A recently published study in the British Journal of Haematology has revealed that the preautologous stem-cell transplantation (preASCT) measures, including mean tumor volume (MTV) and maximum standardized uptake value (SUVmax ), seem to be of greater predictive value compared to the degree of response in prognostication for patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) undergoing salvage immunochemotherapy.

The retrospective study investigated the prognostic value of MTV and SUVmax at the presalvage and preASCT time points. A total of 125 eligible patients with R/R DLBCL who underwent high-dose chemotherapy and ASCT between January 1, 2002, and June 30, 2017, at Peter MacCallum Cancer Center and the Royal Melbourne Hospital in Australia, were included in the study.

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The inclusion criteria for patients were that they should be at least 18 years of age and must have received salvage chemotherapy followed by ASCT for histologically proven DLBCL after the failure of at least 1 line of treatment. Multiple parameters, including progression-free survival (PFS), overall survival (OS), and median follow-up, were characterized using the Kaplan–Meier methods.

Study results indicated that 80 of the 125 patients had presalvage positron emission tomography (PET), while 90 patients were found to have preASCT PET. The median follow-up was found to be 5.6 years, with PFS and OS reported to be 52% and 65%, respectively.

Additionally, for patients with PET-positive residual disease following salvage therapy, the preASCT MTV was a significant negative prognosticator for PFS and OS. Similarly, the preASCT SUVmax was negatively associated with OS and PFS. Specifically, no association was reported between PFS or OS with the presalvage MTV and SUVmax and ∆MTV and ∆SUVmax.

“These results suggest a promising role for MTV and SUVmax, as measured on the preASCT PET, in prognostication for patients with R/R DLBCL undergoing salvage immunochemotherapy and ASCT,” the authors highlighted.

Around 30% to 40% of patients with DLBCL do not respond well to current first-line treatment, and therefore, salvage immunochemotherapy followed by ASCT is currently the recommended standard of care for fit patients with R/R DLBCL.

Recent studies on CD19-directed chimeric antigen receptor T cells (CAR-T) have challenged this standard, although the high cost, complexity, and toxicity of CAR-T may limit its use, the researchers noted. The success of high-dose chemotherapy and ASCT requires a partial response to second-line salvage chemotherapy. Still, the optimal threshold for moving to ASCT is not yet known, particularly given the emergence of alternative curative approaches, they added.

Reference

Campbell BA, Brown R, Lambertini A et al. Are dynamic or fixed FDG-PET measures of disease of greater prognostic value in patients with relapsed/refractory diffuse large B-cell lymphoma undergoing autologous haematopoietic stem cell transplantation? Br J Haematol. Published online Apr 4, 2023. doi:10.1111/bjh.18644