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Can pre-transplant 18F-choline positron emission tomography predict relapse following autologous stem cell transplantation in primary central nervous system lymphoma?

Bone Marrow Transplantation volume 57, pages 113–115 (2022)Cite this article

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Primary central nervous system lymphoma (PCNSL) is a rare and devastating disease, with overall survival of ~3 years [1], for which there is a clinical need for advances in treatment and imaging. First line treatment for patients fit enough for high-dose chemotherapy is to utilise intensive methotrexate-based immunochemotherapy, with the MATRix regimen recommended as first line remission induction therapy in the UK [2]. Optimal consolidation therapy depends upon the patient’s performance status and comorbidities, but in responding transplant eligible patients, consolidation is with thiotepa-based-conditioned autologous stem cell transplant (ASCT), while transplant ineligible patients are recommended to undergo whole brain radiotherapy (WBRT).

The advantage of ASCT is that it avoids the significant risk of neurocognitive morbidity following WBRT [3]. In further support of its use, ASCT has comparable outcomes in terms of overall survival [4]. Of concern though is a lack of prognostic tools in PCNSL prior to transplant, in particular methods to predict early post-transplant relapse. In classic Hodgkin lymphoma (cHL), and systemic diffuse large B-cell lymphoma (DLBCL), 2-deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography (PET) has been found to have prognostic value for this purpose [5, 6]. If a patient with cHL is FDG-PET positive they would not proceed to ASCT as short interval relapse would be expected. In this case in cHL alternative salvage chemotherapy prior to stem cell transplant would be administered, with the aim of achieving metabolic complete response (mCR) before proceeding where possible.

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Fig. 1: MRI images at diagnosis and pre-ASCT, along with the FCH-PET pre-ASCT images, from three cases.

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Acknowledgements

The authors acknowledge research support for manuscript preparation by Ms Hannah Holmes, The Royal Marsden Hospital, and NHS National Institute of Health and Research (NIHR) funding to the Royal Marsden Hospital NHS Trust Biomedical Research Centre (BRC). This work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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  1. The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK

    Thomas Millard, Fatin Sammour, Chloe Anthias, Sandra Easdale, Carlos Gonzalez-Arias, Mark Ethell, Mike Potter, Sunil Iyengar, Dima El-Sharkawi, Ayoma D. Attygalle, Ian Chau, David Cunningham, Emma Nicholson & Bhupinder Sharma

  2. The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK

    Chloe Anthias, Sunil Iyengar, Dima El-Sharkawi, Ian Chau, David Cunningham & Bhupinder Sharma

  3. Anthony Nolan Research Institute, London, UK

    Chloe Anthias

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Contributions

TM, FS, EN and BS wrote the draft of the manuscript. TM, FS, EN and BS collated the data. BS provided the radiology images. All authors contributed to design, review and redrafting of the manuscript.

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Correspondence to Bhupinder Sharma.

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Competing interests

EN: KITE/Gilead—advisory board, conference fees support, speaker fees. Novartis—advisory board, conference fees support. BMS/Celgene—Ad Board. Pfizer—Ad board. DE-S: Honoraria—Abbvie, AstraZeneca, Janssen, Roche and Takeda. Conference/Travel support—Abbvie and Novartis. Ad boards: Abbvie, ASTEX, AstraZeneca, Beigene, Janssen and Kyowa Kiirin. IC: Advisory Board—Eli-Lilly, Bristol Meyers Squibb, MSD, Bayer, Roche, Merck-Serono, Five Prime Therapeutics, Astra-Zeneca, OncXerna, Pierre Fabre, Boehringer Ingelheim and Incyte. Research funding: Eli-Lilly, Janssen-Cilag and Sanofi Oncology. Honorarium: Eli-Lilly. DC: MedImmune /AZ, Clovis, Eli-Lilly, 4SC, Bayr, Celgene, NIHR EME, Leap and Roche, and participated on the advisory board for OVIBIO.

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Millard, T., Sammour, F., Anthias, C. et al. Can pre-transplant 18F-choline positron emission tomography predict relapse following autologous stem cell transplantation in primary central nervous system lymphoma?. Bone Marrow Transplant 57, 113–115 (2022). https://doi.org/10.1038/s41409-021-01484-7

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