Interim 18F-FDG PET validated and included in guidelines for DLBCL

Coreline Burggraaff received her PhD on September 9 at VU University Amsterdam his thesis entitled ‘18F-FDG PET as a biomarker in aggressive lymphoma; technical and clinical validation’. Prof. Dr. JM Zijlstra-Baalbergen and Prof. Dr. Ir. HCW de Vet acted as supervisors. Co-promoters were Prof. Dr. OS Hoekstra and Prof. Dr. R. Boellaard. Burggraaff is currently working as a resident intern and will begin Differential Hematology on 1-1-2023.

What was the purpose of your PhD research?

The goal was to validate the interim 18F-FDG PET as a biomarker of response during treatment in patients with diffuse large B-cell lymphoma (DLBCL), as well as to determine optimal response criteria (visually using the 5-point Deauville scale or quantitatively using the ΔSUVmax criteria) and the timing (after how many R-CHOP cycles) from the interim 18F-FDG PET. Establishing an international consortium PETRA (PET Re-Analysis).1 enough patient data and PET scans from the DLBCL studies could be collected and reanalysed to answer these questions.

What do you want the clinician to know about your research?

In addition to baseline staging and response assessment after first-line treatment, the value of the interim 18F-FDG PET validated. In an extensive meta-analysis of individual patient data, we demonstrated that the interim 18F-FDG PET has a high negative predictive value of over 80% when using the Deauville visual and quantitative ΔSUVmax criteria for response assessment in DLBCL. This led to interim 18PET-guided F-FDG treatment is included in the current Dutch guidelines for DLBCL.2

What was the most frustrating part of your research?

Establishing the contracts – the so-called data sharing policy documents for the PETRA database – with the various international firms. Much time was spent in contact with various legal departments to get these documents corrected. And this despite the fact that the “letters of intent” had already been signed by the principal investigators themselves before the project started and we were able to use a sample policy document via another individual data meta-analysis project from the department of epidemiology. After this hurdle was cleared, we could finally start with research (patient data and scans).

What moment/intuition led to a turning point?

The PETRA consortium’s annual meetings in Amsterdam provided many new research insights for all present, as well as increased motivation to provide data, analyze it and meet deadlines. The ever-growing enthusiasm of this expert group of hematologists, nuclear medicine physicians, researchers and epidemiologists has led to the interim 18The F-FDG PET research was successfully completed and also led to new projects.

What is the follow-up question from your research?

Currently, the PETRA database is being used provisionally 18The F-FDG PET study was designed and used for a baseline predictive value follow-up study 18F-FDG PET factors (so-called radiomic factors). In addition, further research is ongoing on the validation of metabolic tumor volume (MTV) and how the positive predictive value of end of treatment 18F-FDG PET can be improved. Recently, the PETRA consortium proposed a new prognostic index (consisting of MTV, age and stage) with a better predictive value than the well-known IPI score.3

What will you take away from your PhD research? What are your next steps?

What I bring with me is the importance of good multidisciplinary collaboration, where knowledge and interest in each other’s profession really helps to be able to offer better research and therefore better patient care. Starting January 1, 2023 I will start differentiation hematology at the UMC in Amsterdam, VUmc headquarters. In the future, as an internist-haematologist, I hope to continue to develop my research expertise, both in day-to-day clinical patient care and in research itself.


  3. Mikhael GN, Heymans MW, Eertink JJ, et al. Proposed new dynamic prognostic index for diffuse large B-cell lymphoma: International Metabolic Prognostic Index. J Clin Oncol. Rev. 2022;40:2352–6

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