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Aggressive Non-Hodgkin Lymphoma: Early Prediction of Outcome with ⁶⁷Ga Scintigraphy¹

¹ From the Departments of Nuclear Medicine (D.F., R.B.S., M.M., A.F., G.M.K., O.I.), Oncology (N.H., R.E.), and Radiology (D.G.), Rambam Medical Center, Haifa 35254, Israel. Received November 20, 1998; revision requested February 11, 1999; revision received April 22; accepted July 27. Address reprint requests to D.F.

PURPOSE: To evaluate use of gallium 67 scintigraphy early during chemotherapy to predict the outcome in patients with aggressive non-Hodgkin lymphoma.

MATERIALS AND METHODS: Among 118 patients, ⁶⁷Ga scintigraphy was performed after one cycle of chemotherapy in 51 patients, after a median of 3.5 cycles in 97 patients, and both in 30 patients. Computed tomography (CT) was performed after a median of 3.5 cycles of treatment in 87 patients. The failure-free survival was compared between patients with positive or negative ⁶⁷Ga or CT scans by using the log-rank test. Multivariate analysis helped determine the relation between ⁶⁷Ga scintigraphic and CT findings and the outcome.

RESULTS: The differences in failure-free survival between patients with positive versus negative ⁶⁷Ga scans after one cycle of treatment (P < .001) and at midtreatment (P < .001) were significant. There was no statistically significant difference in failure-free survival between patients with positive versus negative CT findings during treatment. In multivariate analysis, ⁶⁷Ga scintigraphy after one cycle (P < .045) and at midtreatment (P < .006) was an independent factor associated with outcome.

CONCLUSION: Gallium 67 scintigraphic findings after one cycle of chemotherapy and at midtreatment are predictive of outcome in patients with aggressive non-Hodgkin lymphoma. CT findings are not predictive. Early ⁶⁷Ga scintigraphy during chemotherapy is a good indicator of patients who may benefit from a change to a more aggressive treatment. A future study is necessary to investigate the potential effect of early change of treatment.

Index terms: Gallium, radioactive, 99.12962 • Lymphoma, 99.8343 • Lymphoma, CT, 99.12912 • Lymphoma, SPECT, 99.12962 • Lymphoma, radionuclide studies, 99.12962, 99.12974 • Treatment planning, 99.8343

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