positron emission tomography

Results of the Russian Multi-Center Cooperative Prospective-Retrospective Observational Program for Hodgkin’s Lymphoma Treatment RNWOHG-HD1

AUTOIMMUNE THROMBOCYTOPENIA ,

IS Moiseev1, SM Alekseev2,24, NB Mikhailova1, KD Kaplanov3,21, MV Demchenkova4, LV Anchukova5, VV Baikov1, AM Belyaev2, YuA Vasil’eva6, NP Volkov1, YuN Vinogradova7, AYu Zaritskey8, AE Zdorov9, NV Il’in7, LO Kashintseva10, EV Kondakova1, PV Kotselyabina1, VA Lapin11, KV Lepik1, IV Lesechko12, VM Moiseenko13, GM Manikhas14, NV Medvedeva15, YuA Oleinik2, ES Pavlyuchenko16, KS Parfenova17, EV Patrakova18, AV Proidakov19, DV Saidullaeva20, EV Tarasova21, AL Shipaeva22, TV Shneider23, BV Afanasyev1

1 RM Gorbacheva Scientific Research Institute of Pediatric Oncology, Hematology and Transplantation; IP Pavlov First Saint Petersburg State Medical University, 6/8 L’va Tolstogo str., Saint Petersburg, Russian Federation, 197022

2 NN Petrov National Medical Cancer Research Center, 68 Leningradskaya str., Pesochnyi settlement, Saint Petersburg, Russian Federation, 197758

3 SP Botkin Municipal Clinical Hospital, 5 2-i Botkinskii pr-d, Moscow, Russian Federation, 125284

4 Regional Oncology Dispensary, 32 Frunze str., Irkutsk, Russian Federation, 664035

5 Vologda Regional Clinical Hospital, 17 Lechebnaya str., Vologda, Russian Federation, 160002

6 Pskov Oncology Dispensary, 15a Vokzalnaya str., Pskov, Russian Federation, 180004

7 AM Granov Russian Research Centre for Radiology and Surgical Technologies, 70 Leningradskaya str., Pesochnyi settlement, Saint Petersburg, Russian Federation, 197758

8 VA Almazov National Medical Research Center, 2 Akkuratova str., Saint Petersburg, Russian Federation, 197341

9 VA Baranov Republican Hospital, 3 Pirogova str. (Perevalka district), Petrozavodsk, Republic of Karelia, Russian Federation, 185002

10 Tula Regional Clinical Hospital, 1a Yablochkova str., Tula, Russian Federation, 300053

11 Yaroslavl Regional Clinical Hospital, 7 Yakovlevskaya str., Yaroslavl, Russian Federation, 150062

12 Stavropol Krai Clinical Oncology Dispensary, 182a Oktyabrskaya str., Stavropol, Russian Federation, 355047

13 Saint Petersburg Clinical Applied Research Center for Specialized Types of Medical Care (Oncology), 68A Leningradskaya str., Pesochnyi settlement, Saint Petersburg, Russian Federation, 197758

14 Municipal Clinical Oncology Dispensary, 3/5 2-ya Berezovaya alley, Saint Petersburg, Russian Federation, 197022

15 Municipal Clinical Hospital No. 31, 3 Dinamo pr-t, Saint Petersburg, Russian Federation, 197110

16 EE Eikhvald Clinic, II Mechnikov North-Western State Medical University, 41 bld. 7 Kirochnaya str., Saint Petersburg, Russian Federation, 191123

17 Samara Regional Clinical Oncology Dispensary, 11 Solnechnaya str., Syzran, Russian Federation, 446020

18 Vologda Regional Clinical Hospital No. 2, 15 Danilova str., Cherepovets, Vologda Region, Russian Federation, 162602

19 Komi Republican Oncology Dispensary, 46 Nyuvchimskoe sh., Krasnozatonskii town settlement, Syktyvkar, Republic of Komi, Russian Federation, 167904

