Predictive Value of 18F-Fluorodeoxyglucose Positron Emission Tomography (FDG PET) Performed after Two Cycles of Standard Chemotherapy (CT) on Treatment Outcome in Hodgkin Disease.

Gallamini, Andrea; Rigacci, Luigi; Merli, Francesco; Errico, Pasquale; Levis, Alessandro; Biggi, Alberto; Castagnoli, Antonio; Tavera, Silvia; Nassi, Luca

doi:10.1182/blood.v104.11.310.310

Cited by 52 publications

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“…PET results in our patients are in line with other recent reports on 84% PFS of interim PET-negative patients [19]. However, these figures are lower than initial studies, who reported more than 90% PFS in interim PET-negative patients [10,11,19].…”

Section: Discussionsupporting

confidence: 92%

“…In 2006, Gallamini et al and Hutchings et al reported that PET examination with [ 18 F]fluorodeoxyglucose (FDG) after 2 cycles of standard chemotherapy, later on termed "interim-positron emission tomography (PET)", discriminates PET-negative patients with a very high probability of disease control with the standard chemotherapy regimen Adriamycin, Bleomycin, Vinblastine, Dacarbazine (ABVD), from PET-positive patients where standard therapy is most likely to fail [10,11]. These data were confirmed by several studies on patient groups with limited or advanced stage disease treated with ABVD, while the prognostic value of interim PET for patients treated with BEACOPP is not well established [12][13][14][15].…”

Section: Cd68+ Cell Count Early Evaluation With Pet and Plasma Tarc mentioning

confidence: 99%

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CD68+ cell count, early evaluation with PET and plasma TARC levels predict response in Hodgkin lymphoma

et al. 2016

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Early response evaluation with [18F]fluordeoxyglucose (FDG) positron emission tomography after 2 cycles of chemotherapy (interim PET) has been indicated as the strongest predictor for outcome in classical Hodgkin lymphoma (HL). We studied the prognostic role of the number of tumor‐infiltrating CD68+ cells and of the plasma levels of TARC (thymus and activation‐regulated chemokine) in the context of interim PET in 102 patients with classical HL treated with Adriamycin, Bleomycin, Vinblastine, Dacarbazine (ABVD). After 2 ABVD cycles, interim PET according to Deauville criteria was negative (score 0–3) in 85 patients and positive (score 4–5) in 15 patients (2 patients technically not evaluable). TARC levels were elevated in 89% of patients at diagnosis, and decreased after 2 cycles in 82% of patients. Persistently elevated TARC levels in 18% of patients were significantly associated with a positive PET result (P = 0.007). Strong predictors for progression‐free survival (PFS) were a negative interim PET (85% vs. 28%, P < 0.0001) and CD68+ cell counts <5% (89% vs. 67%, P = 0.006), while TARC levels at diagnosis and at interim evaluation had no prognostic role. In multivariate analysis, interim PET, CD68+ cell counts and presence of B‐symptoms were independently associated with PFS. We conclude that although TARC levels are a biomarker for early response evaluation, they cannot substitute for interim PET as outcome predictor in HL. The evaluation of CD68 counts and B‐symptoms at diagnosis may help to identify low‐risk patients regardless positive interim PET.

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Section: Discussionsupporting

confidence: 92%

Section: Cd68+ Cell Count Early Evaluation With Pet and Plasma Tarc mentioning

confidence: 99%

CD68+ cell count, early evaluation with PET and plasma TARC levels predict response in Hodgkin lymphoma

et al. 2016

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“…The 5-year relapse rate was 3.4% in the routine surveillance group and 7.4% in the clinical surveillance group, which are similar to recent studies in which PET-adapted therapy was used and event-free survival was in the 90% to 96% range. [24][25][26][27][28] A recent study that examined patients with cHL who achieved remission with frontline therapy and were followed by routine surveillance imaging versus clinical surveillance had relapse and overall survival rates similar those in our patients. 29 Our study focused on patients who achieved complete remission (defined by PET scan) with frontline therapy.…”

Section: Discussionsupporting

confidence: 68%

Limited utility of routine surveillance imaging for classical Hodgkin lymphoma patients in first complete remission

