Klin Padiatr 2014; 226 - O_26
DOI: 10.1055/s-0034-1371170

Pleural Effusion in Intermediate Hodgkin Lymphoma COG Protocol AHOD0031-Evolution with Therapy and Association with Bulk Mediastinal Disease or Bone, Lung or Pleural Nodular Disease

K McCarten 1, M Metzger 2, R Drachtman 3, S Voss 4, D Friedman 5, C Schwartz 6, S Cho 7
  • 1Hasbro Children's Hospital, Diagnostic Imaging, Providence, United States
  • 2St. Jude Research Hospital, Hematology Oncology, Memphis, United States
  • 3Rutgers University, Hematology Oncology, Neew Brunswick, United States
  • 4Boston Children's Hospital, Diagnostic Imaging, Boston, United States
  • 5Vanderbilt University, Hematology Oncology, Nashville, United States
  • 6MD Anderson Medical Center, Hematology Oncology, Houston, United States
  • 7Johns Hopkins University, Nuclear Medicine, Baltimore, United States

Purpose: Hodgkin Lymphoma (HL) can be associated with pleural effusion but its clinical significance is unclear. We performed a retrospective review of patients enrolled in the COG AHOD0031 intermediate risk HL protocol to determine the evolution of pleural effusion and to determine the significance of coexisting factors such as pleural, lung or bone mass, staging, mediastinal bulk, or response to chemotherapy.

Methods: COG AHOD0031 was conducted between 2002 – 2009 to evaluate a response based treatment regimen in intermediate risk HL patients (Stages IA and IIA with bulk, IIB, IIIA and IVA) who received multi-agent chemotherapy. Of 1712 patients accrued, 1449 had adequate axial CT scans available for evaluation; 195 had effusions recorded as trace, small, moderate, or large. Effusions were classified as simple or complex (i.e. associated pleural nodules or extranodal extension in lung or bone). FDG avidity was evaluated in the 119/195 for whom PET imaging was available.

Results: Simple pleural effusions were seen in 183 of 195 patients; all effusions resolved after 2 cycles of chemotherapy and all who had PET were PET-. Of the 12 with complex effusions 8 had pleural nodules, 2 lung involvement, and 2 bone involvement; PET was available in 10 and positive in the pleural space initially and all became PET – after 2 cycles of chemotherapy but some CT abnormality persisted. Staging in the pleural effusion group did not differ from the entire cohort. 84% of patients in the pleural effusion group had bulky mediastinal disease vs. 73% of the entire cohort with bulk in any location not necessarily mediastinum. 34% with pleural effusion were slow early responders vs. 17% in the entire cohort.

Conclusion: Pleural effusion at diagnosis is associated with mediastinal bulk and with slower response to therapy. While pleural effusion may not be an independent prognostic factor, its association with other predictors of outcome warrants further investigation.