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Therapeutic evaluation and prognostic value of interim hybrid PET/CT with 18F-FDG after three to four cycles of chemotherapy in non-Hodgkin's lymphoma

Abstract Purpose: Modern risk-adapted treatment requires accurate assessment of the patient's prognosis. This study assessed the value of hybrid PET/CT with 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) after 3–4 cycles of chemotherapy for early evaluation of response to therapy and prediction of progression-free survival (PFS) in non-Hodgkin's lymphoma (NHL). Methods: Sixty-one consecutive NHL patients (37 male and 24 female) were included. The 18F-FDG hybrid PET/CT scans were performed prior to chemotherapy (initial scan) and after 3–4 cycles of chemotherapy (interim scan). Interim FDG findings were correlated to the PFS using Kaplan–Meier analysis. Regression analyses were employed to test for independence of established pretreatment prognostic factors. Results: After 3–4 cycles of chemotherapy, positive 18F-FDG lesions were found in 28 patients, minimal residual uptake (MRU) in 8 and negative scans in 25 patients. In FDG-positive group, 22 patients showed progress and three died. Nine 18F-FDG-negative patients and 4 patients from the MRU group relapsed. Survival analyses showed highly significant associations between early interim FDG imaging and PFS (P < 0.0005). The 2-year PFS rate for FDG-negative patients was 72.2 and 23.0% for FDG-positive patients. The regression model showed that the predictive value of FDG imaging owed its significance to the very high hazard ratio between patients with positive FDG imaging and patients with negative FDG imaging (P < 0.001). Conclusions: Early interim FDG imaging is an excellent and independent predictor of PFS in NHL. An early assessment of chemotherapy response with FDG scans may provide useful information for selection of patients for alternative therapeutic strategies.