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The Prognostic Role of Interim [18F]FDG PET/CT in Diffuse Large B-Cell Lymphoma: An Updated Systematic Review and
Domenico Albano1, Stephane Chauvie2, Alessio Rizzo3
1Nuclear Medicine, University of Brescia, Brescia, Italy; Nuclear Medicine Department, ASST Spedali Civili di Brescia, Brescia, Italy.
None:
The prognostic value of interim 18F-fluorodeoxyglucose positron emission tomography/computed tomography (iPET/CT) in diffuse large B-cell lymphoma (DLBCL) remains a subject of debate due to inconsistencies in timing and interpretation. This updated systematic review and meta-analysis aimed to investigate the ability of iPET to predict progression-free survival (PFS). A systematic literature search was conducted across PubMed/MEDLINE, Cochrane, and Embase databases until December 31, 2025. Studies investigating the prognostic value of iPET/CT for PFS in DLBCL were included. Data on complete metabolic response (CMR) rates and hazard ratios (HR) for PFS were pooled using a random-effects model. The pooled CMR rate across 66 articles (9.335 patients) was 67.2% (95% confidence interval [CI]. 63.9%-70.4%), though significant variability (38%-94%) and extreme heterogeneity were observed (I2 = 92.45%). Subgroup analysis confirmed that timing influenced these rates: CMR was 63.3% after 2 cycles vs. 74.4% after 4 cycles. Regarding PFS, the pooled HR across 63 studies was 3.05 (95% CI, 2.63-3.54) for a positive iPET. Notably, utilizing a Deauville score (DS) threshold of 5 alone yielded a significantly higher pooled HR of 5.72 (95% CI, 4.35-7.51) with more moderate heterogeneity (I2 = 40.7%). In contrast, the prognostic effect of ΔSUV66% was weaker, with a pooled HR of 1.83. Scans performed after 4 cycles (iPET4, HR: 3.20) showed slightly stronger prognostic performance than those after 2 cycles (iPET2, HR: 2.84). Interim PET/CT, particularly when utilizing the DS 5 threshold, is a strong biomarker for identifying high-risk DLBCL patients.
