Early Interim 18f-FDG PET In Hodgkin's Lymphoma: Evaluation on 304 Patients

Zinzani, Pier Luigi; Rigacci, Luigi; Stefoni, Vittorio; Puccini, Benedetta; Gandolfi, Letizia; Fanti, Stefano; Castagnoli, Antonio; Pellegrini, Cinzia; Montini, Gian Carlo; Quirini, Federica; Antognoli, Giulia; Vaggelli, Luca; Derenzini, Enrico; Argnani, Lisa; Ambrosini, Valentina; Agostinelli, Claudio; Pileri, Stefano; Bosi, Alberto; Baccarani, Michele

doi:10.1182/blood.v116.21.3879.3879

Cited by 15 publications

(24 citation statements)

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“…Notably, even end‐PET positive patients fared well with a 4‐year OS of 84%, re‐emphasizing the efficacy of available salvage therapies for relapsed low‐risk patients. These results contrast with that recently reported by Zinzani the prognostic role of interim PET in a large retrospective cohort of 304 HL patients, half of them (147) with early‐stage disease. Patients were treated with ABVD × 4 + IFRT or ABVD × 6 without RT in two Italian Institutions: 128 (87%) had a negative and 19 (13%) a positive PET‐2: the 9‐y PFS was 94.7% and 31.3%, respectively ( P = 0.0000).…”

Section: Discussionmentioning

confidence: 96%

The prognostic value of positron emission tomography performed after two courses (INTERIM‐PET) of standard therapy on treatment outcome in early stage Hodgkin lymphoma: A multicentric study by the fondazione italiana linfomi (FIL)

et al. 2015

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This retrospective study included 246 patients with a new diagnosis of Hodgkin Lymphoma (HL) with a localized-stage (IA-IIA), consecutively admitted from January 2002 to December 2008, by twelve Italian hematological centers on behalf of Fondazione Italiana Linfomi (FIL). Patients were staged at baseline and after two cycles of chemotherapy with PET. All patients were treated with four cycles of ABVD followed by involved-field radiotherapy. No treatment change, based on PET-2 results was allowed. Endpoint of the study was the predictive role of PET-2 on 2-y failure-free survival (FFS). PET-2 was positive in 36 patients (15%) and negative in 210. After a mean follow-up of 46 (3-105) months 19/36 PET-2 positive patients progressed or relapsed and 17 achieved and maintained a CCR. The positive and negative predictive value of a PET2 was 53% and 95%, respectively. The sensibility, specificity and accuracy of PET2 were 65.5%, 92% and 89%, respectively. PET-2 positive scans were centrally reviewed according to the recently defined Deauville Criteria. Upon review the PPV and NPV was 73% and 96% overall. Factors with prognostic significance for progression in univariate analysis were a positive PET-2 (P 5 0.000) and the presence of bulky disease (P < 0.01). In a multivariate analysis the only factor that affected negatively FFS was a positive PET-2 (P 5 0.000). This study confirms that interim-PET could be considered a prognostic test also in early stage HL, but is unlikely to be a factor that will justify the change of therapeutical approach.

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Section: Discussionmentioning

confidence: 96%

The prognostic value of positron emission tomography performed after two courses (INTERIM‐PET) of standard therapy on treatment outcome in early stage Hodgkin lymphoma: A multicentric study by the fondazione italiana linfomi (FIL)

et al. 2015

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“…Overall, the methodological quality of included studies was moderate. There was moderate risk of bias for the domain of prognostic factor measurement in six studies, because five studies (Gallamini et al, 2007;Cerci et al, 2010;Straus et al, 2011;Markova et al, 2012;Zinzani et al, 2012) used a stand-alone PET system rather than integrated PET/CT, and one study did not report at all which PET system was used (Furth et al, 2011). In addition, there was moderate risk of bias for the domain of outcome measurement in five studies, because four studies (Gallamini et al, 2007;Markova et al, 2012;Filippi et al, 2013;Rossi et al, 2014) did not report the reference criteria for the confirmation of treatment failure and one study reported that histology was not used to confirm treatment failure in all cases (Straus et al, 2011).…”

Section: Methodological Qualitymentioning

confidence: 99%

Prognostic value of interim FDG‐PET in Hodgkin lymphoma: systematic review and meta‐analysis

2015

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SummaryThis study aimed to systematically review and meta-analyse the value of interim 18 F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in predicting treatment failure in Hodgkin lymphoma. MEDLINE was systematically searched for original studies that used standardized international criteria for interim FDG-PET interpretation. Included studies were methodologically assessed. Summary receiver operating characteristic (sROC) analysis was performed, and pooled sensitivity and specificity were calculated using a random effects model. Heterogeneity in diagnostic odds ratios (DORs) across studies was assessed and potential sources for interstudy heterogeneity were explored using subgroup analyses. Ten studies, comprising a total of 1389 Hodgkin lymphoma patients, were included. Sensitivity, specificity, positive predictive value and negative predictive value of interim FDG-PET for predicting treatment failure ranged between 0Á0-81Á5%, 72Á2-96Á6%, 0Á0-86Á0% and 84Á4-98Á6%, respectively. The area under the sROC curve was 0Á877. Pooled sensitivity and specificity were 70Á8% [95% confidence interval (CI): 64Á7-76Á4%] and 89Á9% (95% CI: 88Á0-91Á6%). There was heterogeneity in DORs across individual studies (I 2 = 72Á7). The overall prognostic value of interim FDG-PET appears to be moderate for excluding and relatively high for identifying treatment failure in Hodgkin lymphoma. However, interim FDG-PET cannot yet be implemented in routine clinical practice due to moderate-quality evidence and inter-study heterogeneity that cannot be fully explained yet.

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“…Therefore, Gallamini et al's results [3,4] have been seriously biased. In other studies on the value of interim FDG-PET/CT in patients with advanced-stage Hodgkin lymphoma treated with ABVD, the predictive value was less strong, with PFS rates ranging between 28.8% and 43% for those with positive interim FDG-PET/CT results [6][7][8]. Of note, in two recent studies including an ABVD treated cohort of early-and advanced-stage Hodgkin lymphoma patients, interim FDG-PET/CT had minor or no predictive value at all, with interim FDG-PET/CT positive patients having PFS of 56.3% [9] and 100% [10], respectively.…”

Section: Fundingmentioning

confidence: 95%