20 Tver Regional Oncology Dispensary, 57/37 15 let Oktyabrya str., Tver, Russian Federation, 170008

21 First Republican Clinical Hospital, 57 Votkinskoe sh., Izhevsk, Russian Federation, 426039

22 Volgograd Regional Clinical Oncology Dispensary, 78 Zemlyachki str., Volgograd, Russian Federation, 400138

23 Leningrad Regional Clinical Hospital, 45 bld. 2A Lunacharskogo pr-t, Saint Petersburg, Russian Federation, 194291

24 LD Roman Leningrad Regional Clinical Oncology Dispensary, 2 Zaozernaya str., Kuzmolovskii settlement, Vsevolozhskii district, Leningrad Region, Russian Federation, 188663

For correspondence: Ivan Sergeevich Moiseev, MD, PhD, 6/8 L’va Tolstogo str., Saint Petersburg, Russian Federation, 197022; Tel.: 8(812)338-62-65; e-mail: moisiv@mail.ru

For citation: Moiseev IS, Alekseev SM, Mikhailova NB, et al. Results of the Russian Multi-Center Cooperative Prospective-Retrospective Observational Program for Hodgkin’s Lymphoma Treatment RNWOHG-HD1. Clinical oncohematology. 2021;14(4):455–65. (In Russ).

DOI: 10.21320/2500-2139-2021-14-4-455-465

ABSTRACT

Aim. The observational program was aimed at obtaining data on classical Hodgkin’s lymphoma (cHL) incidence in the Russian Federation, therapy options, and clinical outcomes of treatment. The aim of the prospective part of the program was to standardize the approaches to therapy and to compare its outcomes with off-protocol treatment.

Materials & Methods. The prospective-retrospective observational program for Hodgkin’s lymphoma treatment engaged 32 regional and federal centers. It included 218 patients, 21 out of them were included into the prospective part of the RNWOHG-HD1 (Russian North-West Oncology and Hematology Group — Hodgkin Disease Study 1) program. The median age was 36 years (range 22–87 years). cHL stages I/II were identified in 48 % of patients, III/IV stages were reported in 52 % of patients. The prospective part of the program used escalating protocol in patients with stages I/IIA and without risk factors and de-escalating protocol in patients with advanced stages. Overall (OS) and progression-free (PFS) survivals were analyzed in 160 and 152 patients, respectively. PET-CT was used to assess the response in 33 % of patients.

Results. The study used the following first-line chemotherapy regimens: ABVD in 42 %, BEACOPPst in 11 %, BEACOPP-14 in 17 %, BEACOPPesc in 25 %, and EACOPP in 1 % of cases. After the completion of first-line therapy objective response rate was 91 % including 61 % of complete responses. Response structure did not significantly differ in the groups of non-intensive therapy (ABVD and BEACOPPst), intensified regimens (BEACOPP-14, BEACOPPesc, and EACOPP), and treatment according to the RNWOHG-HD1 protocol (91 %, 92 %, and 96 %, respectively; p = 0.7226). In the total cohort the 3-year OS was 97 % (95% confidence interval [95% CI] 94–99 %), PFS was 87 % (95% CI 80–92 %). The 3-year PFS did not differ in ABVD, BEACOPPst, BEACOPP-14, BEACOPPesc, and RNWOHG-HD1 recipients (p = 0.37). International Prognostic Score (IPS) yielded significant results in PFS prediction for patients with IPS score of 5–6, but not for those with IPS score of 1–4 (p = 0.0028).

Conclusion. The observational program showed that the majority of participating centers use the risk-adapted ABVD/BEACOPPesc approach which explains no difference in PFS being found with the use of these chemotherapy options. The study demonstrated the need for PET-CT to assess the response since the CT alone cannot distinguish between complete and partial responses in a considerable number of patients. The prospective unified program for cHL treatment may well be implemented in the Russian Federation.

Keywords: classical Hodgkin’s lymphoma, multi-center study, ABVD, BEACOPP, positron emission tomography, risk-adapted therapy.