Pingali

Jewell

Havlat

et al. 2014

Cancer

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BACKGROUND:The objective of this study was to compare the outcomes of patients with classical Hodgkin lymphoma (cHL) who achieved complete remission with frontline therapy and then underwent either clinical surveillance or routine surveillance imaging. METHODS: In total, 241 patients who were newly diagnosed with cHL between January 2000 and December 2010 at 3 participating tertiary care centers and achieved complete remission after first-line therapy were retrospectively analyzed. Of these, there were 174 patients in the routine surveillance imaging group and 67 patients in the clinical surveillance group, based on the intended mode of surveillance. In the routine surveillance imaging group, the intended plan of surveillance included computed tomography and=or positron emission tomography scans; whereas, in the clinical surveillance group, the intended plan of surveillance was clinical examination and laboratory studies, and scans were obtained only to evaluate concerning signs or symptoms. Baseline patient characteristics, prognostic features, treatment records, and outcomes were collected. The primary objective was to compare overall survival for patients in both groups. For secondary objectives, we compared the success of second-line therapy and estimated the costs of imaging for each group. RESULTS: After 5 years of follow-up, the overall survival rate was 97% (95% confidence interval, 92%-99%) in the routine surveillance imaging group and 96% (95% confidence interval, 87%-99%) in the clinical surveillance group (P 5.41). There were few relapses in each group, and all patients who relapsed in both groups achieved complete remission with second-line therapy. The charges associated with routine surveillance imaging were significantly higher than those for the clinical surveillance strategy, with no apparent clinical benefit. CONCLUSIONS: Clinical surveillance was not inferior to routine surveillance imaging in patients with cHL who achieved complete remission with frontline therapy. Routine surveillance imaging was associated with significantly increased estimated imaging charges. Cancer 2014;120:2122-9.

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“…The use of PET scans to predict response to chemotherapy in patients with advanced disease is being explored. Gallamini et al [17] prospectively studied 108 patients to determine whether a PET scan can predict treatment outcome in advanced-stage HD. All patients underwent a PET scan after two cycles of chemotherapy, and recurrences were confirmed by biopsy.…”

Section: Predicting Relapse and Improving Therapymentioning

confidence: 99%

Salvage Therapy in Hodgkin's Lymphoma

Byrne

Gockerman

2007

The Oncologist

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Hodgkin's disease is a rare malignancy that affects approximately 7,500 patients per year in the U.S., leading to an estimated 1,400 deaths. The relapse rate for this disease varies from around 5% for early-stage disease to 35% for patients with advanced disease. Patients who relapse after chemotherapy have about a 20% cure rate with conventional salvage chemotherapy. Two randomized phase III studies have shown an improved failure-free survival rate with high-dose chemotherapy and autologous stem cell support compared with conventional chemotherapy in re- CASE PRESENTATIONMr. T is a 50-year-old African-American male with a past medical history significant for type 2 diabetes mellitus. In January 2002, he presented to the emergency room with complaints of fever, chills, right groin pain, and a 25-pound weight loss over the last several months. Initial laboratory evaluation revealed an elevated white cell count of 11,800, hemoglobin of 11.7 g/dl, hematocrit of 35.8, platelet count of 406,000, and an elevated blood sugar of 516 mg/dl. A chest radiograph revealed right paratracheal lymphadenopathy and a patchy density overlying the left upper lung field. A computed tomography (CT) scan of the chest, abdomen, and pelvis showed enlarged lymph nodes in the mediastinum and the prevascular, right paratracheal, subcarinal, left axillary, left subclavian, azygoesophageal recess, and inguinal and bilateral iliac regions. A biopsy of the enlarged right cervical lymph node revealed fibrofatty connective tissue. A mediastinoscopy with biopsy was performed, and the pathology revealed mixed cellularity-type Hodgkin's lymphoma (Fig. 1). A gallium scan was positive in the mediastinal, left axillary, and right inguinal nodes. A bone marrow biopsy revealed Hodgkin's lymphoma, and the patient was considered to have clinical-stage IVB disease (Fig. 2). He underwent treatment with adriamycin, bleomycin, vincristine, and dacarbazine (ABVD) chemotherapy for four cycles. Restaging gallium scan was negative for nodal uptake, and a CT scan showed significant decrease in the lymphadenopathy. After four additional cycles of ABVD, repeat staging revealed new gallium-avid disease in the right paratracheal region, with stable disease upon CT scan. Repeat bone marrow biopsy was negative. The patient was considered to have refractory disease and underwent salvage therapy with rituximab, ifosfamide, carboplatin, and etoposide. After two cycles, he had a negative gallium

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Predictive Value of 18F-Fluorodeoxyglucose Positron Emission Tomography (FDG PET) Performed after Two Cycles of Standard Chemotherapy (CT) on Treatment Outcome in Hodgkin Disease.

Cited by 52 publications

References 0 publications

CD68+ cell count, early evaluation with PET and plasma TARC levels predict response in Hodgkin lymphoma

CD68+ cell count, early evaluation with PET and plasma TARC levels predict response in Hodgkin lymphoma

Limited utility of routine surveillance imaging for classical Hodgkin lymphoma patients in first complete remission

Salvage Therapy in Hodgkin's Lymphoma

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