Validation of the ΔSUVmax for Interim PET Interpretation in Diffuse Large B-Cell Lymphoma on the Basis of the GAINED Clinical Trial

Emmanuel Itti; Paul Blanc-Durand; Alina Berriolo-Riedinger; Salim Kanoun; Françoise Kraeber-Bodéré; Michel Meignan; Elodie Gat; Steven Le Gouill; René-Olivier Casasnovas; Caroline Bodet-Milin

doi:10.2967/jnumed.123.265871

Validation of the ΔSUV_max for Interim PET Interpretation in Diffuse Large B-Cell Lymphoma on the Basis of the GAINED Clinical Trial

J Nucl Med. 2023 Nov;64(11):1706-1711. doi: 10.2967/jnumed.123.265871. Epub 2023 Sep 21.

Affiliations

¹ Nuclear Medicine, CHU Henri Mondor, Paris-Est University, Créteil, France; emmanuel.itti@aphp.fr.
² Nuclear Medicine, CHU Henri Mondor, Paris-Est University, Créteil, France.
³ Nuclear Medicine, Georges-François Leclerc Center, Dijon, France.
⁴ Nantes University, Angers University, CHU Nantes, INSERM, CNRS, CRCI2NA, Nantes, France.
⁵ Lymphoma Study Association Recherche Clinique (LYSARC), Pierre-Bénite, France.
⁶ Hematology, CHU de Nantes, Nantes, France; and.
⁷ Hematology, CHU Dijon Bourgogne, Dijon, France.

PMID: 37734837
DOI: 10.2967/jnumed.123.265871

Abstract

The GAINED phase 3 trial (ClinicalTrials.gov identifier: NCT01659099) evaluated a PET-driven consolidative strategy in patients with diffuse large B-cell lymphoma. In this post hoc analysis, we aimed to compare the prognostic value of the per-protocol PET interpretation criteria (Menton 2011 consensus) with the change in the SUV_max (ΔSUV_max) alone. Methods: Real-time central review of ¹⁸F-FDG PET/CT was performed in 581 patients after 2 cycles (PET2) and 4 cycles (PET4) of immunochemotherapy using the Menton 2011 criteria, combining the ΔSUV_max (cutoffs of 66% and 70% at PET2 and PET4, respectively) and the Deauville scale. In "special cases," when the baseline SUV_max was less than 10.0 or the interim residual tumor SUV_max was greater than 5.0, the Menton 2011 experts' consensus agreed that the ΔSUV_max may not be reliable and that the Deauville score is preferable. Prognostic values of Menton 2011 and ΔSUV_max were evaluated by Kaplan-Meier analyses in terms of progression-free survival (PFS). Results: Seventeen percent of patients at PET2 (100/581) and 8% at PET4 (49/581) had PET-negative results by ΔSUV_max but were considered to have PET-positive results according to Menton 2011 with residual SUV_max of greater than 5.0. For the population with PET2-positive results, 2-y PFS was 70% (range, 58%-80%) with ΔSUV_max alone, whereas the outcome tended to be better for those who were considered to have PET-positive results by Menton 2011, 81% (range, 72%-87%). Conversely, all 10 patients with baseline SUV_max of less than 10.0 had PET2-positive results by ΔSUV_max but were considered to have PET2-negative results by Menton 2011. These patients had the same 2-y PFS as patients with PET2-negative/PET4-negative results, indicating that the ΔSUV_max yielded false-positive results in this situation. Conclusion: We recommend the use of the ΔSUV_max alone rather than the Menton 2011 criteria for assessing the interim metabolic response in patients with diffuse large B-cell lymphoma, except when the baseline SUV_max is less than 10.0.

Keywords: Deauville scale; central review; diffuse large B-cell lymphoma; interim 18F-FDG PET; ΔSUVmax.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Fluorodeoxyglucose F18 / therapeutic use
Humans
Lymphoma, Large B-Cell, Diffuse* / diagnostic imaging
Lymphoma, Large B-Cell, Diffuse* / drug therapy
Positron Emission Tomography Computed Tomography* / methods
Positron-Emission Tomography / methods
Prognosis

Substances

Fluorodeoxyglucose F18

Associated data

ClinicalTrials.gov/NCT01659099