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Interim  18 F‐fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (I‐PET/CT) is a powerful tool for monitoring the response to therapy in diffuse large B‐cell lymphoma (DLBCL). This retrospective study aimed to determine when and how to use I‐PET/CT in DLBCL. A total of 197 patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R‐CHOP) were enrolled between October 2005 and July 2011; PET/CT was performed at the time of diagnosis (PET/CT0), after 2 and 4 cycles of chemotherapy (PET/CT2 and PET/CT4, respectively), and at the end of treatment (F‐PET/CT). According to the International Harmonization Project for Response Criteria in Lymphoma, 110 patients had negative PET/CT2 scans, and 87 had positive PET/CT2 scans. The PET/CT2‐negative patients had significantly higher 3‐year progression‐free survival rate (75.8% vs. 38.2%) and 3‐year overall survival rate (93.5% vs. 55.6%) than PET/CT2‐positive patients. All PET/CT2‐negative patients remained negative at PET/CT4, but 3 were positive at F‐PET/CT. Among the 87 PET/CT2‐positive patients, 57 remained positive at F‐PET/CT, and 32 progressed during chemotherapy (15 at PET/CT4 and 17 at F‐PET/CT). Comparing PET/CT4 with PET/CT0, 7 patients exhibited progression, and 8 achieved partial remission. Comparing F‐PET/CT with PET/CT0, 10 patients exhibited progression, and 7 achieved partial remission. In conclusion, our results indicate that I‐PET/CT should be performed after 2 rather than 4 cycles of immunochemotherapy in DLBCL patients. There is a limited role for subsequent PET/CT in the detection of relapse in PET/CT2‐negative patients, but repeat PET/CT is required if the PET/CT2 findings are positive.

Use of subsequent PET/CT in diffuse large B‐cell lymphoma patients in complete remission following primary therapy