Contributions
Abstract: EP774
Type: E-Poster Presentation
Session title: Hodgkin lymphoma - Clinical
Background
Positive PET/CT after 2 cycles of ABVD (interim PET, iPET) has a strong adverse prognostic significance in patients with advanced Hodgkin lymphoma (HL), who continue treatment with ABVD. These patients could be successfully salvaged by treatment escalation to BEACOPP, but more “real-life” data are needed in order to predict their outcome.
Aims
The aim of this study is the evaluation of treatment strategies, patient outcome and potential prognostic factors in iPET positive (iPET+) patients in 15 hematological departments of Greece.
Methods
This is a retrospective study of 282 patients with advanced HL according to GHSG (stages III/IV or IIB with bulky mediastinal and/or extranodal disease), who received 2 cycles of ABVD and underwent PET/CT. iPET was evaluated according to the Deauville 5-point scale score (D5PSS) and scores 4 and 5 were considered positive (residual uptake >liver). In case of PET positivity, further treatment strategy (intensification to BEACOPP or not) was at the treating physician’s discretion, as this study reflects every-day clinical practice. However, consistent strategies have been followed within the same Department. Radiotherapy was also at physician’s discretion.
Results
iPET was negative in 77% and positive in 23% of patients respectively. 62 out of 65 iPET(+) patients were ≤60 years old and consisted the study population, as they were eligible for treatment intensification. Of these patients, 37 received intensified treatment: 36 with BEACOPP (of whom 31 received BEACOPP-escalated, 2 BEACOPP-14 and 3 BEACOPP-baseline) and 1 with ESHAP. 25 patients continued with ABVD due to individual Department’s treatment strategy (n=18), or, in 7 patients, because of treating physician’s decision or due to misclassification as D5PSS 3. The 5-year progression free survival (PFS) was 53% in the whole population of iPET(+) patients. It was 59% vs 41% for patients who received intensified treatment or continued with ABVD respectively (p=0.09). In Departments which did not follow the treatment intensification strategy the 5-year PFS was 32% for patients who continued with ABVD. Patients who remained iPET(+) with D5PSS 4 had 5-year PFS 60% vs 37% for patients with D5PSS 5 (p=0.13). Apart from patient’s age, no other potential prognostic factor associated with disease extent or aggressiveness affected the outcome of iPET(+) patients. Surprisingly, patients <45 years old had inferior outcome in univariate analysis. In multivariate analysis, D5PSS 5 (vs 4) was an independent adverse prognostic factor for PFS (HR: 2.789, 95% CI: 1.049-7.416, p=0.04), whereas continuation with ABVD vs treatment intensification was of borderline significance (HR: 2.434, 95% CI: 0.934-6.340, p=0.069).
Conclusion
Our study provides “real-life” data confirming the adverse outcome of iPET(+) patients as well as the remarkable efficacy of treatment intensification with BEACOPP-escalated. Of note, the 5-year PFS almost reached 60% despite the fact that the study included patients with “strictly” advanced-stage disease, without admixing early stages with adverse characteristics. Conventional prognostic factors may be replaced by different scores of iPET positivity. However, larger studies are needed in order to confirm and extend these results in order to draw safe conclusions.
Keyword(s):
Abstract: EP774
Type: E-Poster Presentation
Session title: Hodgkin lymphoma - Clinical
Background
Positive PET/CT after 2 cycles of ABVD (interim PET, iPET) has a strong adverse prognostic significance in patients with advanced Hodgkin lymphoma (HL), who continue treatment with ABVD. These patients could be successfully salvaged by treatment escalation to BEACOPP, but more “real-life” data are needed in order to predict their outcome.
Aims
The aim of this study is the evaluation of treatment strategies, patient outcome and potential prognostic factors in iPET positive (iPET+) patients in 15 hematological departments of Greece.
Methods
This is a retrospective study of 282 patients with advanced HL according to GHSG (stages III/IV or IIB with bulky mediastinal and/or extranodal disease), who received 2 cycles of ABVD and underwent PET/CT. iPET was evaluated according to the Deauville 5-point scale score (D5PSS) and scores 4 and 5 were considered positive (residual uptake >liver). In case of PET positivity, further treatment strategy (intensification to BEACOPP or not) was at the treating physician’s discretion, as this study reflects every-day clinical practice. However, consistent strategies have been followed within the same Department. Radiotherapy was also at physician’s discretion.
Results
iPET was negative in 77% and positive in 23% of patients respectively. 62 out of 65 iPET(+) patients were ≤60 years old and consisted the study population, as they were eligible for treatment intensification. Of these patients, 37 received intensified treatment: 36 with BEACOPP (of whom 31 received BEACOPP-escalated, 2 BEACOPP-14 and 3 BEACOPP-baseline) and 1 with ESHAP. 25 patients continued with ABVD due to individual Department’s treatment strategy (n=18), or, in 7 patients, because of treating physician’s decision or due to misclassification as D5PSS 3. The 5-year progression free survival (PFS) was 53% in the whole population of iPET(+) patients. It was 59% vs 41% for patients who received intensified treatment or continued with ABVD respectively (p=0.09). In Departments which did not follow the treatment intensification strategy the 5-year PFS was 32% for patients who continued with ABVD. Patients who remained iPET(+) with D5PSS 4 had 5-year PFS 60% vs 37% for patients with D5PSS 5 (p=0.13). Apart from patient’s age, no other potential prognostic factor associated with disease extent or aggressiveness affected the outcome of iPET(+) patients. Surprisingly, patients <45 years old had inferior outcome in univariate analysis. In multivariate analysis, D5PSS 5 (vs 4) was an independent adverse prognostic factor for PFS (HR: 2.789, 95% CI: 1.049-7.416, p=0.04), whereas continuation with ABVD vs treatment intensification was of borderline significance (HR: 2.434, 95% CI: 0.934-6.340, p=0.069).
Conclusion
Our study provides “real-life” data confirming the adverse outcome of iPET(+) patients as well as the remarkable efficacy of treatment intensification with BEACOPP-escalated. Of note, the 5-year PFS almost reached 60% despite the fact that the study included patients with “strictly” advanced-stage disease, without admixing early stages with adverse characteristics. Conventional prognostic factors may be replaced by different scores of iPET positivity. However, larger studies are needed in order to confirm and extend these results in order to draw safe conclusions.
Keyword(s):