中期PET-CT在DLBCL的文献阅读

1. !"#
Prognostic value of interim FDG-PET in DLBCL

2. 文献背景
文献解读
文献讨论

3. 背景：DLBCL的治疗现状
J Hematol Oncol.2020 Dec 14;13(1):175

4. Nat Rev Clin Oncol. 2017,10:631-645
背景：how to improve?
动态危险分层

5. Cell.2019 Jul 25;178(3):699-713.e19.
背景：动态分层 精准施治

6. Cell.2019 Jul 25;178(3):699-713.e19.
背景：动态分层 精准施治

7. 1. Positron Emission Tomography-Directed Therapy for Patients With Limited-Stage Diffuse Large B-Cell Lymphoma:
Results of Intergroup National Clinical Trials Network Study S1001.
2. Prognostic value of interim FDG-PET in diffuse large cell lymphoma: results from the CALGB 50303 Clinical Trial.
3. Dynamic risk assessment based on positron emission tomography scanning in diffuse large B-cell lymphoma: Post-hoc
analysis from the PETAL trial.
4. Interobserver Agreement of Interim and End-of-Treatment 18 F-FDG PET/CT in Diffuse Large B-Cell Lymphoma:
Impact on Clinical Practice and Trials.(HOVON Imaging Working Group)
5. Can the SUVmax-liver-based interpretation improve prognostic accuracy of interim and posttreatment 18F-FDG
PET/CT in patients with diffuse large B-cell lymphoma?
iPET在DLBCL意义的随机对照临床研究（部分）

8. ü iPET Scans in DLBCL : Is It Ready for Prime Time?
Clin Lymphoma Myeloma Leuk.2016;16(12):655-661
ü Δ SUVmax for interim PET in DLBCL: old is new
Blood. 2020;135(25):2202-2203
ü iPET-driven strategy in DLBCL :do we trust the driver?
Blood.2017;129(23):3059-3070
ü The role of PET in the first-line treatment of in DLBCL
Lancet Haematol.2021;8(1):e80-e93
ü Interim PET in lymphoma: from Deauville to Peking criteria. On the road, again…
Leuk Lymphoma.2018;59(3):523-525
iPET在DLBCL意义:专家的疑虑

9. 关于PET结果判断当前认可的标准
ΔSUVmax方法
DS方法

10. 文献背景
文献解读
文献讨论

11. Prognostic value of interim FDG-PET in DLBCL
-Results from the CALGB 50303 Clinical Trial
Blood.2020;135(25):2224-2234.

12. • to identify biomarkers of response by FDG-PET
• to evaluate the use of ΔSUVmax in defining response
研究目的

13. 流程图

14. 入组人群特征

15. 基线SUVmax分布
• median SUVmax :24.3
• Range:5.9-77

16. “Low” = 1 / 2 / 3, “High” = 4 / 5
结果：采用DS方法评判iPET 结果
PFS OS

17. 结果：ΔSUVmax变化与预后的关系

18. 结果：采用ΔSUVmax评判iPET 结果
PFS OS
ü 2yr PFS：62.5% (95% CI: 42.8%– 91.4%) vs. 85.3% (95% CI: 79.4%–91.6%)
ü 2yr OS： 68.8% (95% CI: 49.4%–95.7%) vs. 93.8% (95% CI: 89.8%–98.1%)

19. 结论：
ü In this phase 3 prospective clinical trial, ΔSUV on iPET predicted OS in large cell lymphoma
ü ΔSUV may be an imaging biomarker that can help guide clinical trials using PET response-adapted therapy

20. iPET-CT Guided Therapy of Aggressive Non-Hodgkin Lymphomas
-Results from the PETAL Clinical Trial
J Clin Oncol.2018 Jul 10;36(20):2024-2034

21. PETAL 研究： iPET-CT驱动的治疗策略
J Clin Oncol.2018 Jul 10;36(20):2024-2034

22. 入组人群特征

23. iPET-CT 结果判定：采用DS方法
EFS OS
PETAL 研究： iPET-CT 结果对预后的影响
ü 2yr EFS：65.9% vs. 75.0%
ü 2yr OS： 80.8% vs. 88.1%

24. PETAL 研究： iPET-CT 结果对预后的影响
iPET-CT 结果判定：采用ΔSUVmax方法
EFS OS
ü 2yr EFS：36.7% vs. 75.6%
ü 2yr OS： 59.3% vs. 88.2%

25. ROC曲线对两种判读方法的比较

26. J Clin Oncol.2018 Jul 10;36(20):2024-2034
PETAL 研究： iPET-CT 结果对预后的影响
ü采用ΔSUVmax方法判断iPET-CT 结果优于DS方法
üiPET-CT结果可以预测预后

27. J Nucl Med.2021 Jan;62(1):37-42
iPET evaluation in DLBCL employing published recommendations
- Comparison of the Deauville 5-point scale and the ΔSUVmax method

28. Key points

29. J Clin Oncol.2015;33(23):2523-9
Predictive Value of iPET-CT in Patients With DLBCL Treated With R-CHOP-14
-Results from the SAKK 38/07 Clinical Trial

30. 流程图
R-CHOP-14

31. 结果：采用DS方法评判iPET 结果
ü 2yr EFS：41.4% vs. 75.9%
ü 2yr OS： 93.9% vs. 84.0%

32. 结果：采用ΔSUVmax评判iPET 结果
ü 2yr EFS：42.1% vs. 61.2% (p=NS)
ü 2yr OS： 73.7% vs. 91.3%

33. iPET-CT in DLBCL predicts CR but has limited value in identifying patients
with poor outcome
-final result of a UK National Cancer Research Institute prospective study
Br J Haematol.2021 Feb;192(3):504-513

34. 文献背景
文献解读
文献讨论

35. Prognostic value of iPET in DLBCL？
ü结果异质性的原因？
ü 疾病的异质性？方法抑制性？

36. Eur J Nucl Med Mol Imaging. 2013;40(9):1312-1320.
既往研究的结果
一项国际多中心回顾研究 • 评价iPET对DLBCL预后的意义
• 采用DS评分法与ΔSUVmax方法

37. Eur J Nucl Med Mol Imaging. 2013;40(9):1312-1320.
既往研究的结果
一项国际多中心回顾研究 • 评价iPET对DLBCL预后的意义 • 采用DS评分法与ΔSUVmax方法

38. Prognostic value of iPET in DLBCL？
üiPET 的价值：依然在路上？