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Prognostic value of interim FDG PET/CT in Hodgkin’s lymphoma patients treated with interim response-adapted strategy: comparison of International Harmonization Project (IHP), Gallamini and London criteria

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Abstract

Purpose

Interim 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) has shown to be an accurate predictor of prognosis in Hodgkin’s lymphoma (HL). However, FDG PET response criteria are a matter of ongoing debate. The aim of this study was to confirm the prognostic value of interim PET/CT in HL patients treated with an interim response-adapted strategy and to compare the respective performances of different published criteria.

Methods

Newly diagnosed patients with HL underwent interim PET/CT after four courses of Adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). The treatment strategy was adapted according to prognostic factors at diagnosis and interim PET/CT and CT results. PET images were prospectively interpreted visually: a negative result was defined as no residual uptake above local background. All other findings were considered as positive. Retrospectively, interim PET/CT was analysed according to International Harmonization Project (IHP), Gallamini and London criteria

Results

The analysis included 90 patients; 6 of 31 patients with positive interim PET/CT and 7 of 59 patients with negative interim result presented treatment failure. The negative predictive value (NPV) and positive predictive value (PPV) for predicting 2-year progression-free survival (PFS) was 95 and 16%, respectively. With the other criteria, NPV remained very high (from 95 to 96%). The PPV increased from 19 to 45% according to the threshold used. Interim PET/CT was significantly correlated with PFS with Gallamini (p = 0.01) and London criteria (p < 0.0001).

Conclusion

Our study confirms the high NPV of interim PET/CT for predicting treatment outcome in HL and a probably better prognostic value using a higher threshold for positivity even after four cycles of chemotherapy as used in Gallamini and London criteria.

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References

  1. Bonfante V, Santoro A, Viviani S, Valagussa P, Bonadonna G. ABVD in the treatment of Hodgkin’s disease. Semin Oncol 1992;19(2 Suppl 5):38–44.

    PubMed  CAS  Google Scholar 

  2. Canellos GP, Anderson JR, Propert KJ, Nissen N, Cooper MR, Henderson ES, et al. Chemotherapy of advanced Hodgkin’s disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med 1992;327(21):1478–84.

    Article  PubMed  CAS  Google Scholar 

  3. Duggan DB, Petroni GR, Johnson JL, Glick JH, Fisher RI, Connors JM, et al. Randomized comparison of ABVD and MOPP/ABV hybrid for the treatment of advanced Hodgkin’s disease: report of an intergroup trial. J Clin Oncol 2003;21(4):607–14.

    Article  PubMed  CAS  Google Scholar 

  4. Aleman BM, van den Belt-Dusebout AW, Klokman WJ, Van’t Veer MB, Bartelink H, van Leeuwen FE. Long-term cause-specific mortality of patients treated for Hodgkin’s disease. J Clin Oncol 2003;21(18):3431–9.

    Article  PubMed  Google Scholar 

  5. Josting A, Wiedenmann S, Franklin J, May M, Sieber M, Wolf J, et al. Secondary myeloid leukemia and myelodysplastic syndromes in patients treated for Hodgkin’s disease: a report from the German Hodgkin’s Lymphoma Study Group. J Clin Oncol 2003;21(18):3440–6.

    Article  PubMed  Google Scholar 

  6. Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin’s disease. International Prognostic Factors Project on Advanced Hodgkin’s Disease. N Engl J Med 1998;339(21):1506–14.

    Article  PubMed  CAS  Google Scholar 

  7. Hutchings M, Mikhaeel NG, Fields PA, Nunan T, Timothy AR. Prognostic value of interim FDG-PET after two or three cycles of chemotherapy in Hodgkin lymphoma. Ann Oncol 2005;16(7):1160–8.

    Article  PubMed  CAS  Google Scholar 

  8. Hutchings M, Loft A, Hansen M, Pedersen LM, Buhl T, Jurlander J, et al. FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma. Blood 2006;107(1):52–9.

    Article  PubMed  CAS  Google Scholar 

  9. Zinzani PL, Tani M, Fanti S, Alinari L, Musuraca G, Marchi E, et al. Early positron emission tomography (PET) restaging: a predictive final response in Hodgkin’s disease patients. Ann Oncol 2006;17(8):1296–300.

    Article  PubMed  CAS  Google Scholar 

  10. Gallamini A, Hutchings M, Rigacci L, Specht L, Merli F, Hansen M, et al. Early interim 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography is prognostically superior to international prognostic score in advanced-stage Hodgkin’s lymphoma: a report from a joint Italian-Danish study. J Clin Oncol 2007;25(24):3746–52.

