Does Interim PET Scan After 2 Cycles of ABVD Predict Outcome in Hodgkin Lymphoma? Real-World Evidence

Abstract

PURPOSE Escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) improves overall survival (OS) in patients with Hodgkin lymphoma (HL) relative to ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy. However, the associated higher cost and toxicity discourage clinicians from prescribing it. Identifying high-risk patients and administering escalated BEACOPP remains an effective strategy. We assessed the significance of interim positron emission tomography (iPET) scan after 2 cycles (iPET2) in identifying this high-risk subset. PATIENTS AND METHODS This cohort study used secondary data from 12 tertiary care centers in South India gathered over 10 years (2008-2018). OS, event-free survival (EFS), determinants of EFS, and complete response (CR) in iPET2 were assessed. RESULTS The study included 409 patients with HL (mean age, 34.5 years; male/female ratio, 1.4:1). The median duration of follow-up was 2.8 years. Of 409 patients, 63% underwent PET-based staging and 37% underwent computerized tomography (CT) staging. Stage IV (28.9%) and bone involvement (9.2%) were seen more often with PET than with CT staging (9.2% and 2%, respectively). Among 171 patients with iPET2 results, 24% did not achieve CR, and no factors were significantly associated. The 5-year EFS and OS rates of the entire cohort were 78% and 97%, respectively. The 5-year EFS and OS rates of patients with CR on iPET2 were 90% and 99%, respectively, whereas these were 65% and 100%, respectively, for patients not achieving CR. On univariable analysis, sex, stage, and iPET2 response significantly predicted inferior EFS. On multivariate analysis, only iPET2 response significantly predicted EFS ( P < .000). CONCLUSION Our study supports the use of PET for staging and iPET2 for response assessment. Nonachievement of CR on iPET2 indicates unfavorable outcome, and such patients may benefit from more intensive treatment.

Role of Interim PET Scan after 2 Cycles of ABVD in Pediatric Hodgkin Lymphoma: Retrospective Multicenter Study from South India

“…In comparison with adult HL patients, the studies on iPET2 response adapted treatment modification in pHL are sparse. 26,[31][32][33][34] In our study, patients not achieving CR in the iPET2 scan had five times increased risk of an adverse outcome when compared with patients achieving CR. Results from several studies on the role of iPET scan in the management of pHL are varied and conflicting.…”

“…[26][27][28][29][30] In comparison with adult HL patients, the studies on interim PET scan after two cycles (iPET2) response adapted treatment modification in children are sparse. 26,[31][32][33][34] This study was conducted to ascertain the outcomes of children with HL treated with ABVD chemotherapy and to analyze various factors predicting the outcome.…”

“…26 27 28 29 30 In comparison with adult HL patients, the studies on interim PET scan after two cycles (iPET2) response adapted treatment modification in children are sparse. 26 31 32 33 34…”

Flavonoids against the Warburg phenotype—concepts of predictive, preventive and personalised medicine to cut the Gordian knot of cancer cell metabolism

“…According to Girinsky et al [166], historic radiation fields encompassed significant portions of healthy tissue, whereas modern radiation therapy techniques are able to limit radiation fields to focus on tumours identified by pre-treatment PET-CT, decreasing toxicities without compromising oncologic outcomes. For certain cancers, PET-CT is also utilised to evaluate treatment response after administration of chemotherapy [167]. This opens a new perspective for glucose-targeted drug therapies [168].…”

Interim-Response-Adapted Therapy in Advanced Hodgkin’s Lymphoma: Current Status

“…[11] Recent reports from a multicenter analysis have shown that RAT can be safely practiced in the Indian conditions. [20] Prasanth Ganesan…”