Received: May 25, 2021

Accepted: August 30, 2021

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Статистика Plumx английский

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Primary Bone Lymphomas: 18F-FDG PET and PET-CT as Methods of Diagnosis and Efficacy Estimation of Antitumor Treatment

AUTOIMMUNE THROMBOCYTOPENIA , , ,

AK Smol’yaninova1, ER Moskalets2, GA Yatsyk1, IE Kostina1, AS Bogolyubskaya3, NG Gabeeva1, EG Gemdzhian1, SA Tatarnikova1, DS Badmadzhapova1, EE Zvonkov1

1 National Research Center for Hematology, 4 Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167

2 European Medical Center, 35 Shchepkina str., Moscow, Russian Federation, 129090

3 NI Pirogov Russian National Research Medical University, 1 Ostrovityanova str., Moscow, Russian Federation, 117997

For correspondence: Anna Konstantinovna Smol’yaninova, MD, PhD, 4 Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167; Tel.: +7(926)912-31-16; e-mail: annmo8@mail.ru

For citation: Smol’yaninova AK, Moskalets ER, Yatsyk GA, et al. Primary Bone Lymphomas: 18F-FDG PET and PET-CT as Methods of Diagnosis and Efficacy Estimation of Antitumor Treatment. Clinical oncohematology. 2020;13(1):33–49 (In Russ).

DOI: 10.21320/2500-2139-2020-13-1-33-49

ABSTRACT

Background. Primary bone lymphoma (PBL) is a rare malignant tumor. Initial examination aimed at detecting all primary lesions is an indispensable prerequisite for the choice of optimal antitumor treatment. Standard methods of diagnosis (X-ray, CT, and MRI) are not always adequate to measure the real tumor mass. Another well-known characteristic feature of PBL is a challenge in evaluating the effect of its treatment because of residual changes in the bones of most patients. However, the data on using 18F-FDG PET, another method of metabolic imaging, in PBL are rather rare in accessible literature.

Aim. To study the specific use of PET with 18F-FDG at initial examination and efficacy estimation of PBL treatment.

Materials & Methods. The trial included 21 PBL patients who received PET with 18F-FDG at initial examination and a month after the end of treatment. The results of 18F-FDG PET imaging were compared with the data obtained by means of structural diagnostic methods (CT and MRI) and the analysis of biopsy samples with pathologic lesions.

Results. Intensive uptake of 18F-FDG (SUVmax 8.6–40.1, mean SUVmax 23.5), according to PET data, was reported in all patients in those tumor lesions which were identified by the structural diagnostic methods and confirmed by biopsies. Besides, each of 21 cases showed pathologic infiltration of adjacent soft tissues with high metabolic activity. In PET-CT with 18F-FDG 13 further tumor localizations were revealed in 8 (38 %) patients. On completing the therapy, according to CT and MRI data, residual changes were observed in all (n = 21, 100 %) patients. The residual metabolic activity in the involved bones was identified in 13 (62 %) patients (SUVmax 2.91–8.7, mean SUVmax 4.2). In 4 of them the residual lesions were subjected to biopsy. None of 4 cases was reported to show tumors. Only in 1 out of 13 patients with residual metabolic changes a tumor relapse was detected. Overall 10-year survival in the groups of patients with and without FDG+ residual changes was 91 % and 100 %, respectively, with insignificant differences (p = 0.39).

Conclusion. PET-CT with 18F-FDG is a highly sensitive technique for evaluating the primary lesion volumes in PBL patients. In 100 % of bone and soft tissue lesions an intensive uptake of 18F-FDG was observed. At the same time our study showed persistent metabolic activity on completing antitumor treatment in more than a half of patients, and in most of them it was not caused by tumor. Therefore, in our view, ongoing residual metabolic activity in PBL cannot always be regarded as an indication for continued treatment or consolidation radiotherapy.

Keywords: primary bone lymphoma, survival, positron emission tomography, diagnosis, efficacy estimation of antitumor treatment.

Received: August 2, 2019

Accepted: December 5, 2019

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Effectiveness of the Initial Escalation of Immunochemotherapy in Patients with High Risk MALT-Lymphoma: Pilot Study Results

LYMPHOID TUMORS , , , , ,

AK Smol’yaninova, NG Gabeeva, SA Tatarnikova, AV Belyaeva, AM Kovrigina, EG Gemdzhyan, EE Zvonkov

National Research Center for Hematology, 4 Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167

For correspondence: Anna Konstantinovna Smol’yaninova, MD, PhD, 4 Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167; Tel.: +7(495)612-48-10; e-mail: annmo8@mail.ru.

For citation: Smol’yaninova AK, Gabeeva NG, Tatarnikova SA, et al. Effectiveness of the Initial Escalation of Immunochemotherapy in Patients with High Risk MALT-Lymphoma: Pilot Study Results. Clinical oncohematology. 2018;11(4):338–48.

