Predictive value of interim positron emission tomography in diffuse large B-cell lymphoma: a systematic review and meta-analysis

Coreline N. Burggraaff, Antoinette de Jong, Otto S. Hoekstra, Nikie J. Hoetjes, Rutger A.J. Nievelstein, Elise P. Jansma, Martijn W. Heymans, Henrica C.W. de Vet, Josée M. Zijlstra*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Abstract

Purpose: Diffuse large B-cell lymphoma (DLBCL) represents the most common subtype of non-Hodgkin lymphoma. Most relapses occur in the first 2 years after diagnosis. Early response assessment with 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET) may facilitate early change of treatment, thereby preventing ineffective treatment and unnecessary side effects. We aimed to assess the predictive value of visually-assessed interim 18F-FDG PET on progression-free survival (PFS) or event-free survival (EFS) in DLBCL patients treated with first-line immuno-chemotherapy regimens. Methods: For this systematic review and meta-analysis Pubmed, Embase, and the Cochrane Library were searched until July 11, 2017. Prospective and retrospective studies investigating qualitative interim PET response assessment without treatment adaptation based on the interim PET result were eligible. The primary outcome was two-year PFS or EFS. Prognostic and diagnostic measures were extracted and analysed with pooled hazard ratios and Hierarchical Summary Receiver Operator Characteristic Curves, respectively. Meta-regression was used to study covariate effects. Results: The pooled hazard ratio for 18 studies comprising 2,255 patients was 3.13 (95%CI 2.52–3.89) with a 95% prediction interval of 1.68–5.83. In 19 studies with 2,366 patients, the negative predictive value for progression generally exceeded 80% (64–95), but sensitivity (33–87), specificity (49–94), and positive predictive values (20–74) ranged widely. Conclusions: These findings showed that interim 18F-FDG PET has predictive value in DLBCL patients. However, (subgroup) analyses were limited by lack of information and small sample sizes. Some diagnostic test characteristics were not satisfactory, especially the positive predictive value should be improved, before a successful risk stratified treatment approach can be implemented in clinical practice.

Original languageEnglish
Pages (from-to)65-79
Number of pages15
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume46
Issue number1
DOIs
Publication statusPublished - Jan 2019

Keywords

  • Aggressive non-Hodgkin’s lymphoma
  • Diffuse large B-cell lymphoma
  • Meta-analysis
  • Positron-emission tomography
  • Systematic review
  • Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
  • Predictive Value of Tests
  • Humans
  • Fluorodeoxyglucose F18
  • Radiopharmaceuticals
  • Positron-Emission Tomography/methods
  • Aggressive non-Hodgkin's lymphoma

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