The combined evaluation of interim contrast-enhanced computerized tomography (CT) and FDG-PET/CT predicts the clinical outcomes and may impact on the therapeutic plans in patients with aggressive non-Hodgkin's lymphoma

We investigated the concomitant interim response of patients with aggressive non-Hodgkin's lymphoma (NHL) using multi-detector row computerized tomography (CT) and F-18-fluoro-2-deoxy-d-glucose-positron emission tomography (PET)/CT for prediction of clinical outcomes. One hundred six newly diagnosed patients with aggressive NHL were enrolled. Both the CT and PET/CT were serially performed at the time of diagnosis and after three to four cycles of chemotherapy (interim). The patients were categorized into four different responsive groups according to the interim PET/CT and CT: (1) complete metabolic response (CMR)-complete response unconfirmed (CRu), (2) CMR-partial response (PR), (3) partial metabolic response (PMR)-Cru, and (4) PMR-PR. Fifty-five patients with CMR-CRu, 20 patients with CMR-PR, seven patients with PMR-Cru, and 23 patients with PMR-PR were distributed. In addition, one patient experienced a disease progression. There was a significant difference in relapse rates between PET/CT-positive (67.3%) and PET/CT-negative patients (17.3%; P < 0.01). Also, there was a significant difference between patients with PMR-PR (32.0% and 26.1%) and CMR-CRu (89.3% and 80.0%) for 3-year overall survival (OS) and event-free survival (EFS), respectively. A multivariate analysis revealed that high international prognostic index (a parts per thousand yen3) at diagnosis, T-cell phenotype, and PMR-PR in interim PET/CT and CT were independent prognostic significances for OS. Moreover, bulky disease (> 10 cm), T-cell phenotype, and PMR-PR showed significant associations for EFS. PMR-PR in interim response was the predictive prognostic determinant for both OS and EFS, with a hazard ratio of 3.93 (1.61-9.60) and 3.60 (1.62-7.98), respectively. The combined evaluation of interim PET/CT and CT was found to be a significant predictor of disease progression, OS, and EFS.