DOI: 10.21320/2500-2139-2018-11-4-338-348

ABSTRACT

Background. MALT-lymphoma is usually characterized with an indolent course. The factors underlying the effectiveness of the standard chemotherapy in patients with MALT-lymphomas include MALT-IPI risk group and a high SUVmax according to the results of positron emission tomography (PET). All well-known MALT-lymphoma risk factors indirectly indicate a high risk of transformation to large cell lymphoma. The search for an effective chemotherapy continues.

Aim. To evaluate the effectiveness of the R-EPOCH/R-BAC escalated immunochemotherapy for MALT-lymphoma patients with poor prognosis factors.

Materials & Methods. In the period of 2016–2017 the study included 5 female MALT-lymphoma patients (the mean age of 41 years), of which 1 patient had an early relapse after surgery and 4 patients were newly diagnosed. Prior to therapy 4 patients were evaluated with PET. The mean SUVmax was 10.04. According to MALT-IPI 2 patients belonged to a high-risk group and 3 belonged to a middle-risk group. All the patients received R-EPOCH/R-BAC regimen therapy. A month after completing the treatment all the patients were again evaluated with PET.

Results. In 4 patients with 10–24 months follow-up complete remission was reported, which was confirmed by the results of histology and PET. The treatment of 1 patient was not completed. The immunotherapy was well tolerated by the patients. Hematological toxicity grade 3–4 occurred only after completing R-BAC treatment regimens. No severe infectious complications were reported.

Conclusion. MALT-lymphoma patients need to be evaluated in terms of all prognostic factors to identify the high-risk patients for whom escalated therapy is to be used already in the first line treatment. This pilot study of the use of R-EPOCH/R-BAC for treatment of MALT-lymphoma patients with poor prognosis factors yielded positive results and showed its acceptable tolerance.

Keywords: MALT-lymphoma, immunochemotherapy, positron emission tomography, prognosis factors, rituximab, ribomustin, cytarabine.

Received: April 10, 2018

Accepted: August 3, 2018

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Radiotherapy in combined treatment of patients with diffuse large B-cell lymphoma

CLINICAL PRESENTATION, DIAGNOSIS, AND MANAGEMENT OF LYMPHOID MALIGNANCIES , , ,

Yu.N. Vinogradova, N.V. Ilin, D.V. Larionov, M.M. Khodzhibekova, N.A. Kostenikov, and L.I. Korytova

Russian Research Centre for Radiology and Surgical Technologies, RF Ministry of Health, Saint Petersburg, Russian Federation

ABSTRACT

The study included 86 primary patients (age: 18–83) with diffuse large B-cell lymphoma, I to IV stages, who received (R)-CHOP regimen and radiotherapy at the CRIRR (at present RRCRST) over the period 2000–2012. The follow-up period median was 42 months (5–120 months). Positron emission tomography (PET) with 18F-FDG was performed in 45 patients at the various follow-up time-points. In all patients, the changes of hematologic indices were observed using baseline, pre-, and postradiation measurements. After combined treatment completed, remission was achieved in 80 out of 86 (93.0 %) patients, including complete or uncertain complete remission and partial remission in 86.0 % and 7.0 %, respectively. During the initial therapy, disease progression occurred in 6 (7.0 %) patients. After the chemotherapy stage, complete remission was noted in 56 (65.1 %) patients only. Additional radiotherapy promoted the increase in the rate of complete and uncertain complete response by 21.9 %. Disseminated disease relapses developed in 2 out of 80 (2.5 %) patients. The complete response rate in the patients who received radiotherapy using the various fractionation regimens was similar. 5-year overall, relapse-free, and progression–free survival were 89.7 ± 3.9 %, 96.6 ± 2.4 %, and 85.4 ± 4.8 %, respectively. In 20.6 % of the patients examined after chemotherapy, PET gave positive results, while after the radiotherapy stage, all the patients examined at this time-point were PET-negative. Radiotherapy was accompanied by mainly I–II grade hematologic toxicity, and in 16–58 % of patients, no interruption of treatment were required. Neutropenia and thrombocytopenia occurred more frequently at the twice-a-day irradiation.

Keywords: diffuse large B-cell lymphoma, radiotherapy, positron emission tomography, hematologic toxicity.

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