<sup>18</sup>F-FDG PET After 2 Cycles of ABVD Predicts Event-Free Survival in Early and Advanced Hodgkin Lymphoma

Cerci, Juliano Júlio; Pracchia, Luís Fernando; Linardi, Camila C.G.; Pitella, Felipe Arriva; Delbeke, Dominique; Izaki, Marisa; Trindade, Evelinda; Soares, José; Buccheri, Valéria; Meneghetti, José Cláudio

doi:10.2967/jnumed.109.073197

Cited by 135 publications

(92 citation statements)

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“…These results confirm that ABVD with or without consolidation radiotherapy, whatever the IPS score, is an adequate treatment for approximately 80% of patients with advanced-stage Hodgkin lymphoma. 4,5,[8][9][10]25,26 Currently, it remains uncertain whether optimizing the timing of interim PET imaging during treatment could further improve the NPV of the interim-PET scan 27 and prospective studies to answer this question are underway. [28][29][30][31][32][33][34][35][36][37][38][39] The proportion of patients in whom ABVD treatment was unsuccessful in controlling disease (17.3%) is in line with that in earlier studies.…”

Section: Discussionmentioning

confidence: 99%

The predictive role of interim positron emission tomography for Hodgkin lymphoma treatment outcome is confirmed using the interpretation criteria of the Deauville five-point scale

et al. 2014

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© F e r r a t a S t o r t i F o u n d a t i o ncomparable, with different timing of the interim PET during the course of treatment and differing PET methodologies. Most studies used stand-alone PET, which has now been replaced by PET-CT. Reporting methods were not consistent making it difficult to judge how these results should be applied in clinical practice.In 2009 an international meeting attended by hematologists and nuclear medicine specialists was held in Deauville, France, with the intention of defining simple and reproducible criteria for interim-PET reporting in lymphoma.11 A five-point scale (5-PS) developed at Guy's and St. Thomas' Hospital in London was adopted 12 as the "Deauville criteria". An international study was launched to compare previous reports on the accuracy of interim PET in predicting treatment outcome in Hodgkin lymphoma with an international cohort of patients scanned using PET-CT after two cycles of ABVD and to evaluate the reproducibility of the 5-PS among reporters. The criteria for enrollment, the breakdown of patients according to stage (early unfavorable and advanced-stage) and the endpoints were the same as in the JID. Methods Retrieval of patients' dataConsecutive patients affected by Hodgkin lymphoma from participating centers worldwide diagnosed between January 2002 and December 2009 were retrospectively enrolled with the following inclusion criteria: (i) stage IIB to stage IVB or stage IIA Hodgkin lymphoma with adverse prognostic factors (at least three nodal sites involved, sub-diaphragmatic presentation, bulky disease, and erythrocyte sedimentation rate > 40 mm/h); (ii) treatment with four to eight cycles of ABVD with or without involved-field radiotherapy or consolidation radiotherapy; (iii) staging with PET/CT at baseline and after two courses of ABVD (PET-0 and PET-2, respectively); (iv) no change to treatment based on interim-PET results; and (v) a minimum follow-up of 1 year after completion of firstline treatment. Patients escalated to salvage treatment during ABVD chemotherapy were eligible only if the treatment change was based on clinical and/or radiological evidence of disease progression/resistance.The study was approved by the ethical committee of the coordinating center in Cuneo (Italy) and conducted according to the Helsinki declaration. Specific informed written consent was not required as all data were retrospectively collected in an anonymized format, in agreement with specific institutional and national requirements. AG, SC and ER analyzed the data and all co-authors had access to the primary data.Clinical data on 400 patients were collected; however only 335 paired scans (baseline and interim) were available for review. Of these, 75 were then excluded because there were no CT data (n=21), no baseline PET (n=25), no interim PET (n=1), missing CT slices (n=3), missing PET slices (n=10), poor quality PET images (n=6) or miscellaneous reasons (n=9). Complete data from 260 patients were available for analysis from 17 international academic institut...

