Skip to main content

Advertisement

SpringerLink
Log in

Ability of final PET/CT to predict response to first-line treatment in real patients with classical Hodgkin lymphoma

  • Original Article
  • Published:
International Journal of Hematology Aims and scope Submit manuscript

Abstract

Up to 25% of patients with classical Hodgkin lymphoma (cHL) and a negative interim PET/CT will progress. Unfortunately, there are few published studies on the predictive value of PET/CT performed after finishing treatment. The objective of our study was to assess the role of the final PET/CT (fPET/CT) in predicting progression in a retrospective series of patients treated in the last 10 years with a homogeneous protocol (ABVD + / − radiotherapy). We reviewed a cohort of 227 patients with newly diagnosed cHL. fPET/CT was performed on 212 patients (93%). In patients with a positive fPET, progression-free survival at 60 months was 17% (94% if fPET was negative, p = 0.000). The positive and negative predictive values for the fPET were 76% and 94%, respectively (Fisher’s exact test, p = 0.000). In the subgroup of patients with advanced-stage cHL, progression-free survival at 60 months was 91% with negative fPET and 0% with positive fPET (p = 0.000). However, fPET was negative in 19 of the 29 patients with a positive interim PET/CT (only 2 showed progression). In conclusion, fPET is a useful tool to predict treatment failure in patients with newly diagnosed cHL, especially advanced-stage disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Siegel R, DeSantis C, Virgo K, Stein K, Mariotto A, Smith T, et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin. 2012;62(4):220–41.

    Article  Google Scholar 

  2. Donaldson SS, Hancock SL, Hoppe RT. The Janeway lecture. Hodgkin’s disease–finding the balance between cure and late effects. Cancer J Sci Am. 1999;5(6):325–33.

    CAS  PubMed  Google Scholar 

  3. Canellos GP, Rosenberg SA, Friedberg JW, Lister TA, Devita VT. Treatment of Hodgkin lymphoma: a 50-year perspective. J Clin Oncol. 2014;32(3):163–8.

    Article  CAS  Google Scholar 

  4. Meyer RM, Gospodarowicz MK, Connors JM, Pearcey RG, Wells WA, Winter JN, et al. ABVD alone versus radiation-based therapy in limited-stage Hodgkin’s lymphoma. N Engl J Med. 2012;366(5):399–408.

    Article  CAS  Google Scholar 

  5. Pavlovsky A, Fernandez I, Kurgansky N, Prates V, Zoppegno L, Negri P, et al. PET-adapted therapy after three cycles of ABVD for all stages of Hodgkin lymphoma: results of the GATLA LH-05 trial. Br J Haematol. 2019;185(5):865–73.

    Article  CAS  Google Scholar 

  6. Fuchs M, Goergen H, Kobe C, Kuhnert G, Lohri A, Greil R, et al. Positron emission tomography-guided treatment in early-stage favorable Hodgkin lymphoma: final results of the International, Randomized Phase III HD16 Trial by the German Hodgkin Study Group. JCO. 2019;37:2835.

    Article  CAS  Google Scholar 

  7. Radford J, Illidge T, Counsell N, Hancock B, Pettengell R, Johnson P, et al. Results of a trial of PET-directed therapy for early-stage Hodgkin’s lymphoma. N Engl J Med. 2015;372(17):1598–607.

    Article  CAS  Google Scholar 

  8. André MPE, Girinsky T, Federico M, Reman O, Fortpied C, Gotti M, et al. Early positron emission tomography response-adapted treatment in stage I and II Hodgkin lymphoma: final results of the randomized EORTC/LYSA/FIL H10 trial. J Clin Oncol. 2017;35(16):1786–94.

    Article  Google Scholar 

  9. Engert A, Haverkamp H, Kobe C, Markova J, Renner C, Ho A, et al. Reduced-intensity chemotherapy and PET-guided radiotherapy in patients with advanced stage Hodgkin’s lymphoma (HD15 trial): a randomised, open-label, phase 3 non-inferiority trial. Lancet. 2012;379(9828):1791–9.

    Article  CAS  Google Scholar 

  10. Kobe C, Dietlein M, Franklin J, Markova J, Lohri A, Amthauer H, et al. Positron emission tomography has a high negative predictive value for progression or early relapse for patients with residual disease after first-line chemotherapy in advanced-stage Hodgkin lymphoma. Blood. 2008;112(10):3989–94.

