Tomás JF, Dang J, Pro B, Rodriguez MA, McLaughlin P, Romaguera J, Younes A, Hagemeister F, Cabanillas F, Podoloff D, Fayad L

Language: English
References: 47
Page: 5-14
PDF size: 154.91 Kb.

ABSTRACT

Purpose: To evaluate utility of gallium scans as a predictor of survival and response duration in patients with aggressive NHL.
Patients and Methods: From 1992 to 1996, 190 patients with aggressive non-Hodgkin’s lymphoma (NHL) were enrolled in two different anthracyclin-containing treatment protocols. One hundred-sixteen of these patients (61%) had an International Prognostic Score (IPI), of low, and low-intermediate risk; 74 (39%) had high-intermediate and high-risk. All patients had positive gallium scans (Ga67) prior to initiation of chemotherapy, and additional scans were performed after cycles two (n=139), four (n=113), and six (n=24) of chemotherapy. Patients also received radiation to known sites of bulky disease.
Results: Patients whose gallium scan remained positive after two courses of chemotherapy had a median overall survival (OS) of only 23 months compared to a median OS of 107 months for those whose gallium scans turned negative (p=.00434). Similarly, Ga67 positivity after two cycles of chemotherapy was associated with a disease-free survival (DFS) of 6.6 months compared to 106 months for those who had Ga-67 negativity (p=.00279). After four courses of chemotherapy, persistent Ga67- positivity also correlated with a shorter median OS (14.6 months vs. 102.5 months respectively, p=.00092) and a shorter median DFS (6.2 months vs. 90 months respectively, p=.00006). By Cox regression analysis, the result of the gallium scan was independent of the International Prognostic Index (IPI) as a predictor of poor outcomes in aggressive NHL.
Conclusions: Persistent gallium scan positivity after two, four, or six cycles of chemotherapy identifies a group of patients with great tendency for early disease progression and poor overall survival. The effect appears to be independent of IPI. This test targets patients with disease which has intrinsic resistance to their treatment and who may benefit from more aggressive and innovative therapies such as early intensification.

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