Trotman J, Luminari S, Boussetta S et al.
University of Sydney, Sydney, NSW, Australia.
Lancet Haematol 2014;1:e17–27.
Christopher Fox’s review: Although patients with follicular lymphoma (FL) can typically expect a long survival, significant clinical and biological heterogeneity is recognized. Reliably predicting the outcome for an individual, however, is not straightforward, and patients with a particularly poor outlook are not reliably identified by existing prognostic indices. Positron emission tomography-computed tomography (PET-CT) is a powerful prognostic tool in Hodgkin lymphoma, but fewer data are available on the value of PET-CT for response assessment in FL.
The present analysis applied the 5-point Deauville score to a large cohort of patients with FL, pooled from three prospective cooperative group studies (J Clin Oncol 2011;29:3194–200, J Clin Oncol 2012;30:4317–22, Ann Oncol 2014;25:442–7), to provide a precise correlation between post-induction PET and survival. All of the patients had symptomatic high tumor burden or advanced-stage disease and were treated with rituximab plus chemotherapy, with 15% of the total cohort subsequently receiving rituximab maintenance therapy. A blinded, expert, consensus review of PET-CT scans was undertaken and a Deauville score of 4 (i.e. 18F-fluorodeoxyglucose uptake moderately higher than uptake in the liver) or higher was considered positive.