evidenceforuseofctscanningandpet-ctinmanaging-ukmf.pptVIP

PET-CT normalization before maintenance METABOLIC RESPONSE TO THERAPY Moreau P. et al, ASH 2015 PFS in Arm B: frontline ASCT OS in Arm B: frontline ASCT Adjusted on other prognostic factors p = 0.008 Univariate log-rank, p 0.001 PFS in Arm A: RVD x 8 cycles Adjusted on other prognostic factors p = 0.01 Univariate log-rank, p = 0.01 Adjusted on other prognostic factors p = 0.009 Univariate log-rank, p = 0.027 PET/CT and MFC MRD MONITORING BEFORE MAINTENANCE METABOLIC RESPONSE TO THERAPY Moreau P. et al, ASH 2015 86/134 evaluated by both PET/CT and flow 47,7% both negative p = 0.02 PFS 89,6% 54,5% PET/CT and MFC neg PET/CT and/or MFC pos Caldarella C. et al, Int J Mol Imaging 2012 Study Study design N° pts Treatment PFS OS Cox reg Bartel Blood 2009 P 239 TT3 PET-CR pre ASCT PET-CR pre ASCT Yes Zamagni Blood 2011 P 192 Thal-dex + double ASCT PET SUV post induction and PET-CR post ASCT PET-CR post ASCT Yes Usmani Blood 2013 P 302 TT3 PET FLs (3) day +7 PET FLs (3) day +7 Yes Dimitrakopoulou-Strauss Clin Nucl Med 2009 P 19 CHT SUV during CHT / / Eliott EJH 2011 R 56 Various (CHT, ASCT, novel agents) PET-CR post therapy / / Fonti J Nucl Med 2012 R 47 Novel agents + ASCT in 19 pts MTV post therapy MTV post therapy / Bakanay ASH 2012 R 50 Various + ASCT PET-CR post ASCT / Yes for PFS PROGNOSTIC VALUE OF PET/CT AFTER TREATMENT IMAGING TECHNIQUES AFTER TREATMENT: PET/CT PROS CONS Specificity Earlier post-therapy changes Prognostic significance in CR patients (MRD monitoring) Good correlation with biochemical response Lack of standardization Applicability in 75% of the patients Availability, cost Zamagni E. et al, BJH 2012 Hillengass J. et al, Leuk and Lymphoma 2013 Mesguich C et al, EJR 2014 IMAGING TECHNIQUES AFTER TREATMENT OPEN ISSUES Do we need the same imaging technique at baseline and after treatment to evaluate metabolic response? Is the persistence of ?severe? positive imaging findings during treatment allowing to change therapy and do we need to