Imaging of Early Response to Predict Prognosis in the First-Line Management of Follicular Non-Hodgkin Lymphoma with Iodine-131-Rituximab Radioimmunotherapy

Murali Kesavan, Jan Boucek, William MacDonald, Andrew McQuillan, J. Harvey Turner

Research output: Contribution to journalArticle


The purpose of this study was to evaluate prediction of prognosis after first-line radioimmunotherapy (RIT) of advanced follicular non-Hodgkin lymphoma (FL), by imaging with fluorine-18-fluorodeoxyglucose positron emission tomography with computed tomography (F-18-FDG-PET/CT) three months after induction treatment by Iodine-131-rituximab (I-131-rituximab). Objective response was determined using the Deauville 5-point scale in 68 prospective clinical trial patients. Baseline F-18-FDG-PET/CT studies were used to calculate total-metabolic-tumor-volume (TMTV). Non-imaging studies included the Follicular lymphoma international prognostic index (FLIPI) and absolute baseline monocyte and lymphocyte counts. Patients were monitored for over ten years (median follow-up 59 months), and no patient was lost to follow-up. Complete response (CR) of 88% predicted excellent prognosis with median time-to-next-treatment (TTNT) not yet reached. Those patients (12%) who failed to achieve CR (Deauville 3) on F-18-FDG-PET/CT at three months had significantly poorer outcomes (p <0.0001) with a median TTNT of 41 months. Requirement for re-treatment was predicted by FLIPI and absolute baseline monocyte count but not lymphocyte count. The TTNT was accurately predicted by F-18-FDG-PET/CT Deauville response at three months following first-line therapy of FL with RIT. Early response demonstrated by imaging does, therefore, foretell prognosis in the individual FL patients.

Original languageEnglish
Article number26
Number of pages13
Issue number2
Publication statusPublished - Jun 2017

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