Contributions
Abstract: PB2006
Type: Publication Only
Background
PET, combined with computed tomography (PET-CT), performed during and after therapy, has a high prognostic value for predicting first-line therapy results in Hodgkin lymphoma (HL) patients. Quantitative PET parameters (qPET) as a predictive factor for HL progression are still not well established.
Aims
The primary endpoint was to evaluate influence qPET values of event-free survival (EFS) after treatment. We analyzed absolute value of PET parameters, such as negative predictive value (negative PET scan and no treatment failure, NPV), positive predictive value (positive PET scan and treatment failure, PPV) and qPET (SUVmean, SUVmax, MTV and TLG) which might associate with EFS.
Methods
Quantitative PET parameters at the baseline (PET-1), interim (PET-2, after 2-4 cycles) and end of chemotreatment (PET-3) PET-CT scans were investigated. Metabolic PET-CT imaging were performed at participating PET centers according to routine protocols, compatible with EANM guidelines for FDG PET-CT imaging in malignant tumors. MTV was computed by using the 41% maximum standardized uptake value thresholding method, and the optimal cutoff for survival prediction was determined.
Results
In this retrospective analysis 96 patients with HL with a stage I-II (58.3%), III-IV (41.7%) who were admitted between Aug 2012 and Feb 2018 in 9 Ukrainian hematological centers were analyzed. Patients were treated with ABVD or BEACOPP-14/esc, based on risk group. The ORR of 96 patients (CR ,PR) was 85.4%. A negative PET-2 had 76 % pts, while 9.4 % had a positive PET-2. Patients with negative PET-2 and positive PET-2 had CR rates of 75 % and 4.16 %, respectively, which yielded a PPV of 11.4% and NPV of 88.6%.
ROC analysis revealed that PPV is an important marker which is associated with poor EFS in primary patients with HL (Se=100 %; Sp=100 %; AUC=1.0, p<0.0001). 5-year EFS was 100% for NPV patients and 10% for PPV patients, which was statistically different (p < 0.05). Multivariate analysis confirmed NPV and PPV significant variables on EFS (p<0.0001).
In our study we found two new strong associations between qPET at PET-3 and EFS (PET-3 negative in 77% cases): SUVmax [Se=63 %; Sp=100 %; AUC=0.88, p<0.0001], SUVmean [Se=75 %; Sp=90 %; AUC=0.86, p<0.0001] at PET-3 and EFS by ROC analysis. Patients with SUVmax <1.84 had higher level of 5-year EFS vs SUVmax >1.84 (93% vs 15%, p<0.05). Also, 5-year EFS was 85% vs 25% in patients with SUVmean <3.19 vs SUVmean >3.19, respectively (p<0.05).
∑MTV [HRs1.4; 95% (CI) 1.0–2.0, p <0.0001 by Cox regression] and TLG [Se=75 %; Sp=100 %; AUC=0.97, p<0.0001 by ROC analyses] parameters at PET-3 were confirmed as important markers to predict survival in patients with primary HL. 5-year EFS was 85% and 20% in patients with ∑MTV <0 and ∑MTV >0, respectively (p<0.05).
Unfortunately, qPET at PET-1 and PET-2 were not statistically significant in predicting clinical outcomes, due to the small sample size of our study.
Conclusion
Quantitative PET parameters is an important tool for clinicians in the diagnosis and management of patients with HL. The prognostic role and validity of the qPET for interpretation of PET should be confirmed prospectively.
Session topic: 17. Hodgkin lymphoma – Clinical
Keyword(s): Hodgkin's disease, PET, Survival
Abstract: PB2006
Type: Publication Only
Background
PET, combined with computed tomography (PET-CT), performed during and after therapy, has a high prognostic value for predicting first-line therapy results in Hodgkin lymphoma (HL) patients. Quantitative PET parameters (qPET) as a predictive factor for HL progression are still not well established.
Aims
The primary endpoint was to evaluate influence qPET values of event-free survival (EFS) after treatment. We analyzed absolute value of PET parameters, such as negative predictive value (negative PET scan and no treatment failure, NPV), positive predictive value (positive PET scan and treatment failure, PPV) and qPET (SUVmean, SUVmax, MTV and TLG) which might associate with EFS.
Methods
Quantitative PET parameters at the baseline (PET-1), interim (PET-2, after 2-4 cycles) and end of chemotreatment (PET-3) PET-CT scans were investigated. Metabolic PET-CT imaging were performed at participating PET centers according to routine protocols, compatible with EANM guidelines for FDG PET-CT imaging in malignant tumors. MTV was computed by using the 41% maximum standardized uptake value thresholding method, and the optimal cutoff for survival prediction was determined.
Results
In this retrospective analysis 96 patients with HL with a stage I-II (58.3%), III-IV (41.7%) who were admitted between Aug 2012 and Feb 2018 in 9 Ukrainian hematological centers were analyzed. Patients were treated with ABVD or BEACOPP-14/esc, based on risk group. The ORR of 96 patients (CR ,PR) was 85.4%. A negative PET-2 had 76 % pts, while 9.4 % had a positive PET-2. Patients with negative PET-2 and positive PET-2 had CR rates of 75 % and 4.16 %, respectively, which yielded a PPV of 11.4% and NPV of 88.6%.
ROC analysis revealed that PPV is an important marker which is associated with poor EFS in primary patients with HL (Se=100 %; Sp=100 %; AUC=1.0, p<0.0001). 5-year EFS was 100% for NPV patients and 10% for PPV patients, which was statistically different (p < 0.05). Multivariate analysis confirmed NPV and PPV significant variables on EFS (p<0.0001).
In our study we found two new strong associations between qPET at PET-3 and EFS (PET-3 negative in 77% cases): SUVmax [Se=63 %; Sp=100 %; AUC=0.88, p<0.0001], SUVmean [Se=75 %; Sp=90 %; AUC=0.86, p<0.0001] at PET-3 and EFS by ROC analysis. Patients with SUVmax <1.84 had higher level of 5-year EFS vs SUVmax >1.84 (93% vs 15%, p<0.05). Also, 5-year EFS was 85% vs 25% in patients with SUVmean <3.19 vs SUVmean >3.19, respectively (p<0.05).
∑MTV [HRs1.4; 95% (CI) 1.0–2.0, p <0.0001 by Cox regression] and TLG [Se=75 %; Sp=100 %; AUC=0.97, p<0.0001 by ROC analyses] parameters at PET-3 were confirmed as important markers to predict survival in patients with primary HL. 5-year EFS was 85% and 20% in patients with ∑MTV <0 and ∑MTV >0, respectively (p<0.05).
Unfortunately, qPET at PET-1 and PET-2 were not statistically significant in predicting clinical outcomes, due to the small sample size of our study.
Conclusion
Quantitative PET parameters is an important tool for clinicians in the diagnosis and management of patients with HL. The prognostic role and validity of the qPET for interpretation of PET should be confirmed prospectively.
Session topic: 17. Hodgkin lymphoma – Clinical
Keyword(s): Hodgkin's disease, PET, Survival