Article Dans Une Revue Blood Advances Année : 2025

Interim PET after 4 Cycles Predicts Outcome in Histomolecularly Confirmed Primary Mediastinal B-Cell Lymphoma

1 CLCC Henri Becquerel - Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen
2 Hôpital Necker - Enfants Malades [AP-HP]
3 Centre Hospitalier Universitaire [Rennes]
4 CHU Henri Mondor [Créteil]
5 CRCT - Centre de Recherches en Cancérologie de Toulouse
6 CHU Amiens-Picardie
7 Institut Curie [Paris]
8 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
9 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
10 IUCT Oncopole - UMR 1037 - Institut Universitaire du Cancer de Toulouse - Oncopole
11 Hôpital Claude Huriez [Lille]
12 IGR - Institut Gustave Roussy
13 MOBIDIC - Microenvironment and B-cells: Immunopathology, Cell Differentiation, and Cancer
14 AP-HP - Hopital Saint-Louis [AP-HP]
15 CHD Vendée - Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon
16 CHUGA - CHU de Grenoble-Alpes - Centre Hospitalier Universitaire CHU Grenoble
17 CHU Pessac
18 Service de médecine nucléaire [CHU Caen]
19 ICANS - Institut de Cancérologie de Strasbourg Europe
20 IPC - Institut Paoli-Calmettes
21 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
22 NGERE - Nutrition-Génétique et Exposition aux Risques Environnementaux
23 CHU Montpellier = Montpellier University Hospital
24 IGMM - Institut de Génétique Moléculaire de Montpellier
25 CHU-Liège - Centre Hospitalier Universitaire de Liège
26 UCLouvain - Université Catholique de Louvain = Catholic University of Louvain
27 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
28 IFR105 - IUH - IFR de Saint-Louis - Institut universitaire d'hématologie
29 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
30 LYSARC - The Lymphoma Academic Research Organisation [Lyon]
Paul Blanc-Durand
Amine Moslemi
  • Fonction : Auteur
  • PersonId : 1513561
  • IdRef : 259349054
Steven Le Gouill
Franck Morschhauser
Vincent Ribrag
Krimo Bouabdallah
Corinne Haioun
Robin Noel
David Sibon
Emmanuel Itti

Résumé

The GAINED study (NCT01659099) was a randomized phase 3 trial comparing obinutuzumab (G) to rituximab (R) plus ACVBP or CHOP14 induction, followed by PET-guided consolidation. This post-hoc analysis aimed to detail the outcomes of primary mediastinal B-cell lymphoma (PMBL) patients, verified through expert pathological review and the use of gene-expression profiling (GEP) and Next-Generation sequencing. Of the centrally reviewed 620 patients, 138 (22.3%) confirmed PMBL cases were analyzed. Baseline characteristics included a median age of 33.5 years, 63.8% female, 55.1% stage III-IV, 90.6% elevated LDH, 87.6% ECOG 0-1, 62.3% extranodal involvement, 52.6% aaIPI 2-3, and 53.6% Bulk (>10cm). Induction regimens were R/G-CHOP14 (56.9%) and R/G-ACVBP (43.1%). Post-induction treatments, based on interim PET (iPET) results, included: standard consolidation chemotherapy (59.8%) if ΔSUVmax >66% after cycle 2 and >70% after cycle 4 (PET2−/4−), intensive treatment and autologous transplantation (26.8%) if PET2+/4-, and salvage therapy (13.4%) if PET4+ (ΔSUVmax ≤70%). Among patients with GEP data (n=107), 38 (35.5%) were PDL1high/PDL2high. Key somatic mutations data (n=87) included SOCS1 (70.1%), B2M (56.3%), STAT6 (49.4%), TNFAIP3 (47.1%), GNA13 (39.1%), CIITA (37.9%), CD58 (36.8%), and TP53 (29.9%). After a median follow-up of 39.5 months, 2-year PFS and OS rates were 86.2% and 93.2%, respectively. In a multivariate model including Bulk, aaIPI, and ΔSUVmax PET2/PET4, only Bulk and ΔSUVmax PET4 ≤70% were associated with shorter PFS (HR 4.39 [1.28-15.11] and 4.95 [1.71-14.3], respectively), while none were associated with OS. The ΔSUVmax-based interim PET4 response emerged as the strongest predictor of patient outcomes in this selected clinical trial population.Clinical trial registration information (if any): NCT01659099

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hal-04982054 , version 1 (05-11-2025)

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Vincent Camus, Thierry Molina, Fabienne Desmots-Loyer, Paul Blanc-Durand, Salim Kanoun, et al.. Interim PET after 4 Cycles Predicts Outcome in Histomolecularly Confirmed Primary Mediastinal B-Cell Lymphoma. Blood Advances, 2025, 9 (9), pp.2232-2246. ⟨10.1182/bloodadvances.2024015577⟩. ⟨hal-04982054⟩
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