Contributions
Abstract: PB2001
Type: Publication Only
Background
The prognostic value of post 2-3 chemotherapy blocks PET-CT scan metabolic response has established validity for adult Hodgkin Lymphoma (HL) patients (pts). The Pediatric Protocol EuroNet-PHL-C1 STUDY evaluates patients with CT/MRI imaging and PET-CT-Scan following 2 OEPA chemotherapy blocks in an effort to avoid irradiation.
Aims
To present preliminary imaging and outcome results of a Greek pediatric pt cohort.
Methods
From 2/2009-4/2017 22 pts (13 boys) with median age of 13,1 years (range 3,9-16,3) with newly-diagnosed HL were treated according to the EuroNet-PHL-C1 STUDY. PET-CT-Scan was performed at diagnosis, following 2 OEPA cycles (PET+2) and at the end of treatment. Three Therapy-Groups (TG) were are defined: TG-1: pts stage IA/B, IIA, without mases≥200 ml, Erythrocyte Sedimentation Rate (ESR)<30mm/hr; TG-2: pts stage IEA/B, IIEA, IIB, IIIA and pts stage IA/B and IA with≥200 ml masses and/or ESR≥30mm/hr; TG-3: pts stage IIEB, IIIEA/B, IIIB, IV A/B. Treatment plan: Initially 2 OEPA for all pts; 2 or 4 COPP or COPDAC blocks followed for TG2 and TG3 pts, respectively. Irradiation of the initially involved sites 20-30Gy was prescribed only for pts with inadequate response (MRI/CT and/or PET+2) following 2 OEPA blocks, for all TGs.
Results
A total of 22 pts stage IIΑ (7), III (4/ 1Α) and IV (11/ 9Β, 8S, 6Ε) diagnosed with nodular sclerosis (19) or mixed cellularity (3) were treated according to groups TG1 (3), TG2 (3) and TG3 (16). Seven pts had bulky-disease (stage II:5, stage IV:2) and 15 pts ESR≥30mm/hr (stage II:1, III:4, IV:10). Adequate overall response following 2 OEPA cycles was observed in 2/3, 2/3 and 5/16 pts group TG1, TG2 and TG3, respectively. Good metabolic response (PET+2 with Dauville-score ≤3) was documented in3/3, 3/3 and 10/16 pts, respectively. Irradiation was prescribed to 11/15 pts following appropriate TG chemotherapy (TG1:1, TG3:10), while 4 TG3 pts had disease progression (3) or no complete response following 6 chemotherapy blocks (1).All 4 received protocol-allocated second line treatment, (IEPx2-ABVDx2) and with responsive disease they underwent autologous stem cell transplantation (ASCT) with BEAM cytoreduction, without irradiation in 2/4, due to good response. Of these, only 1 pt relapsed (4,3 from diagnosis) with single pulmonary nodule; she remains in complete remission following surgical resection only, for another 4,6 years. Another 2 pts relapsed 3,8 and 0,7 years from diagnosis and were treated accordingly (IEPx2-ABVDx2 and ASCT), without irradiation.
Conclusion
PET+2 inadequate metabolic response was observed in pts who had resistant disease or subsequent relapse. To the contrary, it appeared that pts with adequate mass regression and metabolic response can be managed without irradiation, while maintaining CR. Pts with resistant or relapsed disease can be rescued with second line chemotherapy and ASCT. Good response following ASCT allows for elimination of irradiation, too. The effectiveness of intensification of chemotherapy following the initial 2 OEPA cycles, in PET+2 scan positive pts while diminishing the number of pts receiving irradiation in children, is under investigation, in an effort to improve overall outcome, while diminishing the number of pediatric pts receiving irradiation.
Session topic: 17. Hodgkin lymphoma – Clinical
Keyword(s): Childhood, Hodgkin's Lymphoma, Lymphoma therapy, PET
Abstract: PB2001
Type: Publication Only
Background
The prognostic value of post 2-3 chemotherapy blocks PET-CT scan metabolic response has established validity for adult Hodgkin Lymphoma (HL) patients (pts). The Pediatric Protocol EuroNet-PHL-C1 STUDY evaluates patients with CT/MRI imaging and PET-CT-Scan following 2 OEPA chemotherapy blocks in an effort to avoid irradiation.
Aims
To present preliminary imaging and outcome results of a Greek pediatric pt cohort.
Methods
From 2/2009-4/2017 22 pts (13 boys) with median age of 13,1 years (range 3,9-16,3) with newly-diagnosed HL were treated according to the EuroNet-PHL-C1 STUDY. PET-CT-Scan was performed at diagnosis, following 2 OEPA cycles (PET+2) and at the end of treatment. Three Therapy-Groups (TG) were are defined: TG-1: pts stage IA/B, IIA, without mases≥200 ml, Erythrocyte Sedimentation Rate (ESR)<30mm/hr; TG-2: pts stage IEA/B, IIEA, IIB, IIIA and pts stage IA/B and IA with≥200 ml masses and/or ESR≥30mm/hr; TG-3: pts stage IIEB, IIIEA/B, IIIB, IV A/B. Treatment plan: Initially 2 OEPA for all pts; 2 or 4 COPP or COPDAC blocks followed for TG2 and TG3 pts, respectively. Irradiation of the initially involved sites 20-30Gy was prescribed only for pts with inadequate response (MRI/CT and/or PET+2) following 2 OEPA blocks, for all TGs.
Results
A total of 22 pts stage IIΑ (7), III (4/ 1Α) and IV (11/ 9Β, 8S, 6Ε) diagnosed with nodular sclerosis (19) or mixed cellularity (3) were treated according to groups TG1 (3), TG2 (3) and TG3 (16). Seven pts had bulky-disease (stage II:5, stage IV:2) and 15 pts ESR≥30mm/hr (stage II:1, III:4, IV:10). Adequate overall response following 2 OEPA cycles was observed in 2/3, 2/3 and 5/16 pts group TG1, TG2 and TG3, respectively. Good metabolic response (PET+2 with Dauville-score ≤3) was documented in3/3, 3/3 and 10/16 pts, respectively. Irradiation was prescribed to 11/15 pts following appropriate TG chemotherapy (TG1:1, TG3:10), while 4 TG3 pts had disease progression (3) or no complete response following 6 chemotherapy blocks (1).All 4 received protocol-allocated second line treatment, (IEPx2-ABVDx2) and with responsive disease they underwent autologous stem cell transplantation (ASCT) with BEAM cytoreduction, without irradiation in 2/4, due to good response. Of these, only 1 pt relapsed (4,3 from diagnosis) with single pulmonary nodule; she remains in complete remission following surgical resection only, for another 4,6 years. Another 2 pts relapsed 3,8 and 0,7 years from diagnosis and were treated accordingly (IEPx2-ABVDx2 and ASCT), without irradiation.
Conclusion
PET+2 inadequate metabolic response was observed in pts who had resistant disease or subsequent relapse. To the contrary, it appeared that pts with adequate mass regression and metabolic response can be managed without irradiation, while maintaining CR. Pts with resistant or relapsed disease can be rescued with second line chemotherapy and ASCT. Good response following ASCT allows for elimination of irradiation, too. The effectiveness of intensification of chemotherapy following the initial 2 OEPA cycles, in PET+2 scan positive pts while diminishing the number of pts receiving irradiation in children, is under investigation, in an effort to improve overall outcome, while diminishing the number of pediatric pts receiving irradiation.
Session topic: 17. Hodgkin lymphoma – Clinical
Keyword(s): Childhood, Hodgkin's Lymphoma, Lymphoma therapy, PET