Prognostic value of early 18F-FDG PET scanning evaluation in immunocompetent primary CNS lymphoma patients

// Rudy Birsen 1, 2 , Estelle Blanc 3 , Lise Willems 1, 2 , Barbara Burroni 1, 4 , Marielle Legoff 1, 2 , Emmanuelle Le Ray 1, 2 , Sylvain Pilorge 2 , Sawsen Salah 1, 5 , Aude Quentin 6 , Benedicte Deau 1, 2 , Patricia Franchi 1, 2 , Marguerite Vignon 1, 2 , Laurence Mabille 3 , Charles Nguyen 3 , Yioula Kirova 7 , Pascale Varlet 1, 8 , Myriam Edjlali 1, 9 , Edouard Dezamis 1, 10 , Khe Hoang-Xuan 11 , Carole Soussain 12 , Caroline Houillier 11 , Diane Damotte 1, 4 , Johan Pallud 1, 10 , Didier Bouscary 1, 2 and Jerome Tamburini 1, 2 1 Paris Descartes University, Sorbonne Paris Cite, Paris, France 2 Hematology Department, Cochin Hospital, Assistance Publique–Hopitaux de Paris, Paris, France 3 Department of Nuclear Medicine, Marie Lannelongue Hospital, Le Plessis Robinson, France 4 Pathology Department, Cochin Hospital, Assistance Publique–Hopitaux de Paris, Paris, France 5 Ophtalmology Department, Cochin Hospital, Assistance Publique–Hopitaux de Paris, Paris, France 6 Jean Jaures Hospital, Paris, France 7 Radiotherapy Department, Curie Institute, Paris, France 8 Department of Neuropathology, Sainte-Anne Hospital, Paris, France 9 Department of NeuroImaging, Sainte-Anne Hospital, Paris, France 10 Department of Neurosurgery, Sainte-Anne Hospital, Paris, France 11 Department of Neurology 2-Mazarin, Groupe Hospitalier Pitie-Salpetriere, Assistance Publique–Hopitaux de Paris, Sorbonne Universites UPMC Universites Paris VI, IHU, ICM, Paris, France 12 Hematology Department, Rene Huguenin-Institut Curie Hospital, Saint Cloud, France Correspondence to: Jerome Tamburini, email: jerome.tamburini@aphp.fr Keywords: primary CNS lymphoma; PET scanner Received: December 17, 2017      Accepted: February 25, 2018      Published: March 30, 2018 ABSTRACT Primary central nervous system lymphoma (PCNSL) is a rare topographic variant of diffuse large B-cell lymphoma (DLBCL). While prognostic scales are useful in clinical trials, no dynamic prognostic marker is available in this disease. We report here the prognostic value of early metabolic response by 18F-FDG PET scanner (PET) in 25 newly diagnosed immunocompetent PCNSL patients. Induction treatment consisted of four cycles of Rituximab, Methotrexate and Temozolamide (RMT). Based on patient's general condition, consolidation by high-dose Etoposide and Aracytine was given to responding patients. Brain MRI and PET were performed at diagnosis, after two and four cycles of RMT, and after treatment completion. Two-year progression-free (PFS) and overall survival (OS) were 62% and 74%, respectively for the whole cohort. Best responses after RMT induction were 18 (72%) complete response (CR)/CR undetermined (CRu), 4 (16%) partial response, 1 (4%) progressive disease and 2 (8%) stable disease. Response evaluation was concordant between MRI and PET at the end of induction therapy. Nineteen patients (76%) had a negative PET2. Predictive positive and negative values of PET2 on end-of-treatment (ETR) CR were 66.67% and 94.74%, respectively. We observed a significant association between PET2 negativity and ETR ( p = 0.001) and longer PFS ( p = 0.02), while having no impact on OS ( p = 0.32). Two years PFS was 72% and 33% for PET2– and PET2+ patients, respectively ( p < 0.02). PET2 evaluation may help to early define a subgroup of CR PCNSL patients with a favorable outcome.