الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 133 |  |  |
| | | from | 133 | | |
Abstract
The aim of this study was to compare between the accuracy of the
visual (Deauville criteria) and SUVmax also to correlate SUVmax with
patients, disease features and outcome including response, PFS and OS.
This prospective study was conducted on seventy-three patients with
biopsy-proven lymphoma (including both HL and NHL). Those patients
were either presented to oncology department at Menoufia University or
the health insurance clinic at Menoufia governorate in the period between
October 2019 and April 2020. And patients were followed up for at least
2 years. An informed consent was obtained before patients entered the
study and from all patients who underwent biopsy.
Inclusion criteria: were patients with untreated histologically proven
high-grade lymphoma (DLBCL) or HD. A baseline PET scan (PET0) was
mandatory with 1 or more evaluable hyper metabolic lesions. All patients
were eligible for high-dose therapy with or without autologous stem cell
Exclusion criteria: any patient with atopic disorders, bad general
conditions, or renal impairment. Those without baseline PET/CT scans
were excluded from the study.
Patient evaluation was done through: Performance status (PS) was
assessed, the international prognostic index was calculated for patients with
DLBCs, and risk stratification was also calculated for patients with HD
using the German Hod Lymphoma Study Group. Patients were
staged using the Ann Arbor system.
Patients with DLBCL received the planned treatment regimen
rituximab in combination with cyclophosphamide, vincristine, doxorubicin,
Summary
98
and hostacortine (R-CHOP). Those with HD received the ABVD regimen,
which included doxorubicin, bleomycin, vinblastine, and dacarbazine.
Patients were followed up for 24 months from the time of diagnosis
and underwent clinical examination every cycle for signs of treatment
toxicity and clinical response.
Baseline PET/CT scanning was performed using FDG-PET at
baseline (PET 0) before initiation of therapy and 21 days after cycle 2
(PET2) and cycle 4 (PET4). G-CSF was stopped 48 hours before PET, as
bone marrow uptake (post-G-CSF) can lead to an apparent decrease in
tumor SUVs.
Statistical analysis of the presenting data revealed:
Significant differences in age, PS and extranodal site involvement were
observed between the studied groups. Stage 4 represented the main
stage in the studied cases.
The histological subtype of the studied cases diagnosed as NHL was
DLBCL and the classic subtype was the main type (86.7%) in patients
diagnosed as HD. Nodular lymphocytic predominant represented only
13.3% in patients with HD.
Significant differences in the results of biopsy between the studied
groups. There were 22 patients who underwent biopsy. Fifteen cases
(34.9%) were diagnosed as NHL while 7 patients (23.3%) diagnosed as
HD. There was one patient who was truly positive and 14 patients who
were false positive. Out of the seven patients diagnosed as HD; four of
them were truly positive and three patients were false positive.
Significant differences in response to treatment were observed between
the studied groups. R-CHOP was the first line of treatment for patients
diagnosed as DLBCL NHL. While ABVD protocol was the first line of
Summary
99
treatment for patients diagnosed as HD. Only 4 patients with nodular
lymphocytic predominant subtypes were treated with R-CHOP. A total
of 62 people (84.9%) reached CR after 2 6 cycles of treatment, while
11 people (15.1 %) were refractory.
After four cycles, 22 patients required a biopsy due to inconclusive
biopsy revealed that PET0-
predictive value, and accuracy (95.45% vs. 54.55%) compared to visual
analysis.
In comparison to Deauville 5 PS, Delta SUV max 0 2 had sensitivity of
50% and specificity of 95. 56.
In comparison to Deauville 5 PS, Delta SUV max 0 4,had sensitivity of
47.62% and specificity 100% .
and patient response to treatment.
Significant relationship was found between the mean SUV uptake value
For
negative scans were compared to those with positive results. There was
significant difference in LDH level, bulky disease, HD stage, B2
microglobulin and biopsy results between the two groups. This
comparison also confirmed the discordance between the results of 5PS
-value = 0.003). 80% of positive
were positive with biopsy. 94% of
were also negative with
biopsy. A significant relationship was observed between the two groups
Summary
100
refractory disease (p-value < 0.0001 ) After 2 cycles, positive Deauville
value ( <0.00). The same was after 4 cycles.
The mean overall survival (OS) was 23.1 months. The median OS did
not reached due to short follow-up time and the small numbers of
deaths as 88.1% of patients were alive at the end of the study. Median
PFS was 16.6 months .At the end of the study only 1.7% did not
develop progression.
There was no significant difference between Patients with positive
PET scans according to Delta SUV max and those with negative scans
regarding overall survival and progression free survival.
Univariate COX regression analysis for the parameters affecting overall
survival was non-significant.
Univariate COX regression analysis for the parameters affecting
progression free survival was non-significant except for type of
lymphoma (NHL) and extra nodal disease.