    Article  PubMed  CAS  Google Scholar 

  11. Barrington SF, Qian W, Somer EJ, Franceschetto A, Bagni B, Brun E, et al. Concordance between four European centres of PET reporting criteria designed for use in multicentre trials in Hodgkin lymphoma. Eur J Nucl Med Mol Imaging 2010;37(10):1824–33.

    Article  PubMed  Google Scholar 

  12. Juweid ME, Stroobants S, Hoekstra OS, Mottaghy FM, Dietlein M, Guermazi A, et al. Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J Clin Oncol 2007;25(5):571–8.

    Article  PubMed  Google Scholar 

  13. Meignan M, Gallamini A, Haioun C. Report on the First International Workshop on Interim-PET-Scan in Lymphoma. Leuk Lymphoma 2009;50(8):1257–60.

    Article  PubMed  Google Scholar 

  14. Gallamini A, Fiore F, Sorasio R, Meignan M. Interim positron emission tomography scan in Hodgkin lymphoma: definitions, interpretation rules, and clinical validation. Leuk Lymphoma 2009;50(11):1761–4.

    Article  PubMed  Google Scholar 

  15. Cheson BD, Horning SJ, Coiffier B, Shipp MA, Fisher RI, Connors JM, et al. Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas. NCI Sponsored International Working Group. J Clin Oncol 1999;17(4):1244.

    PubMed  CAS  Google Scholar 

  16. Cheson BD, Pfistner B, Juweid ME, Gascoyne RD, Specht L, Horning SJ, et al. Revised response criteria for malignant lymphoma. J Clin Oncol 2007;25(5):579–86.

    Article  PubMed  Google Scholar 

  17. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–81.

    Article  Google Scholar 

  18. Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, et al. Design and analysis of randomized clinical trials requiring prolonged observation of each patient: II, analysis and examples. Br J Cancer 1977;35(1):1–39.

    Article  PubMed  CAS  Google Scholar 

  19. Terasawa T, Lau J, Bardet S, Couturier O, Hotta T, Hutchings M, et al. Fluorine-18-fluorodeoxyglucose positron emission tomography for interim response assessment of advanced-stage Hodgkin’s lymphoma and diffuse large B-cell lymphoma: a systematic review. J Clin Oncol 2009;27(11):1906–14.

    Article  PubMed  Google Scholar 

  20. Hutchings M, Barrington SF. PET/CT for therapy response assessment in lymphoma. J Nucl Med 2009;50 Suppl 1:21S–30S.

    Article  PubMed  CAS  Google Scholar 

  21. Markova J, Kobe C, Skopalova M, Klaskova K, Dedeckova K, Plütschow A, et al. FDG-PET for assessment of early treatment response after four cycles of chemotherapy in patients with advanced-stage Hodgkin’s lymphoma has a high negative predictive value. Ann Oncol 2009;20(7):1270–4.

    Article  PubMed  CAS  Google Scholar 

  22. Dann EJ, Bar-Shalom R, Tamir A, Epelbaum R, Avivi I, Ben-Shachar M, et al. A functional dynamic scoring model to elucidate the significance of post-induction interim fluorine-18-fluorodeoxyglucose positron emission tomography findings in patients with Hodgkin’s lymphoma. Haematologica 2010;95(7):1198–206.

    Article  PubMed  Google Scholar 

  23. Meignan M. Interim PET in lymphoma: a step towards standardization. Eur J Nucl Med Mol Imaging 2010;37:1821–3.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital of Brest, 5 avenue Foch, 29200, Brest, France

    Pierre-Yves Le Roux, Solène Querellou & Pierre Yves Salaun

  2. Department of Hematology, University Hospital of Nantes, Nantes, France

    Thomas Gastinne, Steven Le Gouill, Beatrice Mahe, Viviane Dubruille & Nicolas Blin

  3. INSERM CIC 05-02 IFR148, Brest, France

    Emmanuel Nowak

  4. Department of Nuclear Medicine, University Hospital of Nantes, Nantes, France

    Caroline Bodet-Milin & Françoise Bodere-Kraeber

Authors
  1. Pierre-Yves Le Roux
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  2. Thomas Gastinne
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Correspondence to Pierre Yves Salaun.

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PYL and TG contributed equally to this manuscript.

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Le Roux, PY., Gastinne, T., Le Gouill, S. et al. Prognostic value of interim FDG PET/CT in Hodgkin’s lymphoma patients treated with interim response-adapted strategy: comparison of International Harmonization Project (IHP), Gallamini and London criteria. Eur J Nucl Med Mol Imaging 38, 1064–1071 (2011). https://doi.org/10.1007/s00259-011-1741-0

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  • DOI: https://doi.org/10.1007/s00259-011-1741-0

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