Baseline total lesion glycolysis combined with interim positron emission tomography-computed tomography is a robust predictor of outcome in patients with peripheral T-cell lymphoma

Background: Peripheral T-cell lymphoma (PTCL) represents a heterogeneous and rare subgroup of aggressive lymphomas that generally demonstrate poor clinical outcomes with conventional treatment. Since the prognosis of PTCL is heterogeneous, more accurate risk assessment, and risk-adapted treatment strategies are required. In this study, we examined whether interim positron emission tomography (iPET)-computed tomography (PET/CT) results can be combined with baseline volume-based metabolic assessments including total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) for risk stratification in PTCL. Methods: The data of 63 patients with nodal PTCL, who had analyzable baseline PET/CT and iPET, were retrospectively reviewed. We calculated the baseline TMTV and TLG values. All iPET responses were analyzed using the Deauville 5-point scale. Results: On univariate analysis, a prognostic index for PTCL (PIT) higher than 2 (hazard ratio [HR], 2.03; P =.026), high TMTV (>389 cm³; HR, 2.24; P =.01), high TLG (>875; HR, 3.77; P =.0005), and positive iPET (HR, 2.18; P =.009) were significantly associated with poorer progression-free survival (PFS). On multivariate analysis, only high TLG and positive iPET independently predicted both poorer overall survival (OS) and PFS. A model combining TLG and iPET showed that patients with low TLG and negative iPET had superior outcomes, with a 5-year PFS and OS of 72% and 90%, respectively. Conversely, both 5-year PFS and OS for those with high TLG and positive iPET were 0%. Conclusions: In summary, TLG combined with iPET predicted survival in PTCL more accurately. This information may help in the development of risk-adapted treatment strategies for PTCL.