OSTEONECROSIS DETECTED BY WHOLE BODY MAGNETIC RESONANCE IN PATIENTS WITH HODGKIN LYMPHOMA TREATED BY BEACOPP
(Abstract release date: 05/19/16)
EHA Library. Patti C. 06/09/16; 134759; PB1859
Dr. Caterina Patti
Contributions
Contributions
Abstract
Abstract: PB1859
Type: Publication Only
Background
The treatment of Hodgkin Lymphoma (HL) has led to the progressive achievement of high survival rates over the last years . ABVD regimen has been considered for a long time the standard treatment for advanced-stage HL patients, due to well documented efficacy and a favourable toxicity profile. Several studies demonstrated the increase of progression-free survival rates by using BEACOPP regimen compared to ABVD, especially in advanced-stage disease, at the cost of increased toxicity.Osteonecrosis (ON) is a complication of chemotherapy that may compromise the patient's quality of life and it is often identified in advanced stages when the only available treatment is joint replacement. The use of corticosteroids is one of the most common risk factors, responsible for 10-30% of cases of ON
Aims
The purpose of this retrospective study was to assess the frequency of ON with the Whole Body MRI (WB-MRI) scans performed on patients with HL treated by different chemotherapy regimens, including protocols with high doses of corticosteroids
Methods
We evaluated the WB-MRI scans performed on 42 patients with HL treated by three chemotherapy regimens (6 ABVD, 2 ABVD + 4 escalated BEACOPP, 2 ABVD + 4 escalated BEACOPP + 4 standard BEACOPP), excluding those patients with main risk factors for ON. All the patients underwent WB-MRI without contrast agent administration and FDG-PET/CT before treatment, after two cycles of ABVD, after four cycles of escalated BEACOPP and a month after the end of chemotherapy.
Results
Six out of 7 patients (85.7%) who received 2 ABVD followed by 4 cycles of escalated BEACOPP + 4 standard BEACOPP and 1 out of 5 patients (20%) who received 2ABVD followed by 4 BEACOPP escalated presented ON, with a statistically significant difference of frequency between the two groups of patients (p<0.05); whereas no injury has been reported in patients treated by only ABVD. The ON lesions identified in those patients treated with eight BEACOPP were all absent on the WB-MRI scans performed after four escalated BEACOPP, so they developed ON during the last four cycles of chemotherapy. Among a total of 48 ON lesions observed, 23 (48%) were detected in the knee; multifocal ON were detected in six out of seven patients (86%)
Conclusion
The development of ON seems to be strictly related to the chemotherapy protocol adopted and the number of cycles received, strengthening the hypothesis of a correlation between the dose of corticosteroids included in the BEACOPP scheme and this complication. WB-MRI can be considered as a helpful tool that allows, not only for staging and follow patients with lymphoma, but also to detect ON in patients treated with corticosteroids, avoiding radiation exposure or contrast administration.
Session topic: E-poster
Keyword(s): Corticosteroids, Hodgkin's lymphoma, Magnetic resonance imaging, Osteonecrosis
Type: Publication Only
Background
The treatment of Hodgkin Lymphoma (HL) has led to the progressive achievement of high survival rates over the last years . ABVD regimen has been considered for a long time the standard treatment for advanced-stage HL patients, due to well documented efficacy and a favourable toxicity profile. Several studies demonstrated the increase of progression-free survival rates by using BEACOPP regimen compared to ABVD, especially in advanced-stage disease, at the cost of increased toxicity.Osteonecrosis (ON) is a complication of chemotherapy that may compromise the patient's quality of life and it is often identified in advanced stages when the only available treatment is joint replacement. The use of corticosteroids is one of the most common risk factors, responsible for 10-30% of cases of ON
Aims
The purpose of this retrospective study was to assess the frequency of ON with the Whole Body MRI (WB-MRI) scans performed on patients with HL treated by different chemotherapy regimens, including protocols with high doses of corticosteroids
Methods
We evaluated the WB-MRI scans performed on 42 patients with HL treated by three chemotherapy regimens (6 ABVD, 2 ABVD + 4 escalated BEACOPP, 2 ABVD + 4 escalated BEACOPP + 4 standard BEACOPP), excluding those patients with main risk factors for ON. All the patients underwent WB-MRI without contrast agent administration and FDG-PET/CT before treatment, after two cycles of ABVD, after four cycles of escalated BEACOPP and a month after the end of chemotherapy.
Results
Six out of 7 patients (85.7%) who received 2 ABVD followed by 4 cycles of escalated BEACOPP + 4 standard BEACOPP and 1 out of 5 patients (20%) who received 2ABVD followed by 4 BEACOPP escalated presented ON, with a statistically significant difference of frequency between the two groups of patients (p<0.05); whereas no injury has been reported in patients treated by only ABVD. The ON lesions identified in those patients treated with eight BEACOPP were all absent on the WB-MRI scans performed after four escalated BEACOPP, so they developed ON during the last four cycles of chemotherapy. Among a total of 48 ON lesions observed, 23 (48%) were detected in the knee; multifocal ON were detected in six out of seven patients (86%)
Conclusion
The development of ON seems to be strictly related to the chemotherapy protocol adopted and the number of cycles received, strengthening the hypothesis of a correlation between the dose of corticosteroids included in the BEACOPP scheme and this complication. WB-MRI can be considered as a helpful tool that allows, not only for staging and follow patients with lymphoma, but also to detect ON in patients treated with corticosteroids, avoiding radiation exposure or contrast administration.
