (HR 2.41; p=0.10).
Interpretation: LC FDG-PET/CT scan at interim evaluation is an independent predictor of OS and EFS in pediatric lymphoma patients. LC studies are able to independently predict decreased EFS in patients with HL but not patients with NHL.
Funding Statement: IAEA provided funding to investigator institutions from developing countries (Brazil, South Africa, India, Israel, Uruguay, Bangladesh, Pakistan, Philippines) for support of study data management. This research/study/project was funded by IAEA and supported by researchers at the National Institute for Health Research University College London Hospitals Biomedical Research Centre.
Declaration of Interests: No potential conflicts of interest relevant to this article exist.
Ethics Approval Statement: Each center obtained research ethics approval for the study protocol and patient information from local Ethics Review Board. Full informed consent was obtained for all patients with the signed consent forms kept by each institution. To ensure confidentiality while sharing data internationally, all cases were anonymized.
Keywords: PET/CT, Hodgkin Lymphoma, Non-hodgkin Lymphoma, Child, Lugano, Oncology, Tumor Response
Suggested Citation: Suggested Citation