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Pet And Lymphoma
- 1. Corinne Haioun Unité Hémopathies Lymphoides Hôpital Henri Mondor Créteil, France PET and Lymphoma
- 4. HD prognostic score: clinical variables Hasenclever d. NEJM 1998; 339:1506
- 5. HD prognostic score: 7y-FFP and OS Hasenclever d. NEJM 1988; 339:1506 7% of the patients
- 7. PET-0: 25.03.04 PET-2: 30.06.04 PET-6: 08.11.04 Gallamini: Hematologica 2006; 91, 475-81 Gallamini: JCO 2007; 25, 3743-52 Hutchings: Blood 2006; 107, 52-59 Kostakoglu: Cancer 2006; 107:2678-87
- 8. H10 Trial Randomisation Favourable Group F Unfavourable Group U Randomisation ABVD 2 cycles ABVD 2 cycles ABVD 2 cycles ABVD 2 cycles FDG- PET FDG- PET FDG- PET ABVD 2 cycles BEACOPP 2 cycles esca IN-RT 30 Gy (+ boost 6 Gy) ABVD 4 cycles 2 cycles BEACOPP esca IN-RT 30 Gy (+ boost 6 Gy) ABVD 2 cycles IN-RT 30 Gy (+boost 6 Gy résiduels) négative positive negative positive The results whatever The results Second registration First registration Hodgkin Lymphoma Stage I/II FDG- PET 1 cycle ABVD IN-RT 30 Gy (+boost 6 Gy résiduals) whatever
- 9. The situation in Diffuse Large B-Cell Lymphoma Weber W: J.Nucl. Med 2007: 48: 1580-82.
- 12. Early treatment evaluation Before treatment At 2 cycles At 4 cycles FDG-PET2 (+) Haioun C, et al. Blood 2005; 106(4): 1376–81
- 13. Early treatment evaluation FDG-PET2 (-) Before treatment At 2 cycles At 4 cycles Haioun C, et al. Blood 2005; 106(4): 1376–81
- 14. Current questions for DLBCL patients Jerusalem et al. Haematologica, 85(6): 613-8 2000; Spaepen et al. Ann Oncol, 13(9): 1356-63 2002; Kostakoglu et al. J Nucl Med, 43(8): 1018-27 2002; Haioun C et al. Blood 2005; 106(4): 1376–81; Mickaeel et al. 2005 Role of PET to individualize treatment ? 2-year outcome Study n PET after . . . PET- PET+ Jerusalem 2000 28 median: 3 cycles 62% (PFS) 0% (PFS) Spaepen 2002 70 median: 3 cycles 85% (PFS) 4% (PFS) Kostakoglu 2002 30 1 cycle 85% (PFS) <15% (PFS) Haioun 2005 90 2 cycles 82% (EFS) 43% (EFS) Michaël 2005 121 median: 2 cycles 87% (PFS) 34% (PFS)
- 15. (High negative predictive value): NPV= TN TN +FN (Low positive predictive value): PPV= TP TP +FP FN FP FDG-PET in DLBCL
- 16. Event-free survival and overall survival according to response at 2 cycles on the basis of PET (n = 90) PET– (n = 54) PET+ (n = 36) Probability of EFS p < 0.0001 Years after randomisation Event-free survival p = 0.006 median f/u: 2 years Overall survival 100 100 0 1 2 3 0 1 2 3 Years after randomisation probability of OS 80 60 40 20 0 80 60 40 20 0 Haioun C, et al. Blood 2005; 106(4): 1376–81 PET– (n = 54) PET+ (n = 36) PPV 50 % NPV 74 % Accuracy 68.5%
- 17. =1g/cm 3 (Bq/g) Activité injectée Poids du corps C* totale = (Bq/g) Activité mesurée Volume du foyer C* tissulaire = C* tissulaire C* totale SUV = Si distribution homogène, SUV = 1 SUV= Ci*( ) dose/poids
- 19. SUV-based Assessment versus Visual Analysis SUV and EFS : Optimal cut-off point of SUVmax reduction: 65.7% (ROC analysis) Lin C, Itti E. JNM 2007; 48:1626-32. PPV 81.3% NPV 75.0% Accuracy 76.1%
- 20. Visual Analysis versus SUV-based Assessment Months After Randomization > 65.7% 65.7% SUV max Reduction P < .0001 Probability of EFS (%) Visual Analysis PET (-) PET (+) P = .009 n=34 n=58 n=76 n=16 Linh C, Itti E. JNM 2007; 48:1626-32.
- 22. Moskowitz et al., Blood 108: Abstract 532, 2006 MSKCC 01-142-DLBCL: Risk Adapted Therapy Transplant-eligible, CS IIX, III or IV age-adjusted IPI 1, 2, or 3 Risk Factors