BASELINE TOTAL METABOLIC VOLUME (TMTV) PREDICTS THE OUTCOME OF PATIENTS WITH ADVANCED HODGKIN LYMPHOMA (HL) ENROLLED IN THE AHL2011 LYSA TRIAL
(Abstract release date: 05/19/16)
EHA Library. CASASNOVAS O. 06/10/16; 135138; S105
Dr. Olivier CASASNOVAS
Contributions
Contributions
Abstract
Abstract: S105
Type: Oral Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 11:30 - 11:45
Location: Hall A2
Background
The TMTV assessed on the baseline FDG-PET is a novel approach of tumor burden measurement quantifying the most active part of the tumor. It has been reported to influence HL outcome in a retrospective series (Kanoun et al, EJNM 2014; 41: 1735).
Aims
We designed a study evaluating the TMTV prognosis value in patients (pts) prospectively enrolled in a phase III randomized trial testing a treatment strategy driven by PET, compared to a standard treatment not monitored by PET.
Methods
Eligible pts for the present study had to be enrolled in the AHL2011 trial (NCT01358747) and to have a baseline PET (PET0) available for central review and TMTV calculation. Pts were 16-60 y, with a previously untreated advanced HL (Ann Arbor stage III, IV or high risk IIB) and were randomly assigned to a treatment strategy driven by PET after 2 escalated BEACOPP (BEA) cycles (PET2), delivering 4 cycles of ABVD for PET2 negative (PET2-) pts and 4 cycles of BEA for PET2 positive (PET2+) pts or a standard treatment not monitored by PET and delivering 6 cycles of BEA. PET2 were centrally reviewed and interpreted according to Deauville criteria. TMTV was computed on PET0 by summing the metabolic volumes of the individual lesions using the 41% SUVmax thresholding method already described in lymphoma (Meignan et al, EJNM 2014; 41: 113).
Results
392 pts with a median age of 30 years were included: 64% were male, 89% had stage III/IV, and 59% an IPS≥3. Median TMTV was 200 ml (23 – 2149). Using a X-tile method a 350ml cut off value was firstly identified in a training set of patients (n = 262; 67%) randomly obtained from the whole population, and found to predict PFS in both the training and validation sets of pts (n = 130; 33%). With a median follow up of 16 months, 2y-PFS was 81% vs 93% in pts with high and low TMTV respectively in the whole population (p = 0.0015; HR = 3). PET2 positivity was also related to a lower 2y-PFS compared to PET2- pts (76% vs 92%; p<0.0001). Then 3 groups could be identified: pts with either [high TMTV and PET2+ (n = 23; 6%)], or [high TMTV and PET2-, or low TMTV and PET2+ (n = 103; 27%)], or [low TMTV and PET2- (n = 261; 67%)] had a 61%, 88%, 94% 2y-PFS respectively (p<0.0001).
Conclusion
The TMTV predicts the outcome of young advanced HL pts independently of the early metabolic response to treatment. The combination of TMTV and PET2 allows identifying 3 subsets of HL pts with significantly different outcome that may help clinician to better tailor therapy.
Session topic: First-line treatment of Hodgkin Lymphoma
Keyword(s): Hodgkin's lymphoma, PET, Prognosis
Type: Oral Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 11:30 - 11:45
Location: Hall A2
Background
The TMTV assessed on the baseline FDG-PET is a novel approach of tumor burden measurement quantifying the most active part of the tumor. It has been reported to influence HL outcome in a retrospective series (Kanoun et al, EJNM 2014; 41: 1735).
Aims
We designed a study evaluating the TMTV prognosis value in patients (pts) prospectively enrolled in a phase III randomized trial testing a treatment strategy driven by PET, compared to a standard treatment not monitored by PET.
Methods
Eligible pts for the present study had to be enrolled in the AHL2011 trial (NCT01358747) and to have a baseline PET (PET0) available for central review and TMTV calculation. Pts were 16-60 y, with a previously untreated advanced HL (Ann Arbor stage III, IV or high risk IIB) and were randomly assigned to a treatment strategy driven by PET after 2 escalated BEACOPP (BEA) cycles (PET2), delivering 4 cycles of ABVD for PET2 negative (PET2-) pts and 4 cycles of BEA for PET2 positive (PET2+) pts or a standard treatment not monitored by PET and delivering 6 cycles of BEA. PET2 were centrally reviewed and interpreted according to Deauville criteria. TMTV was computed on PET0 by summing the metabolic volumes of the individual lesions using the 41% SUVmax thresholding method already described in lymphoma (Meignan et al, EJNM 2014; 41: 113).
Results
392 pts with a median age of 30 years were included: 64% were male, 89% had stage III/IV, and 59% an IPS≥3. Median TMTV was 200 ml (23 – 2149). Using a X-tile method a 350ml cut off value was firstly identified in a training set of patients (n = 262; 67%) randomly obtained from the whole population, and found to predict PFS in both the training and validation sets of pts (n = 130; 33%). With a median follow up of 16 months, 2y-PFS was 81% vs 93% in pts with high and low TMTV respectively in the whole population (p = 0.0015; HR = 3). PET2 positivity was also related to a lower 2y-PFS compared to PET2- pts (76% vs 92%; p<0.0001). Then 3 groups could be identified: pts with either [high TMTV and PET2+ (n = 23; 6%)], or [high TMTV and PET2-, or low TMTV and PET2+ (n = 103; 27%)], or [low TMTV and PET2- (n = 261; 67%)] had a 61%, 88%, 94% 2y-PFS respectively (p<0.0001).
Conclusion
The TMTV predicts the outcome of young advanced HL pts independently of the early metabolic response to treatment. The combination of TMTV and PET2 allows identifying 3 subsets of HL pts with significantly different outcome that may help clinician to better tailor therapy.