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Section: Discussionmentioning

confidence: 99%

The predictive role of interim positron emission tomography for Hodgkin lymphoma treatment outcome is confirmed using the interpretation criteria of the Deauville five-point scale

et al. 2014

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“…9 Furthermore, there is comparatively much less data regarding the predictive value of interim PET in earlystage HL versus advanced-stage HL, especially in favorable earlystage HL. 12,14,15,18,22,38 In the observational study by Gallamini and Hutchings that ignited an intense interest into response-adapted therapy in HL, only a minority of patients had early-stage disease and most of these patients had adverse risk factors (ie, unfavorable/ intermediate early-stage HL). 12 In a retrospective analysis of 85 HL patients who had interim FDG-PET/CT after 2-3 cycles of ABVD, the predictive power of FDG-PET/CT was much less robust for early-stage versus advancedstage HL patients (Figure 2A,B).…”

Section: Interim Pet/ct In Early-stage Hlmentioning

confidence: 99%

The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease

Evens

Kostakoğlu

2014

Hematology

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“…In another prospective study, of 104 mixed-stage HL patients (early stage, n 5 43) treated with ABVD (100%) and IFRT (79%), and using interpretation criteria similar to those of the IHP, a negative interim PET-2 result was highly predictive of treatment success regardless of stage or IPS risk category (42). In the earlystage group, the PPV and NPV of PET for treatment failure were 44% and 94%, respectively.…”

Section: What We Learned From Published 18 F-fdg Pet Studies On Hl LImentioning

confidence: 99%

“…reported a 3-y event-free survival of 55% and 94% for PET-2-positive and -negative patients, respectively (P , 0.001) (42). In the advanced-stage group, the 3-y event-free survival rates for PET-2-positive and PET-2-negative patients were 90% and 50%, respectively (P 5 0.002), and the PPV and NPV of PET-2 for treatment failure were 57% and 90%, respectively.…”

Section: Advanced-stage Hlmentioning

confidence: 99%

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

Kostakoğlu

Gallamini

2013

J Nucl Med

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the rationale behind the design of PET-adaptive studies either in a deescalation or an escalation setting; (2) the limitations of 18 F-FDG PET/CT interpretation criteria proposed for end-therapy and interimtherapy response evaluation; and (3) the challenges involved in the use of interim PET as a surrogate for therapy response.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, participants can access this activity through the SNMMI Web site (http:// www.snmmi.org/ce_online) through July 2016.Hodgkin lymphoma (HL) is a curable disease with currently available chemotherapy regimens. Major late morbidities can potentially be avoided in most limited-stage HL patients if the treatment can be adapted to the patient's early response profile. The therapy efficacy can also be increased early during therapy in nonresponding HL patients with the addition of involved-field radiation therapy or a switch to an escalated therapy protocol, particularly in advancedstage or unfavorable-risk patients. 18 F-FDG PET is a well-established surrogate for tumor chemosensitivity early during therapy. The ongoing PET-adaptive clinical trials are testing the hypothesis that a decision can reliably be made on escalating or deescalating therapy based on interim PET results. Discussed in this review is the integral role of interim 18 F-FDG PET in HL, challenges, critical issues to improve its accuracy, and the observations from completed interim PET studies and ongoing PET-adaptive clinical trials.

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¹⁸F-FDG PET After 2 Cycles of ABVD Predicts Event-Free Survival in Early and Advanced Hodgkin Lymphoma

Cited by 135 publications

References 17 publications

The predictive role of interim positron emission tomography for Hodgkin lymphoma treatment outcome is confirmed using the interpretation criteria of the Deauville five-point scale

The predictive role of interim positron emission tomography for Hodgkin lymphoma treatment outcome is confirmed using the interpretation criteria of the Deauville five-point scale

The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease

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

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18F-FDG PET After 2 Cycles of ABVD Predicts Event-Free Survival in Early and Advanced Hodgkin Lymphoma

Cited by 135 publications

References 17 publications

The predictive role of interim positron emission tomography for Hodgkin lymphoma treatment outcome is confirmed using the interpretation criteria of the Deauville five-point scale

The predictive role of interim positron emission tomography for Hodgkin lymphoma treatment outcome is confirmed using the interpretation criteria of the Deauville five-point scale

The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease

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

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¹⁸F-FDG PET After 2 Cycles of ABVD Predicts Event-Free Survival in Early and Advanced Hodgkin Lymphoma

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