Role of [18F]-fluoro-2-deoxy-d-glucose positron emission tomography in early and late therapy assessment of patients with advanced Hodgkin lymphoma treated with bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine and prednisone

Abstract

The prognostic value of positron emission tomography (PET) in early therapy response assessment, after completion of chemotherapy and 3 months after the end of treatment in advanced Hodgkin lymphoma (HL) remains to be defined. We report the results of 69 patients with first presentation of advanced HL. [18F]-fluoro-2-deoxy-d-glucose (FDG)-PET scan was performed after four cycles (PET-4), on completion of chemotherapy after 6/8 cycles (PET-6/8) and 3 months after the completion of chemotherapy (PET 3-months). Median follow-up was 55 months. The negative predictive value (NPV) for PET-4, PET-6/8 and PET 3-months was 98%, 95% and 97%, respectively. The 4-year progression-free survival (PFS) for PET-4 negative (n = 51) and PET-4 positive (n = 18) patients was 96% and 78%, respectively (p = 0.016). The 4-year PFS for PET-6/8 negative (n = 59) and PET-6/8 positive (n = 9) patients was 95% and 78%, respectively (p = 0.046). Patients with a large mediastinal mass constituted nearly all of the PET-4 positive (16/18) and PET-6/8 positive (8/9) patients. After radiotherapy of PET-6/8 positive patients, PET 3-months was negative in 64 (97%) and positive in two (3%) patients. PET 3-months after the end of chemotherapy was of limited value when the interim PET-4 was negative. Interim PET after four cycles of bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine and prednisone (BEACOPP) is a strong prognostic marker for PFS in advanced HL.

Clinical pretreatment risk factors and prediction of outcome using gallium 67 scintigraphy in patients with Hodgkin's lymphoma

“…Considering the common finding of persistent masses on CT scan, the assessment of response and, consequently, the disease status, often represent a problem among patients diagnosed with HL due to the difficulties in distinguishing fibrotic tissue from active disease (31). In addition to PET scan, which is a technique based on tumor metabolic rate to distinguish fibrotic tissue from residual masses (32,33), gallium scan has been successfully used for several years for this purpose in patients with HL following standard chemotherapy and prior to autologous hematopoietic transplantation (34,35).…”

Response Assessment Criteria and Their Applications in Lymphoma: Part 2

“…Most of these studies performed PET scans after 2 cycles of chemotherapy (PET-2) and at the completion of therapy and follow-up. The value of interim imaging at other points during treatment has been compared with that of PET-2; PET-1 has been shown to be prognostically inferior (12), whereas PET-4 has been comparable (13,14). PET-2 has therefore come to be the most common and well-validated interim response measurement in HL.…”

Interim18F-FDG PET in Hodgkin Lymphoma: Would PET-Adapted Clinical Trials Lead to a Paradigm Shift?

“…The efficacy of BEACOPP regimen intensification in PET-2-positive patients with advancedstage HL during ABVD therapy is currently being tested in several multicenter clinical trials whose results are pending (Table 2). Four studies have reported the results of a PET-adapted strategy in this population (33,(47)(48)(49).…”

“…In the HD15 trial from the GHSG, a subset of 69 patients who had newly diagnosed clinical stage III, IV, or IIB HL with a large mediastinal mass or extranodal disease were treated with either 8 (n 5 35) or 6 (n 5 24) cycles of escalated BEACOPP or with 8 cycles of BEACOPP14 (n 5 10), and interim PET after 4 cycles proved to have quite a high NPV for PFS (47). Similar to the IHP criteria, 18 F-FDG uptake above the level of the mediastinal blood pool was considered PET-positive.…”