Clinical characteristics of interim-PET negative patients with a positive end PET from the prospective HD08-01 FIL study

Abstract

FDG-positron emission tomography (PET) performed early during therapy in advanced Hodgkin lymphoma patients has been confirmed as being important for progression-free survival. A group of patients with a negative interim-PET (i-PET) showed a positive end induction PET (e-PET). The aim of this study was to evaluate the clinical characteristics of patients with a positive e-PET as a secondary end point of the HD0801 study. A total of 519 patients with advanced-stage de novo Hodgkin lymphoma received initial treatment and underwent an i-PET. Patients with negative results continued the standard treatment. i-PET negative patients were then evaluated for response with an e-PET and those patients found to have a positive one were also then given a salvage therapy. Among 409 i-PET negative, 16 interrupted the therapy, 393 patients were evaluated with an e-PET, and 39 were positive. Sixteen out of 39 underwent a diagnostic biopsy and 15 were confirmed as HD. Seventeen out of 39 e-PET were reviewed according to the Deauville Score and, in sixteen, it was confirmed positive (10 DS 5, 6 DS 4). With the exception of high LDH value at diagnosis (p = 0.01; HR 95% CI 1.18-4.89), no clinical characteristics were significantly different in comparison with e-PET negative patients. Positive e-PET after a negative i-PET has a worse outcome when compared with i-PET positive patients salvaged with therapy intensification. It was not possible to identify clinical characteristics associated with a positive e-PET.

Role of radiotherapy to bulky sites of advanced Hodgkin lymphoma treated with ABVD: final results of FIL HD0801 trial

“…Among them, 16 patients interrupted therapy, and 393 were assessed for final response after 6 ABVD cycles. Of 393 patients, 38 were judged positive on the end-of-therapy PET scan and salvage therapy was initiated 25 ; 355 were screened for entering the phase 3 part of the study; 230 had nonbulky lesions and 125 had bulky masses at baseline ( Figure 2 ); 9 patients with bulky masses were not assigned to a study group (details in supplemental Table 1). Finally, 116 patients were randomly assigned to consolidation (RT arm, 58 patients) or OBS (OBS arm, 58 patients).…”

Hodgkin Lymphoma: Recent Progress in Overall Management

“…Therefore, end-of-treatment PET/CT remains important in the setting of a negative interim PET/CT (37). Patients who have a positive end of treatment PET/CT after a negative interim PET/CT have worse outcomes than patients salvaged after a positive interim PET/CT (38). For patients who are in remission after end-of-treatment PET/CT, no further imaging is warranted in routine clinical practice.…”

Optimizing First-Line Therapy for Advanced-Stage Classic Hodgkin Lymphoma

“…End of therapy PET imaging is also important for both PFS and OS, Dr. Advani said. 9 "The worst outcome is if a patient is PET-positive at the end of therapy," she noted. "Approximately 8% to 10% of patients may have been interim PET-negative but are then PET-positive at the end of therapy, and they do pretty poorly.…”