Contributions
Abstract: EP776
Type: E-Poster Presentation
Session title: Hodgkin lymphoma - Clinical
Background
Using PET in a metabolic response assessment has provided an opportunity of individualized treatment for patients with newly diagnosed HL. Current risk assessment systems cannot provide a reliable prediction of failure in an individual treatment. The main idea lying behind several PET protocol studies is identifying patients within a high-risk group and potential early relapse/refractory disease.
Aims
The primary endpoints were to assess a correlation between PET findings and response to therapy, type of regimen and clinical outcome, as well as whether there is a difference when patient treatment is intensified or not intensified depending on PET findings.
Methods
This sub-study was conducted in a scope of a broader prospective multicenter study on the predictive value of PET response assessment (205 patients with HL, up to 69 years of age). Patients received a treatment with ABVD or BEACOPP-14/esc or “switched-regimens” (ABVD+BEACOPP-esc/14, BEACOPP-esc/14+ABVD). Metabolic PET imaging was performed on routine protocols using Deauville criteria for response assessment.
Results
The ORR was 91.7%. The ORR for patients with stage I-II was 95.5% (106/111) vs 87.2% (82/94) for patients with stage III-IV.
In total, the disease progression occurred in 48.3% (15/31) of interim PET-positive (PET2+) patients and 11.5% (20/174) of interim PET-negative (PET2-) patients (p<0.05). We confirmed a significant difference between the 5-year event free survival (EFS) rate for patients with PET2+ vs PET2-. Thus, PET2- patients with early and advanced stages had an EFS level much higher than the PET2+ patient group (87% and 85% vs 55% and 15% respectively, Log-rank test, p=0.0001).
Using ABVD and “switched-regimens” for I-II-stage patients did not reveal a significant correlation to the 5-year EFS.However, a more intensified treatment for patients with stage III-IV of HL showed a significantly better level of EFS compared to the ABVD regimen, and it did not depend on PET2 status (Log-rank test, p=0.0003). Moreover, intermediate-risk group cohort (2B stage) tends to improve the EFS levels when the regimens was given BEACOPP-esc/14+ABVD vs ABVD+BEACOPP-esc/14 vs ABVD (80% vs 60% vs 55% respectively, p=0.064) and was independent of PET2 status.
End-of-treatment PET-negative (PET3-) status was found in 83.8% (130/155) of the study group patients and 16.1% (25/155) had the end-of-treatment PET-positive (PET3+), respectively (p<0.05). Using the Cox regression, we confirmed a significant correpatienlation between the EFS with PET3 status and ABVD regimen. 1-year EFS for this group of ts with PET3+ was worse than PET3-(15% vs 83% respectively, p<0.0001). Additionally, the combination of ABVD and radiotherapy for early stages has improved the EFS rate compared to sole ABVD treatment without radiation (86% compared 60%, p=0.013) based on PET3 status.
Conclusion
Our results of PET use with primary HL patients have demonstrated a high prognostic value of the interim and end-of-treatment PET. For intermediate-risk group and advanced stages in particular, the efficiency of treatment intensification improves regardless of their PET status.
Keyword(s): Hodgkin's lymphoma, Positron emission tomography (PET), Prognosis, Regimen
Abstract: EP776
Type: E-Poster Presentation
Session title: Hodgkin lymphoma - Clinical
Background
Using PET in a metabolic response assessment has provided an opportunity of individualized treatment for patients with newly diagnosed HL. Current risk assessment systems cannot provide a reliable prediction of failure in an individual treatment. The main idea lying behind several PET protocol studies is identifying patients within a high-risk group and potential early relapse/refractory disease.
Aims
The primary endpoints were to assess a correlation between PET findings and response to therapy, type of regimen and clinical outcome, as well as whether there is a difference when patient treatment is intensified or not intensified depending on PET findings.
Methods
This sub-study was conducted in a scope of a broader prospective multicenter study on the predictive value of PET response assessment (205 patients with HL, up to 69 years of age). Patients received a treatment with ABVD or BEACOPP-14/esc or “switched-regimens” (ABVD+BEACOPP-esc/14, BEACOPP-esc/14+ABVD). Metabolic PET imaging was performed on routine protocols using Deauville criteria for response assessment.
Results
The ORR was 91.7%. The ORR for patients with stage I-II was 95.5% (106/111) vs 87.2% (82/94) for patients with stage III-IV.
In total, the disease progression occurred in 48.3% (15/31) of interim PET-positive (PET2+) patients and 11.5% (20/174) of interim PET-negative (PET2-) patients (p<0.05). We confirmed a significant difference between the 5-year event free survival (EFS) rate for patients with PET2+ vs PET2-. Thus, PET2- patients with early and advanced stages had an EFS level much higher than the PET2+ patient group (87% and 85% vs 55% and 15% respectively, Log-rank test, p=0.0001).
Using ABVD and “switched-regimens” for I-II-stage patients did not reveal a significant correlation to the 5-year EFS.However, a more intensified treatment for patients with stage III-IV of HL showed a significantly better level of EFS compared to the ABVD regimen, and it did not depend on PET2 status (Log-rank test, p=0.0003). Moreover, intermediate-risk group cohort (2B stage) tends to improve the EFS levels when the regimens was given BEACOPP-esc/14+ABVD vs ABVD+BEACOPP-esc/14 vs ABVD (80% vs 60% vs 55% respectively, p=0.064) and was independent of PET2 status.
End-of-treatment PET-negative (PET3-) status was found in 83.8% (130/155) of the study group patients and 16.1% (25/155) had the end-of-treatment PET-positive (PET3+), respectively (p<0.05). Using the Cox regression, we confirmed a significant correpatienlation between the EFS with PET3 status and ABVD regimen. 1-year EFS for this group of ts with PET3+ was worse than PET3-(15% vs 83% respectively, p<0.0001). Additionally, the combination of ABVD and radiotherapy for early stages has improved the EFS rate compared to sole ABVD treatment without radiation (86% compared 60%, p=0.013) based on PET3 status.
Conclusion
Our results of PET use with primary HL patients have demonstrated a high prognostic value of the interim and end-of-treatment PET. For intermediate-risk group and advanced stages in particular, the efficiency of treatment intensification improves regardless of their PET status.
Keyword(s): Hodgkin's lymphoma, Positron emission tomography (PET), Prognosis, Regimen