Session topic: First-line treatment of Hodgkin Lymphoma
Keyword(s): Hodgkin's lymphoma, PET, Prognosis
Abstract: S105
Type: Oral Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 11:30 - 11:45
Location: Hall A2
Background
The TMTV assessed on the baseline FDG-PET is a novel approach of tumor burden measurement quantifying the most active part of the tumor. It has been reported to influence HL outcome in a retrospective series (Kanoun et al, EJNM 2014; 41: 1735).
Aims
We designed a study evaluating the TMTV prognosis value in patients (pts) prospectively enrolled in a phase III randomized trial testing a treatment strategy driven by PET, compared to a standard treatment not monitored by PET.
Methods
Eligible pts for the present study had to be enrolled in the AHL2011 trial (NCT01358747) and to have a baseline PET (PET0) available for central review and TMTV calculation. Pts were 16-60 y, with a previously untreated advanced HL (Ann Arbor stage III, IV or high risk IIB) and were randomly assigned to a treatment strategy driven by PET after 2 escalated BEACOPP (BEA) cycles (PET2), delivering 4 cycles of ABVD for PET2 negative (PET2-) pts and 4 cycles of BEA for PET2 positive (PET2+) pts or a standard treatment not monitored by PET and delivering 6 cycles of BEA. PET2 were centrally reviewed and interpreted according to Deauville criteria. TMTV was computed on PET0 by summing the metabolic volumes of the individual lesions using the 41% SUVmax thresholding method already described in lymphoma (Meignan et al, EJNM 2014; 41: 113).
Results
392 pts with a median age of 30 years were included: 64% were male, 89% had stage III/IV, and 59% an IPS≥3. Median TMTV was 200 ml (23 – 2149). Using a X-tile method a 350ml cut off value was firstly identified in a training set of patients (n = 262; 67%) randomly obtained from the whole population, and found to predict PFS in both the training and validation sets of pts (n = 130; 33%). With a median follow up of 16 months, 2y-PFS was 81% vs 93% in pts with high and low TMTV respectively in the whole population (p = 0.0015; HR = 3). PET2 positivity was also related to a lower 2y-PFS compared to PET2- pts (76% vs 92%; p<0.0001). Then 3 groups could be identified: pts with either [high TMTV and PET2+ (n = 23; 6%)], or [high TMTV and PET2-, or low TMTV and PET2+ (n = 103; 27%)], or [low TMTV and PET2- (n = 261; 67%)] had a 61%, 88%, 94% 2y-PFS respectively (p<0.0001).
Conclusion
The TMTV predicts the outcome of young advanced HL pts independently of the early metabolic response to treatment. The combination of TMTV and PET2 allows identifying 3 subsets of HL pts with significantly different outcome that may help clinician to better tailor therapy.
Session topic: First-line treatment of Hodgkin Lymphoma
Keyword(s): Hodgkin's lymphoma, PET, Prognosis
Type: Oral Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 11:30 - 11:45
Location: Hall A2
Background
The TMTV assessed on the baseline FDG-PET is a novel approach of tumor burden measurement quantifying the most active part of the tumor. It has been reported to influence HL outcome in a retrospective series (Kanoun et al, EJNM 2014; 41: 1735).
Aims
We designed a study evaluating the TMTV prognosis value in patients (pts) prospectively enrolled in a phase III randomized trial testing a treatment strategy driven by PET, compared to a standard treatment not monitored by PET.
Methods
Eligible pts for the present study had to be enrolled in the AHL2011 trial (NCT01358747) and to have a baseline PET (PET0) available for central review and TMTV calculation. Pts were 16-60 y, with a previously untreated advanced HL (Ann Arbor stage III, IV or high risk IIB) and were randomly assigned to a treatment strategy driven by PET after 2 escalated BEACOPP (BEA) cycles (PET2), delivering 4 cycles of ABVD for PET2 negative (PET2-) pts and 4 cycles of BEA for PET2 positive (PET2+) pts or a standard treatment not monitored by PET and delivering 6 cycles of BEA. PET2 were centrally reviewed and interpreted according to Deauville criteria. TMTV was computed on PET0 by summing the metabolic volumes of the individual lesions using the 41% SUVmax thresholding method already described in lymphoma (Meignan et al, EJNM 2014; 41: 113).
Results
392 pts with a median age of 30 years were included: 64% were male, 89% had stage III/IV, and 59% an IPS≥3. Median TMTV was 200 ml (23 – 2149). Using a X-tile method a 350ml cut off value was firstly identified in a training set of patients (n = 262; 67%) randomly obtained from the whole population, and found to predict PFS in both the training and validation sets of pts (n = 130; 33%). With a median follow up of 16 months, 2y-PFS was 81% vs 93% in pts with high and low TMTV respectively in the whole population (p = 0.0015; HR = 3). PET2 positivity was also related to a lower 2y-PFS compared to PET2- pts (76% vs 92%; p<0.0001). Then 3 groups could be identified: pts with either [high TMTV and PET2+ (n = 23; 6%)], or [high TMTV and PET2-, or low TMTV and PET2+ (n = 103; 27%)], or [low TMTV and PET2- (n = 261; 67%)] had a 61%, 88%, 94% 2y-PFS respectively (p<0.0001).
Conclusion
The TMTV predicts the outcome of young advanced HL pts independently of the early metabolic response to treatment. The combination of TMTV and PET2 allows identifying 3 subsets of HL pts with significantly different outcome that may help clinician to better tailor therapy.
Session topic: First-line treatment of Hodgkin Lymphoma
Keyword(s): Hodgkin's lymphoma, PET, Prognosis
{{ help_message }}
{{filter}}