    Article  CAS  Google Scholar 

  11. Fernández KS, Schwartz CL, Chen L, Constine LS, Chauvenet A, de Alarcón PA. Outcome of adolescents and young adults compared to children with Hodgkin lymphoma treated with response-based chemotherapy on pediatric protocols: a Children’s Oncology Group report. Pediatr Blood Cancer. 2017;64(12):e26681.

    Article  Google Scholar 

  12. Henderson TO, Parsons SK, Wroblewski KE, Chen L, Hong F, Smith SM, et al. Outcomes in adolescents and young adults with Hodgkin lymphoma treated on US cooperative group protocols: An adult intergroup (E2496) and Children’s Oncology Group (COG AHOD0031) comparative analysis: outcomes of AYAs With Hodgkin Lymphoma. Cancer. 2018;124(1):136–44.

    Article  Google Scholar 

  13. de Wit M, Bohuslavizki KH, Buchert R, Bumann D, Clausen M, Hossfeld DK. 18FDG-PET following treatment as valid predictor for disease-free survival in Hodgkin’s lymphoma. Ann Oncol. 2001;12(1):29–37.

    Article  Google Scholar 

  14. Spaepen K, Stroobants S, Dupont P, Thomas J, Vandenberghe P, Balzarini J, et al. Can positron emission tomography with [(18)F]-fluorodeoxyglucose after first-line treatment distinguish Hodgkin’s disease patients who need additional therapy from others in whom additional therapy would mean avoidable toxicity? Br J Haematol. 2001;115(2):272–8.

    Article  CAS  Google Scholar 

  15. Weihrauch MR, Re D, Scheidhauer K, Ansén S, Dietlein M, Bischoff S, et al. Thoracic positron emission tomography using 18F-fluorodeoxyglucose for the evaluation of residual mediastinal Hodgkin disease. Blood. 2001;98(10):2930–4.

    Article  CAS  Google Scholar 

  16. Schaefer NG, Taverna C, Strobel K, Wastl C, Kurrer M, Hany TF. Hodgkin disease: diagnostic value of FDG PET/CT after first-line therapy—Is biopsy of FDG-avid lesions still needed? Radiology. 2007;244(1):257–62.

    Article  Google Scholar 

  17. Meignan M, Gallamini A, 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  Google Scholar 

  18. Hindié E, Mesguich C, Bouabdallah K, Milpied N. Advanced Hodgkin’s lymphoma: end-of-treatment FDG-PET should be maintained. Eur J Nucl Med Mol Imaging. 2017;44(8):1254–7.

    Article  Google Scholar 

  19. Zinzani PL, Rigacci L, Stefoni V, Broccoli A, Puccini B, Castagnoli A, et al. Early interim 18F-FDG PET in Hodgkin’s lymphoma: evaluation on 304 patients. Eur J Nucl Med Mol Imaging. 2012;39(1):4–12.

    Article  Google Scholar 

  20. Mesguich C, Cazeau A-L, Bouabdallah K, Soubeyran P, Guyot M, Milpied N, et al. Hodgkin lymphoma: a negative interim-PET cannot circumvent the need for end-of-treatment-PET evaluation. Br J Haematol. 2016;175(4):652–60.

    Article  Google Scholar 

  21. Domingo-Domenech E, Ramchandren R, Rueda A, Trněný M, Feldman T, Lee HJ, et al. Nivolumab más doxorrubicina, vinblastina y dacarbazina para linfoma de Hodgkin clásico avanzado recién diagnosticado: seguimiento ampliado de dos años de la cohorte del estudio fase 2 CHECKMATE 205. Spanish Society Oncology Medical Congress 2019. P-Dest 51. 22–25 Oct.

  22. Sieber M, Engert A, Diehl V. Treatment of Hodgkin’s disease: results and current concepts of the German Hodgkin’s Lymphoma Study Group. Ann Oncol. 2000;11(Suppl 1):81–5.

    Article  Google Scholar 

  23. Hasenclever D, Diehl V, Armitage JO, Assouline D, Björkholm M, Brusamolino E, et al. A prognostic score for advanced Hodgkin’s disease. N Engl J Med. 1998;339(21):1506–14.

    Article  CAS  Google Scholar 

  24. 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  Google Scholar 

  25. Adams HJA, Nievelstein RAJ, Kwee TC. Prognostic value of interim FDG-PET in Hodgkin lymphoma: systematic review and meta-analysis. Br J Haematol. 2015;170(3):356–66.

