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. 2017 Nov;179(3):488-496.
doi: 10.1111/bjh.14902. Epub 2017 Aug 18.

Early-stage Hodgkin lymphoma outcomes after combined modality therapy according to the post-chemotherapy 5-point score: can residual pet-positive disease be cured with radiotherapy alone?

Sarah A Milgrom  1 , Chelsea C Pinnix  1 , Hubert Chuang  2 , Yasuhiro Oki  3 , Mani Akhtari  1 , Osama Mawlawi  4 , Naveen Garg  5 , Jillian R Gunther  1 , Jay P Reddy  1 , Grace L Smith  1 , Eric Rohren  6 , Frederick B Hagemeister  3 , Hun J Lee  3 , Luis E Fayad  3 , Wenli Dong  7 , Eleanor M Osborne  1 , Zeinab Abou Yehia  1 , Michelle Fanale  3 , Bouthaina S Dabaja  1
Affiliations

Early-stage Hodgkin lymphoma outcomes after combined modality therapy according to the post-chemotherapy 5-point score: can residual pet-positive disease be cured with radiotherapy alone?

Sarah A Milgrom et al. Br J Haematol. 2017 Nov.

Abstract

Early-stage classical Hodgkin lymphoma (HL) patients are evaluated by an end-of-chemotherapy positron emission tomography-computed tomography (eoc-PET-CT) after doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) and before radiation therapy (RT). We determined freedom from progression (FFP) in patients treated with ABVD and RT according to the eoc-PET-CT 5-point score (5PS). Secondarily, we assessed whether patients with a positive eoc-PET-CT (5PS of 4-5) can be cured with RT alone. The cohort comprised 174 patients treated for stage I-II HL with ABVD and RT alone. ABVD was given with a median of four cycles and RT with a median dose of 30·6 Gy. Five-year FFP was 97%. Five-year FFP was 100% (0 relapses/98 patients) for patients with a 5PS of 1-2, 97% (2/65) for a 5PS of 3, 83% (1/8) for a 5PS of 4, and 67% (1/3) for a 5PS of 5 (P < 0·001). Patients with positive eoc-PET-CT scans who were selected for salvage RT alone had experienced a very good partial response to ABVD. Risk factors for recurrence in this subgroup included a small reduction in tumour size and a 'bounce' in ≥1 PET-CT parameter (reduction then rise from interim to final scan). Thus, a positive eoc-PET-CT is associated with inferior FFP; however, appropriately selected patients can be cured with RT alone.

Keywords: 5-point score; Hodgkin lymphoma; radiation therapy; radiotherapy; salvage.

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Figures

Figure 1
Figure 1
Freedom from progression as a function of the eoc-PET-CT Deauville 5-point score (5PS) for patients selected for treatment with ABVD and RT (n = 174). Log-rank P < 0.001.
Figure 2
Figure 2
Relative change in PET-CT parameters during the course of chemotherapy for the select group of eoc-PET-positive patients who received salvage RT alone. The graphs demonstrate positron emission tomography-computed tomography (PET-CT) measurements for patients with pre-chemotherapy (1), interim (2), and post-chemotherapy (3) scans (n = 9). The 2 patients with subsequent relapse (red and green) experienced a “bounce” in ≥1 final PET or CT parameter, defined as a reduction in the value from the pre-chemotherapy to the interim scan followed by an increase in the value from the interim to the end-of-chemotherapy-PET-CT scan. A) Relative change in maximum standardized uptake value (SUVmax) B) Relative change in metabolic tumour volume (MTV) C) Relative change in total lesion glycolysis (TLG) D) Relative change in soft tissue volume (STV)
Figure 2
Figure 2
Relative change in PET-CT parameters during the course of chemotherapy for the select group of eoc-PET-positive patients who received salvage RT alone. The graphs demonstrate positron emission tomography-computed tomography (PET-CT) measurements for patients with pre-chemotherapy (1), interim (2), and post-chemotherapy (3) scans (n = 9). The 2 patients with subsequent relapse (red and green) experienced a “bounce” in ≥1 final PET or CT parameter, defined as a reduction in the value from the pre-chemotherapy to the interim scan followed by an increase in the value from the interim to the end-of-chemotherapy-PET-CT scan. A) Relative change in maximum standardized uptake value (SUVmax) B) Relative change in metabolic tumour volume (MTV) C) Relative change in total lesion glycolysis (TLG) D) Relative change in soft tissue volume (STV)
Figure 2
Figure 2
Relative change in PET-CT parameters during the course of chemotherapy for the select group of eoc-PET-positive patients who received salvage RT alone. The graphs demonstrate positron emission tomography-computed tomography (PET-CT) measurements for patients with pre-chemotherapy (1), interim (2), and post-chemotherapy (3) scans (n = 9). The 2 patients with subsequent relapse (red and green) experienced a “bounce” in ≥1 final PET or CT parameter, defined as a reduction in the value from the pre-chemotherapy to the interim scan followed by an increase in the value from the interim to the end-of-chemotherapy-PET-CT scan. A) Relative change in maximum standardized uptake value (SUVmax) B) Relative change in metabolic tumour volume (MTV) C) Relative change in total lesion glycolysis (TLG) D) Relative change in soft tissue volume (STV)
Figure 2
Figure 2
Relative change in PET-CT parameters during the course of chemotherapy for the select group of eoc-PET-positive patients who received salvage RT alone. The graphs demonstrate positron emission tomography-computed tomography (PET-CT) measurements for patients with pre-chemotherapy (1), interim (2), and post-chemotherapy (3) scans (n = 9). The 2 patients with subsequent relapse (red and green) experienced a “bounce” in ≥1 final PET or CT parameter, defined as a reduction in the value from the pre-chemotherapy to the interim scan followed by an increase in the value from the interim to the end-of-chemotherapy-PET-CT scan. A) Relative change in maximum standardized uptake value (SUVmax) B) Relative change in metabolic tumour volume (MTV) C) Relative change in total lesion glycolysis (TLG) D) Relative change in soft tissue volume (STV)
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