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Follicular Lymphoma Treated with First-Line Immunochemotherapy: A Review of PET/CT in Patients Who Did Not Achieve a Complete Metabolic Response in the GALLIUM Study.

ABSTRACT: Complete metabolic response (CMR) on PET/CT was the sole independent predictor of overall survival in the PET substudy of the phase III GALLIUM trial (NCT01332968) in first-line treatment of high-tumor-burden follicular lymphoma. The aim of this analysis was to further investigate the outcome of patients not achieving CMR. Methods: Two international experts rereviewed PET/CT scans from patients failing to achieve CMR assessed by the Independent Review Committee masked otherwise to committee results. Metabolic response category and Deauville score were assigned. Progression-free survival (PFS) was investigator-assessed with contrast-enhanced CT. Kaplan-Meier methodology was used to estimate landmark PFS and time to next treatment from end of induction by Deauville score. Patients who experienced CT-based progressive disease at the end of induction were excluded. Results: Fifty-four patients were reviewed. Six had CMR, 37 had a partial metabolic response, 2 had no metabolic response, and 9 had progressive metabolic disease. Patients were reassigned to CMR because ¹⁸F-FDG uptake was considered inflammatory (n = 2), was considered incidental neoplasia (n = 2), or was visually close to liver uptake but quantitatively lower (n = 2). There was a trend for shorter PFS and time to next treatment for patients with a Deauville score of 5 than a score of 4. High-grade mesenteric uptake at the end of induction was common, occurring in 20 patients with non-CMR, 14 of whom achieved CMR at all other sites. Only 3 of 14 (21%) patients with mesenteric uptake as the only site of disease experienced progression or death within 24 mo, whereas 4 of 6 patients (67%) with mesenteric and additional sites of ¹⁸F-FDG-avid disease experienced progression or death within 24 mo. All patients with early progression had measurable disease on contrast-enhanced CT at ¹⁸F-FDG-avid sites at the end of induction. Conclusion: After induction immunochemotherapy, CMR was assigned after reassessment in some patients, in whom increased ¹⁸F-FDG uptake was considered due to inflammation or incidental neoplasia rather than to lymphoma. Quantitative assessment to confirm the visual impression of residual uptake in lesions is suggested. Isolated mesenteric ¹⁸F-FDG uptake is likely a common false-positive finding at the end of induction and does not warrant changes in clinical management or disease surveillance unless there is measurable disease on contrast-enhanced CT or clinical suspicion of active disease.

SUBMITTER: Barrington SF

PROVIDER: S-EPMC9364340 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Follicular Lymphoma Treated with First-Line Immunochemotherapy: A Review of PET/CT in Patients Who Did Not Achieve a Complete Metabolic Response in the GALLIUM Study.

Barrington Sally F SF Mir Farheen F El-Galaly Tarec Christoffer TC Knapp Andrea A Nielsen Tina G TG Sahin Denis D Wenger Michael M Kostakoglu Lale L Trotman Judith J Meignan Michel M

Journal of nuclear medicine : official publication, Society of Nuclear Medicine 20211202 8

Complete metabolic response (CMR) on PET/CT was the sole independent predictor of overall survival in the PET substudy of the phase III GALLIUM trial (NCT01332968) in first-line treatment of high-tumor-burden follicular lymphoma. The aim of this analysis was to further investigate the outcome of patients not achieving CMR. <b>Methods:</b> Two international experts rereviewed PET/CT scans from patients failing to achieve CMR assessed by the Independent Review Committee masked otherwise to committ ...[more]

PMID: 34857656

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Project description:ObjectiveTo investigate the predictive value of machine learning-based PET/CT radiomics and clinical risk factors in predicting interim efficacy in patients with follicular lymphoma (FL).MethodsThis study retrospectively analyzed data from 97 patients with FL diagnosed via histopathological examination between July 2012 and November 2023. Lesion segmentation was performed using LIFEx software, and radiomics features were extracted through the uAI Research Portal (uRP) platform, including first-order features, shape features, and texture features. Fourteen filters were applied to the raw images to extract higher-order features from the derived images. Univariate analysis was employed to identify clinical risk factors, and correlation coefficients, MRMR, and LASSO algorithms were used for dimensionality reduction and selection of radiomics features. Finally, a logistic regression machine learning model was developed to predict the interim efficacy of FL using a five-fold cross-validation strategy. Model performance was assessed using the area under the receiver operating characteristic (ROC) curve, accuracy, and the Delong test to compare AUC differences.ResultAmong the 97 patients, 42 (43.30%) achieved complete response (CR) for interim efficacy, while 55 (56.70%) had non-complete response (non-CR). A total of 2264 radiomics features were extracted from the images. Seven clinical risk factors and ten radiomics features associated with interim efficacy were selected to construct the clinical, radiomics, and radiomics-clinical combined models. Among the three logistic regression machine learning models developed, the radiomics-clinical combined model demonstrated the best performance, achieving a mean AUC of 0.849 (95% CI, 0.676-1.000) and an accuracy of 0.795, outperforming the other two models.ConclusionOur preliminary results demonstrate that a radiomics-clinical combined model, based on baseline [18F]FDG PET/CT radiomics features and clinical risk factors, may contribute to predicting interim efficacy in FL patients.

Dataset Information

Follicular Lymphoma Treated with First-Line Immunochemotherapy: A Review of PET/CT in Patients Who Did Not Achieve a Complete Metabolic Response in the GALLIUM Study.

Publications

Follicular Lymphoma Treated with First-Line Immunochemotherapy: A Review of PET/CT in Patients Who Did Not Achieve a Complete Metabolic Response in the GALLIUM Study.

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