Clinical pretreatment risk factors and prediction of outcome using gallium 67 scintigraphy in patients with Hodgkin's lymphoma

Abstract

This study was conducted to investigate the prognostic effect and implications of gallium 67 scintigraphy (gallium scan) at mid-treatment and at the end of first-line treatment in patients with early- and advanced-stage Hodgkin's lymphoma (HL). A total of 216 HL patients were included in the study. Gallium scan was performed at mid-treatment and at the end of first-line treatment. The overall survival (OS) and event-free survival (EFS) were calculated using the Kaplan-Meier method. The log-rank test was used to identify univariate predictors of EFS and OS. For early-stage disease, bulky mediastinal involvement (yes vs. no, 98 vs. 79%, respectively; P=0.01), erythrocyte sedimentation rate (good vs. adverse, 98 vs. 88%, respectively; P=0.03), presence of B symptoms (no vs. yes, 94 vs. 78%, respectively; P=0.006), post-chemotherapy disease status [complete response (CR) vs. unconfirmed CR (uCR) vs. partial response (PR) vs. progressive disease (PGR), 95 vs. 90 vs. 87 vs. 0%, respectively; P<0.01] and gallium scan at mid-treatment and at the end of treatment (negative vs. positive, 88 vs. 20%, P<0.001; and 85 vs. 10%, P<0.001, respectively) significantly affected the EFS. In addition, age (<50 vs. ≥50 years, 96 vs. 78%, respectively; P=0.01), presence of B symptoms (no vs. yes, 97 vs. 87%, respectively; P=0.03), post-chemotherapy disease status (CR vs. uCR vs. PR vs. PGR, 95 vs. 90 vs. 90 vs. 0%, respectively; P<0.01) and gallium scan results at mid-treatment and at the end of treatment (negative vs. positive, 87 vs. 60%, P<0.001; and 95 vs. 0%, P<0.001, respectively) significantly affected the OS. For advanced-stage disease, Hassenclever index (1-3 vs. 4-6, 80 vs. 57%, respectively; P=0.05) and gallium scan results at mid-treatment and at the end of treatment (negative vs. positive, 84 vs. 18%, P<0.001; and 84 vs. 0%, P<0.001, respectively) significantly affected the EFS, whereas age at diagnosis (<50 vs. ≥50 years, 92 vs. 78%, respectively; P=0.04), Hassenclever index (1-3 vs. 4-6, 86 vs. 61%, respectively; P=0.04) and gallium scan results at mid-treatment and at the end of treatment (negative vs. positive, 98 vs. 40%, P<0.001; and 97 vs. 23%, P<0.001, respectively) significantly affected the OS. On the multivariate analysis, gallium scan at the end of first-line treatment retained statistical significance in terms of EFS and OS. In conclusion, post-chemotherapy gallium scan is an important prognostic factor in patients with early- or advanced-stage HL and a predictor of adverse outcome.

Keywords: Hodgkin's lymphoma; gallium scan; prognostic factors; risk factors.