The Emerging Role of PET in Hodgkin Lymphoma Patients Receiving Autologous Stem Cell Transplant

Bastian von Tresckow; Andreas Engert

Disclosures

Expert Rev Hematol. 2012;5(5):483-486. 

In This Article

Summary of Methods & Results

Methods

Cocorocchio et al. present a retrospective analysis on 97 consecutive patients who received high-dose chemotherapy (HDCT) with autologous stem cell transplant (ASCT) for refractory (62 patients) or relapsed (35 patients) Hodgkin lymphoma (HL) in a single institution from 1995 to 2009.[1] In these patients, chemotherapy at initial diagnosis consisted of hybrid regimens such as chlorambucil, vinblastine, procarbazine, prednisone, adriamycin, bleomycin and etoposide (ChlVPP/ABVVP)[2] or mechlorethamine, vincristine, procarbazine, prednisone, adriamycin, bleomycin, vinblastine and dacarbazine (MOPP/ABVD)[3] in 34 patients, whereas 37 patients received adriamycin, bleomycin, vinblastine and dacarbazine (ABVD)[4] and 11 patients received vinblastine, bleomycin and methotrexate (VBM).[5] Overall, 44 patients received combined modality treatment with additional radiotherapy. For the treatment of relapse or refractory disease, one to three cycles of etoposide, methylprednisolone, cytarabine and cisplatin (ESHAP) were chosen as induction therapy in 73 patients, whereas 16 patients received one to four cycles of ifosfamide, gemcitabine, vinorelbine and prednisone (IGEV). HDCT after induction therapy consisted of carmustine, etoposide, cytarabine and melphalan (BEAM) in 84 patients or idarubicin and melphalan in 13 patients. Consolidation radiotherapy was performed in 18 patients. Responses were assessed according to the Cheson criteria.[6] Additionally, 41 patients underwent positron emission tomography (PET) before and 78 patients after transplant. PET results were evaluated according to the Gallamini criteria.[7]

To identify prognostic factors for progression-free survival (PFS) and overall survival (OS), a multivariate analysis was performed that included age, sex, disease status (refractory/relapsed), disease stage, B symptoms, presence of extranodal involvement, bulky disease, elevated lactate dehydrogenase, number of previous chemotherapy lines, remission status before transplant and 18F-fluoro-deoxy-D-glucose PET. Survival curves were estimated using the Kaplan-Meier method and the log-rank test was applied to assess survival differences between the groups in the univariate analysis. The Cox proportional hazard regression model was used for the multivariate survival analysis.

Results

After induction therapy, 39 patients obtained complete remission (CR) or CR unconfirmed (CRu), 51 partial remission (PR) and seven stable disease (SD) or progressive disease (PD). After transplant, overall response rate was 91%, with CR in 76 out of 97 patients. Thirty-four patients were considered as treatment failures: 13 patients progressed after CR and 21 did not achieve CR after transplant. Altogether, 28 patients died and HL was the most frequent cause of death (23 patients). With a median follow-up of 45 months, 5-year PFS and OS were 64 and 71%, respectively.

Disease status after induction therapy was the most important prognostic factor for PFS and OS in univariate and multivariate analyses. 5-year PFS was 81, 56 and 29% for patients with CR, PR and SD/PD, respectively; 5-year OS was 85, 65 and 43% for patients with CR, PR and SD/PD, respectively. Neither refractory disease before induction therapy nor time to relapse was a statistically significant prognostic factor in the analysis. Both pre- and post-transplant PET results were significant prognostic factors: 5-year PFS among patients with negative PET before ASCT was 79 versus 43% in PET-positive patients (log-rank test p-value: <0.01). 5-year OS among patients with negative PET was 92%, whereas it was 43% among PET-positive patients (log-rank test p-value: <0.01). Similar results were observed for PET after transplant: 5-year PFS for patients with negative and positive PET was 86 and 22%, respectively (log-rank test p-value: <0.01); 5-year OS for patients with negative and positive PET was 92 and 43%, respectively (log-rank test p-value: <0.01).

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