Purpose

Treatment strategies of lymphoid malignancies have been revolutionized by immunotherapy. Because of the inherent property of Hodgkin lymphoma and some subtypes of non-Hodgkin lymphoma as a highly FDG-avid tumor, functional ¹⁸F-FDG PET/CT imaging is already embedded in their routine care. Nevertheless, the question is whether it is still valuable in the context of these tumors being treated with immunotherapy. Herein, we will review the value of ¹⁸F-FDG PET/CT imaging lymphoid tumors treated with immunotherapy regimens.

Methods

A comprehensive literature search of the PubMed database was conducted on the value of the ¹⁸F-FDG PET/CT for immunotherapy response monitoring of patients with malignant lymphoma. The articles were considered eligible if they met all of the following inclusion criteria: (a) clinical studies on patients with different types of malignant lymphoma, (b) treatment with anti-CD20 antibodies, immune checkpoint inhibitors or immune cell therapies, (c) and incorporated PET/CT with ¹⁸F-FDG as the PET tracer.

Results

From the initial 1488 papers identified, 91 were ultimately included in our study. In anti-CD20 therapy, the highest pooled hazard ratios (HRs) of baseline, early, and late response monitoring parameters for progression-free survival (PFS) belong to metabolic tumor volume (MTV) (3.19 (95%CI: 2.36–4.30)), maximum standardized uptake value (SUVmax) (3.25 (95%CI: 2.08–5.08)), and Deauville score (DS) (3.73 (95%CI: 2.50–5.56)), respectively. These measurements for overall survival (OS) were MTV (4.39 (95%CI: 2.71–7.08)), DS (3.23 (95%CI: 1.87–5.58)), and DS (3.64 (95%CI: 1.40–9.43)), respectively. Early and late ¹⁸F-FDG PET/CT response assessment in immune checkpoint inhibitors (ICI) and immune cell therapy might be an effective tool for prediction of clinical outcome.

Conclusion

For anti-CD20 therapy of lymphoma, the MTV as a baseline ¹⁸F-FDG PET/CT-derived parameter has the highest HRs for PFS and OS. The DS as visual criteria in early and late response assessment has higher HRs for PFS and OS compared to the international harmonization project (IHP) visual criteria in anti-CD20 therapy. Early changes in ¹⁸F-FDG PET parameters may be predictive of response to ICIs and cell therapy in lymphoma patients.

中文翻译：

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FDG PET/CT 成像在免疫治疗淋巴瘤患者预后预测和反应评估中的价值：一项荟萃分析和系统评价

目的

免疫疗法彻底改变了淋巴恶性肿瘤的治疗策略。由于霍奇金淋巴瘤和非霍奇金淋巴瘤的一些亚型作为高度 FDG 亲和性肿瘤的固有特性，功能性¹⁸ F-FDG PET/CT 成像已经嵌入到他们的常规护理中。然而，问题是它在这些肿瘤接受免疫疗法治疗的背景下是否仍然有价值。在此，我们将回顾¹⁸ F-FDG PET/CT 成像淋巴肿瘤的免疫治疗方案的价值。

方法

^针对18 F-FDG PET/CT 对恶性淋巴瘤患者免疫治疗反应监测的价值，对 PubMed 数据库进行了全面的文献检索。如果文章符合以下所有纳入标准，则认为这些文章符合条件：(a) 对不同类型恶性淋巴瘤患者的临床研究，(b) 使用抗 CD20 抗体、免疫检查点抑制剂或免疫细胞疗法进行治疗，(c)并结合 PET/CT 与¹⁸ F-FDG 作为 PET 示踪剂。

结果

从最初确定的 1488 篇论文中，有 91 篇最终被纳入我们的研究。在抗 CD20 治疗中，无进展生存期 (PFS) 的基线、早期和晚期反应监测参数的最高合并风险比 (HR) 属于代谢肿瘤体积 (MTV) (3.19 (95%CI: 2.36–4.30) ))、最大标准化摄取值 (SUVmax) (3.25 (95%CI: 2.08–5.08)) 和 Deauville 评分 (DS) (3.73 (95%CI: 2.50–5.56))。这些总生存期 (OS) 测量值是 MTV (4.39 (95%CI: 2.71–7.08))、DS (3.23 (95%CI: 1.87–5.58)) 和 DS (3.64 (95%CI: 1.40–9.43) ）， 分别。免疫检查点抑制剂 (ICI) 和免疫细胞治疗的早期和晚期¹⁸ F-FDG PET/CT 反应评估可能是预测临床结果的有效工具。

结论

对于淋巴瘤的抗 CD20 治疗，作为基线¹⁸ F-FDG PET/CT 衍生参数的 MTV 具有最高的 PFS 和 OS HR。与抗 CD20 治疗中的国际协调项目 (IHP) 视觉标准相比，DS 作为早期和晚期反应评估的视觉标准在 PFS 和 OS 方面具有更高的 HR。^18F -FDG PET 参数的早期变化可预测淋巴瘤患者对 ICI 和细胞治疗的反应。