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Diagnostics 2017, 7(2), 26; doi:10.3390/diagnostics7020026

Imaging of Early Response to Predict Prognosis in the First-Line Management of Follicular Non-Hodgkin Lymphoma with Iodine-131-Rituximab Radioimmunotherapy

Departments of Haematology and Nuclear Medicine, The University of Western Australia, School of Medicine, Crawley 6009, Western Australia, Australia
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Author to whom correspondence should be addressed.
Academic Editor: Kalevi Kairemo
Received: 27 February 2017 / Revised: 4 May 2017 / Accepted: 9 May 2017 / Published: 12 May 2017
(This article belongs to the Special Issue Imaging of Early Response in Cancer Management)
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Abstract

The purpose of this study was to evaluate prediction of prognosis after first-line radioimmunotherapy (RIT) of advanced follicular non-Hodgkin lymphoma (FL), by imaging with fluorine-18-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG-PET/CT) three months after induction treatment by Iodine-131-rituximab (131I-rituximab). Objective response was determined using the Deauville 5-point scale in 68 prospective clinical trial patients. Baseline 18F-FDG-PET/CT studies were used to calculate total-metabolic-tumor-volume (TMTV). Non-imaging studies included the Follicular lymphoma international prognostic index (FLIPI) and absolute baseline monocyte and lymphocyte counts. Patients were monitored for over ten years (median follow-up 59 months), and no patient was lost to follow-up. Complete response (CR) of 88% predicted excellent prognosis with median time-to-next-treatment (TTNT) not yet reached. Those patients (12%) who failed to achieve CR (Deauville ≤ 3) on 18F-FDG-PET/CT at three months had significantly poorer outcomes (p < 0.0001) with a median TTNT of 41 months. Requirement for re-treatment was predicted by FLIPI and absolute baseline monocyte count but not lymphocyte count. The TTNT was accurately predicted by 18F-FDG-PET/CT Deauville response at three months following first-line therapy of FL with RIT. Early response demonstrated by imaging does, therefore, foretell prognosis in the individual FL patients. View Full-Text
Keywords: follicular lymphoma; non-Hodgkin lymphoma; outcome prediction; prognosis; radioimmunotherapy and PET imaging follicular lymphoma; non-Hodgkin lymphoma; outcome prediction; prognosis; radioimmunotherapy and PET imaging
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MDPI and ACS Style

Kesavan, M.; Boucek, J.; MacDonald, W.; McQuillan, A.; Turner, J.H. Imaging of Early Response to Predict Prognosis in the First-Line Management of Follicular Non-Hodgkin Lymphoma with Iodine-131-Rituximab Radioimmunotherapy. Diagnostics 2017, 7, 26.

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