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Am J Nucl Med Mol Imaging 2013;3(3):272-281
Original Article
Baseline total lesion glycolysis measured with 18F-FDG PET/CT as a predictor of
progression-free survival in diffuse large B-cell lymphoma: a pilot study
Shadi A Esfahani, Pedram Heidari, Elkan F Halpern, Ephraim P Hochberg, Edwin L Palmer, Umar Mahmood
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA;
Department of Hematology and Oncology, Massachusetts General Hospital, Boston, MA. Equal contribution.
Received January 28, 2013; Accepted February 22, 2013; Epub April 9, 2013; Published April 15, 2013
Abstract: This pilot study investigates the value of baseline total lesion glycolysis (TLG) in 18F-FDG PET/CT scans for prediction of
progres-sion-free survival (PFS) in patients with Diffuse Large B-Cell Lymphoma (DLBCL). We also evaluate the role of other
quantitative parameters measured at baseline and interim PET/CT for prediction of PFS. A retrospective review (2003-2010) of
patients with DLBCL who underwent 18F-FDG PET/CT before, after cycle two, and after completion of R-CHOP treatment, identified
84 patients. Twenty patients fulfilled the inclu-sion criteria. Standardized uptake values (SUVmax and SUVmean), total metabolic
tumor volume (TMTV), and TLG were measured in baseline and interim PET/CT. Relationship between quantitative parameters and
PFS was statistically analyzed using Log-rank test and univariate Cox-regression analysis. Of 20 patients (F/M: 7/13, range: 20-73
years), six patients (30%) developed recurrence after chemotherapy (mean follow-up: 51.35±17.05 months, range: 12-81 months).
Results of statistical analysis showed TLG as the only discriminator of recurrence at baseline (cut-point: 704.77 g, HR: 11.21, CI:
1.29-97, P=0.02). Among the interim PET/CT parameters, SUVmean (cut -point: 2.07, HR: 6.31, CI: 1.25-31.61), SUVmax (cut-point:
2.3, HR: 6.31, CI: 1.25-31.61), and TLG (cut-point: 96.5 g, HR: 6.38, CI: 1.29 - 31.61) could all help predict PFS (P<0.05). Although not
routinely reported, high baseline TLG may be a useful index to identify patients with DLBCL who are at increased risk for relapse after
conventional R-CHOP. If confirmed in larger prospective studies, this may allow the selection of alternate therapeutic choices at the
onset of treatment. (ajnmmi1301006).
Keywords: Diffuse large B-cell lymphoma, 18F-FDG PET/CT, progression-free survival, quantitative parameters
Address correspondence to: Dr. Umar Mahmood, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology,
Massachu-setts General Hospital, 55 Fruit Street, White 427, Boston, MA 02114. Fax: 617-726-6165; Phone: 617-726-6477; E-mail:
umahmood@mgh.harvard.edu
Original Article
Baseline total lesion glycolysis measured with 18F-FDG PET/CT as a predictor of
progression-free survival in diffuse large B-cell lymphoma: a pilot study
Shadi A Esfahani, Pedram Heidari, Elkan F Halpern, Ephraim P Hochberg, Edwin L Palmer, Umar Mahmood
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA;
Department of Hematology and Oncology, Massachusetts General Hospital, Boston, MA. Equal contribution.
Received January 28, 2013; Accepted February 22, 2013; Epub April 9, 2013; Published April 15, 2013
Abstract: This pilot study investigates the value of baseline total lesion glycolysis (TLG) in 18F-FDG PET/CT scans for prediction of
progres-sion-free survival (PFS) in patients with Diffuse Large B-Cell Lymphoma (DLBCL). We also evaluate the role of other
quantitative parameters measured at baseline and interim PET/CT for prediction of PFS. A retrospective review (2003-2010) of
patients with DLBCL who underwent 18F-FDG PET/CT before, after cycle two, and after completion of R-CHOP treatment, identified
84 patients. Twenty patients fulfilled the inclu-sion criteria. Standardized uptake values (SUVmax and SUVmean), total metabolic
tumor volume (TMTV), and TLG were measured in baseline and interim PET/CT. Relationship between quantitative parameters and
PFS was statistically analyzed using Log-rank test and univariate Cox-regression analysis. Of 20 patients (F/M: 7/13, range: 20-73
years), six patients (30%) developed recurrence after chemotherapy (mean follow-up: 51.35±17.05 months, range: 12-81 months).
Results of statistical analysis showed TLG as the only discriminator of recurrence at baseline (cut-point: 704.77 g, HR: 11.21, CI:
1.29-97, P=0.02). Among the interim PET/CT parameters, SUVmean (cut -point: 2.07, HR: 6.31, CI: 1.25-31.61), SUVmax (cut-point:
2.3, HR: 6.31, CI: 1.25-31.61), and TLG (cut-point: 96.5 g, HR: 6.38, CI: 1.29 - 31.61) could all help predict PFS (P<0.05). Although not
routinely reported, high baseline TLG may be a useful index to identify patients with DLBCL who are at increased risk for relapse after
conventional R-CHOP. If confirmed in larger prospective studies, this may allow the selection of alternate therapeutic choices at the
onset of treatment. (ajnmmi1301006).
Keywords: Diffuse large B-cell lymphoma, 18F-FDG PET/CT, progression-free survival, quantitative parameters
Address correspondence to: Dr. Umar Mahmood, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology,
Massachu-setts General Hospital, 55 Fruit Street, White 427, Boston, MA 02114. Fax: 617-726-6165; Phone: 617-726-6477; E-mail:
umahmood@mgh.harvard.edu
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