Histological verification of positive positron emission tomography findings in the follow-up of patients with mediastinal lymphoma

Zinzani, Pier Luigi; Tani, Monica; Trisolini, Rocco; Fanti, Stefano; Stefoni, Vittorio; Alifano, Marco; Castellucci, Paolo; Musuraca, Gerardo; Dalpiaz, Giorgia; Alinari, Lapo; Marchi, Enrica; Fina, Mariapaola; Pellegrini, Cinzia; Farsad, Mohsen; Cancellieri, Alessandra; Busca, Annalisa; Canini, Romeo; Pileri, Stefano; Baccarani, Michele; Boaron, Maurizio

doi:10.3324/haematol.10798

Cited by 75 publications

(46 citation statements)

References 36 publications

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“…Therefore histology is recommended to prove relapse of the original disease, in keeping with other reports. 23 Patients with overt or histological-proven relapse were treated with chemotherapy and DLI: 50% of treated patients are disease free with a median follow-up of 18 months from DLI. The clinical response, observed after chemotherapy and donor lymphocyte infusions, together with a high number of patients who remain in CR with a 63% disease-free survival at 4 years, would suggest the existence of a graft-versus-Hodgkin's lymphoma effect, operating in the setting of haplo-transplants and PT-CY.…”

Section: Discussionmentioning

confidence: 99%

Unmanipulated haploidentical BMT following non-myeloablative conditioning and post-transplantation CY for advanced Hodgkin’s lymphoma

Raiola

Dominietto

Varaldo

et al. 2013

Bone Marrow Transplant

141

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Twenty-six patients with advanced Hodgkin's disease received a related HLA haploidentical unmanipulated BMT, following a nonmyeloablative conditioning with low-dose TBI, proposed by the Baltimore group; GvHD prophylaxis consisted of high-dose posttransplantation CY (PT-CY), mycophenolate and a calcineurin inhibitor. All patients had received a previous autograft, and 65% had active disease at the time of BMT. Sustained engraftment of donor cells occurred in 25 patients (96%), with a median time to neutrophil recovery (40.5 Â 10 9 /L) and platelet recovery (420 Â 10 9 /L) of þ 18 and þ 23 days from BMT. The incidence of grade II-IV acute GVHD and of chronic GVHD was 24% and 8%, respectively. With a median follow-up of 24 months (range 18-44) 21 patients are alive, 20 disease free. The cumulative incidence of TRM and relapse was 4% and 31%, respectively. The actuarial 3-year survival is 77%, the actuarial 3-year PFS is 63%. In conclusion, we confirm that high-dose PT-CY is effective as prophylaxis of GVHD after HLA haploidentical BMT, can prevent rejection and does not appear to eliminate the allogeneic graft versus lymphoma effect.

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Section: Discussionmentioning

confidence: 99%

Unmanipulated haploidentical BMT following non-myeloablative conditioning and post-transplantation CY for advanced Hodgkin’s lymphoma

Raiola

Dominietto

Varaldo

et al. 2013

Bone Marrow Transplant

141

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“…Less is known about the role of 18 FDG-PET during follow-up, especially its capability to detect relapse earlier with respect to CT or ultrasound imaging. So far, only few studies in literature focused on this issue and conclusions are not definite, raising the concern about sensitivity/specificity of the technique in this setting and the need of histological verification of 18 FDG-PET positivity [1,17,18]. In aggressive lymphomas, earlier detection is important since a timely salvage treatment is related to better outcome.…”

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confidence: 99%

Role of 18FDG-PET/CT in detecting relapse during follow-up of patients with Hodgkin’s lymphoma

et al. 2009

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The role of 18 FDG-PET/CT during follow-up of patients affected by Hodgkin's lymphoma (HL) in complete remission after treatment is not fully elucidated, since a wide use of 18 F fluorodeoxyglucose positron emission tomography/computed tomography ( 18 FDG-PET/CT) in this setting could be limited by a relative high rate of false-positive results. Herein, we summarize a retrospective analysis of 27 patients with Hodgkin's lymphoma in complete remission after the first-line (n=20) or salvage (n=7) therapy receiving serial 18 FDG-PET/CT scans during follow-up. Out of 165 scans, 13 were suspected for relapse, which was confirmed in seven patients. All relapses were correctly identified by 18 FDG-PET/CT positivity, with a 100% sensitivity; false-positive rate was 46% and negative predictive value was 100%. True-positive findings were mostly associated with multiple sites, subdiaphragmatic involvement, and/or previous sites of disease. According to our results, we conclude that performing routine PET/CT scan during follow-up of those patients who are at high risk of relapse would be advisable, although caution must be adopted when interpreting PET/CT results due to the relatively high rate of false-positive findings. If FDG abnormal uptake is present at multiple nodal sites, subdiaphragmatic lymph nodes, or previous sites of disease, histological verification of PET abnormal findings is warranted.