    Article  Google Scholar 

  26. Casasnovas R-O, Bouabdallah R, Brice P, Lazarovici J, Ghesquieres H, Stamatoullas A, et al. PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study. Lancet Oncol. 2019;20(2):202–15.

    Article  Google Scholar 

  27. Molnar Z, Simon Z, Borbenyi Z, Deak B, Galuska L, Keresztes K, et al. Prognostic value of FDG-PET in Hodgkin lymphoma for posttreatment evaluation. Long term follow-up results. Neoplasma. 2010;57(4):349–54.

    CAS  PubMed  Google Scholar 

  28. Pracchia LF, Chaves AAR, Cerci JJ, Soares Junior J, Meneghetti JC, Buccheri V. Metabolic test with fluorine-18-fluorodeoxyglucose in staging and detection of residual tumor or recurrence in Hodgkin lymphoma. Clinics (Sao Paulo). 2007;62(2):121–6.

    Article  Google Scholar 

  29. Barnes JA, LaCasce AS, Zukotynski K, Israel D, Feng Y, Neuberg D, et al. End-of-treatment but not interim PET scan predicts outcome in nonbulky limited-stage Hodgkin’s lymphoma. Ann Oncol. 2011;22(4):910–5.

    Article  CAS  Google Scholar 

  30. Rigacci L, Puccini B, Zinzani PL, Biggi A, Castagnoli A, Merli F, et al. 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): Interim-FDG-PET and early stage Hodgkin’s disease. Am J Hematol. 2015;90(6):499–503.

    Article  CAS  Google Scholar 

  31. Johnson P, Federico M, Kirkwood A, Fosså A, Berkahn L, Carella A, et al. Adapted treatment guided by interim PET-CT scan in advanced Hodgkin’s lymphoma. N Engl J Med. 2016;374(25):2419–29.

    Article  Google Scholar 

  32. Stephens DM, Li H, Schöder H, Straus DJ, Moskowitz CH, Leblanc M, et al. Five-year follow-up of SWOG S0816: limitations and values of a PET-adapted approach for stage III/IV Hodgkin lymphoma. Blood. 2019;134:1238.

    Article  Google Scholar 

  33. Gallamini A, Tarella C, Viviani S, Rossi A, Patti C, Mulé A, et al. Early chemotherapy intensification with escalated BEACOPP in patients with advanced-stage Hodgkin lymphoma with a positive interim positron emission tomography/computed tomography scan after two ABVD cycles: long-term results of the GITIL/FIL HD 0607 Trial. JCO. 2018;36(5):454–62.

    Article  CAS  Google Scholar 

  34. Spina V, Bruscaggin A, Cuccaro A, Martini M, Di Trani M, Forestieri G, et al. Circulating tumor DNA reveals genetics, clonal evolution, and residual disease in classical Hodgkin lymphoma. Blood. 2018;131(22):2413–25.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

None declared.

Author information

Authors and Affiliations

  1. Medical Oncology Intercentre Unit, Regional and Virgen de La Victoria University Hospitals, IBIMA, Teatinos, s/n, C.P., 29010, Málaga, Spain

    Laura Galvez-Carvajal, Inmaculada Ramos, Emilio Alba & Antonio Rueda

  2. Medical Oncology Department, Costa del Sol Hospital, Málaga, Spain

    Cristina Quero

  3. Haematology Department, Costa del Sol Hospital, Málaga, Spain

    María Casanova & Ángeles Medina

  4. Haematology Department, Regional University Hospital, Málaga, Spain

    Carola Díaz & Manuel Espeso

  5. Molecular Imaging Unit, CIMES, Málaga, Spain

    Jose Reinaldo Chícharo

Authors
  1. Laura Galvez-Carvajal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cristina Quero
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. María Casanova
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carola Díaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jose Reinaldo Chícharo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Manuel Espeso
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ángeles Medina
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Inmaculada Ramos
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Emilio Alba
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Antonio Rueda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio Rueda.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest, financial or otherwise. Lectures and advisory fees from Takeda and BMS. Investigational fee from Celgene.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Galvez-Carvajal, L., Quero, C., Casanova, M. et al. Ability of final PET/CT to predict response to first-line treatment in real patients with classical Hodgkin lymphoma. Int J Hematol 115, 54–60 (2022). https://doi.org/10.1007/s12185-021-03223-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12185-021-03223-6

Keywords

Search

Navigation