Session topic: E-poster
Keyword(s): Corticosteroids, Hodgkin's lymphoma, Magnetic resonance imaging, Osteonecrosis
Abstract: PB1859
Type: Publication Only
Background
The treatment of Hodgkin Lymphoma (HL) has led to the progressive achievement of high survival rates over the last years . ABVD regimen has been considered for a long time the standard treatment for advanced-stage HL patients, due to well documented efficacy and a favourable toxicity profile. Several studies demonstrated the increase of progression-free survival rates by using BEACOPP regimen compared to ABVD, especially in advanced-stage disease, at the cost of increased toxicity.Osteonecrosis (ON) is a complication of chemotherapy that may compromise the patient's quality of life and it is often identified in advanced stages when the only available treatment is joint replacement. The use of corticosteroids is one of the most common risk factors, responsible for 10-30% of cases of ON
Aims
The purpose of this retrospective study was to assess the frequency of ON with the Whole Body MRI (WB-MRI) scans performed on patients with HL treated by different chemotherapy regimens, including protocols with high doses of corticosteroids
Methods
We evaluated the WB-MRI scans performed on 42 patients with HL treated by three chemotherapy regimens (6 ABVD, 2 ABVD + 4 escalated BEACOPP, 2 ABVD + 4 escalated BEACOPP + 4 standard BEACOPP), excluding those patients with main risk factors for ON. All the patients underwent WB-MRI without contrast agent administration and FDG-PET/CT before treatment, after two cycles of ABVD, after four cycles of escalated BEACOPP and a month after the end of chemotherapy.
Results
Six out of 7 patients (85.7%) who received 2 ABVD followed by 4 cycles of escalated BEACOPP + 4 standard BEACOPP and 1 out of 5 patients (20%) who received 2ABVD followed by 4 BEACOPP escalated presented ON, with a statistically significant difference of frequency between the two groups of patients (p<0.05); whereas no injury has been reported in patients treated by only ABVD. The ON lesions identified in those patients treated with eight BEACOPP were all absent on the WB-MRI scans performed after four escalated BEACOPP, so they developed ON during the last four cycles of chemotherapy. Among a total of 48 ON lesions observed, 23 (48%) were detected in the knee; multifocal ON were detected in six out of seven patients (86%)
Conclusion
The development of ON seems to be strictly related to the chemotherapy protocol adopted and the number of cycles received, strengthening the hypothesis of a correlation between the dose of corticosteroids included in the BEACOPP scheme and this complication. WB-MRI can be considered as a helpful tool that allows, not only for staging and follow patients with lymphoma, but also to detect ON in patients treated with corticosteroids, avoiding radiation exposure or contrast administration.
Session topic: E-poster
Keyword(s): Corticosteroids, Hodgkin's lymphoma, Magnetic resonance imaging, Osteonecrosis
Type: Publication Only
Background
The treatment of Hodgkin Lymphoma (HL) has led to the progressive achievement of high survival rates over the last years . ABVD regimen has been considered for a long time the standard treatment for advanced-stage HL patients, due to well documented efficacy and a favourable toxicity profile. Several studies demonstrated the increase of progression-free survival rates by using BEACOPP regimen compared to ABVD, especially in advanced-stage disease, at the cost of increased toxicity.Osteonecrosis (ON) is a complication of chemotherapy that may compromise the patient's quality of life and it is often identified in advanced stages when the only available treatment is joint replacement. The use of corticosteroids is one of the most common risk factors, responsible for 10-30% of cases of ON
Aims
The purpose of this retrospective study was to assess the frequency of ON with the Whole Body MRI (WB-MRI) scans performed on patients with HL treated by different chemotherapy regimens, including protocols with high doses of corticosteroids
Methods
We evaluated the WB-MRI scans performed on 42 patients with HL treated by three chemotherapy regimens (6 ABVD, 2 ABVD + 4 escalated BEACOPP, 2 ABVD + 4 escalated BEACOPP + 4 standard BEACOPP), excluding those patients with main risk factors for ON. All the patients underwent WB-MRI without contrast agent administration and FDG-PET/CT before treatment, after two cycles of ABVD, after four cycles of escalated BEACOPP and a month after the end of chemotherapy.
Results
Six out of 7 patients (85.7%) who received 2 ABVD followed by 4 cycles of escalated BEACOPP + 4 standard BEACOPP and 1 out of 5 patients (20%) who received 2ABVD followed by 4 BEACOPP escalated presented ON, with a statistically significant difference of frequency between the two groups of patients (p<0.05); whereas no injury has been reported in patients treated by only ABVD. The ON lesions identified in those patients treated with eight BEACOPP were all absent on the WB-MRI scans performed after four escalated BEACOPP, so they developed ON during the last four cycles of chemotherapy. Among a total of 48 ON lesions observed, 23 (48%) were detected in the knee; multifocal ON were detected in six out of seven patients (86%)
Conclusion
The development of ON seems to be strictly related to the chemotherapy protocol adopted and the number of cycles received, strengthening the hypothesis of a correlation between the dose of corticosteroids included in the BEACOPP scheme and this complication. WB-MRI can be considered as a helpful tool that allows, not only for staging and follow patients with lymphoma, but also to detect ON in patients treated with corticosteroids, avoiding radiation exposure or contrast administration.
Session topic: E-poster
Keyword(s): Corticosteroids, Hodgkin's lymphoma, Magnetic resonance imaging, Osteonecrosis
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