A 45-year-old woman with diffuse large B-cell lymphoma (DLBCL) completes 6 cycles of R-CHOP. PET-CT shows a Deauville score of 4 at the previously involved sites. What is the appropriate next step per NCCN guidelines?
- A Perform biopsy of the PET-avid site to confirm residual disease before salvage therapy ✓
- B Proceed directly to salvage chemotherapy (e.g., R-ICE or R-DHAP) and autologous SCT
- C Repeat PET-CT in 6–8 weeks and reassess
- D Administer consolidation radiation therapy to the Deauville 4 site
Explanation
Deauville score 4 indicates uptake moderately above liver but below mediastinum/blood pool; it is considered 'indeterminate' or 'equivocal' for residual disease in the context of end-of-treatment PET in DLBCL. A Deauville score of 5 (markedly above liver) indicates likely active disease. For a Deauville score of 4 at end of treatment, NCCN guidelines recommend tissue biopsy to confirm residual lymphoma before proceeding to salvage therapy, because PET-avid post-treatment uptake can represent inflammatory/reactive changes rather than viable lymphoma. Proceeding to salvage chemotherapy without histological confirmation risks unnecessary toxicity in a patient who may have achieved complete metabolic remission with post-treatment inflammation.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.