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“…However, both studies had a major (12)(13)(14)(15). Posttreatment and follow-up 18 F-FDG PET/CT studies have a strikingly high number of false-positive results, as has been reported for several lymphoma subtypes (16)(17)(18)(19), including Hodgkin lymphoma (20). Consequently, the studies by Gallamini et al (12,13) are methodologically seriously biased.…”

Section: Replymentioning

confidence: 85%

Reply: Interim PET in Hodgkin Lymphoma: Is It So Useless?

Adams

Kwee²

2017

J Nucl Med

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More than 2,000 patients with advanced disease were included in 3 well-designed prospective trials, in which patients who-after 2 cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine)-were PET-positive (Deauville score $ 4) were escalated to BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone) whereas those who were PET-negative continued with the standard regimen (4 cycles of ABVD) (1-3). The PET positivity rate using this Deauville score as the cutoff was similar across these 3 studies, as was the outcome of both PET-positive and PET-negative patients. The study of the Southwest Oncology Group (1) enrolled 336 patients, 18% of whom were PET-positive. The "Response Adapted Therapy in Advanced Hodgkin Lymphoma" study (2) enrolled 1,119 patients, 25% of whom were PET-positive. The Italian GITIL/FIL HD0607 trial (3) enrolled 773 patients, 19% of whom were PET-positive. Overall, the 2-y progression-free survival of the PET-positive patients ranged between 64% and 67%. PET-negative patients who followed the standard regimen had a 2-y progression-free survival ranging between 82% and 89%, higher than the progression-free survival of the whole population.A major advantage of this strategy is that PET-negative patients (.80% of the total population) can be spared from the adverse effects of BEACOPP. As pointed out by Adams and Kwee, none of the interim 18 F-FDG PET/CT-adapted trials that have been performed so far had a control arm; that is, none continued standard ABVD in PET-positive patients. Apart from the fact that this arm would have been ethically difficult to defend, series have found 2-y progression-free survivals of 12%-27% in advanced-stage Hodgkin lymphoma patients PET-positive after 2 ABVD cycles-much lower than the 64%-67% found when these patients were intensified with BEACOPP (4,5), with this strategy therefore clearly having an advantage in improving outcome and decreasing the number of events. This finding was further confirmed by the results of the EORTC/LYSA/FIL H10 trial (6), which included 1,950 patients with early-stage Hodgkin lymphoma randomized between an experimental arm and a standard arm. Patients PET-positive after 2 ABVD cycles had a 5-y progression-free survival of 77.4% in the experimental arm that received standard ABVD plus involved-node radiotherapy, and survival improved to 90.6% in the experimental arm that received BEACOPP escalation plus involved-node radiotherapy (hazard ratio, 0.42; 95% confidence interval, 0.23-0.74; P 5 0.002).A deescalation trial (7) in 823 patients with advanced Hodgkin lymphoma (AHL2011 LYSA trial) has also recently confirmed the major role of an interim PET-guided strategy. Patients PETnegative after 2 BEACOPP escalations were moved to ABVD. Their progression-free survival was not inferior to that of the standard arm, in which BEACOPP was continued. Thus, deescalation avoids the toxic effect of BEACOPP while producing the same outcome.In view of the cited evidence, we strongly disagree with A...

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Histological verification of positive positron emission tomography findings in the follow-up of patients with mediastinal lymphoma

Cited by 75 publications

References 36 publications

Unmanipulated haploidentical BMT following non-myeloablative conditioning and post-transplantation CY for advanced Hodgkin’s lymphoma

Unmanipulated haploidentical BMT following non-myeloablative conditioning and post-transplantation CY for advanced Hodgkin’s lymphoma

Role of 18FDG-PET/CT in detecting relapse during follow-up of patients with Hodgkin’s lymphoma

Reply: Interim PET in Hodgkin Lymphoma: Is It So Useless?

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