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. 2017 Nov 16;130(20):2196-2203.
doi: 10.1182/blood-2017-06-788877. Epub 2017 Sep 5.

Prognostic significance of baseline metabolic tumor volume in relapsed and refractory Hodgkin lymphoma

Alison J Moskowitz  1 , Heiko Schöder  2 , Somali Gavane  3 , Katie L Thoren  4 , Martin Fleisher  4 , Joachim Yahalom  1 , Susan J McCall  1 , Briana R Cadzin  1 , Stephanie Y Fox  1 , John Gerecitano  1 , Ravinder Grewal  2 , Paul A Hamlin  1 , Steven M Horwitz  1 , Anita Kumar  1 , Matthew Matasar  1 , Andy Ni  5 , Ariela Noy  1 , M Lia Palomba  1 , Miguel-Angel Perales  1 , Carol S Portlock  1 , Craig Sauter  1 , David Straus  1 , Anas Younes  1 , Andrew D Zelenetz  1 , Craig H Moskowitz  1
Affiliations

Prognostic significance of baseline metabolic tumor volume in relapsed and refractory Hodgkin lymphoma

Alison J Moskowitz et al. Blood. .

Abstract

Identification of prognostic factors for patients with relapsed/refractory Hodgkin lymphoma (HL) is essential for optimizing therapy with risk-adapted approaches. In our phase 2 study of positron emission tomography (PET)-adapted salvage therapy with brentuximab vedotin (BV) and augmented ifosfamide, carboplatin, and etoposide (augICE), we assessed clinical factors, quantitative PET assessments, and cytokine and chemokine values. Transplant-eligible patients with relapsed/refractory HL received 2 (cohort 1) or 3 (cohort 2) cycles of weekly BV; PET-negative patients (Deauville score ≤2) proceeded to autologous stem cell transplantation (ASCT) whereas PET-positive patients received augICE before ASCT. Serum cytokine and chemokine levels were measured at baseline and after BV. Metabolic tumor volume (MTV) and total lesion glycolysis were measured at baseline, after BV, and after augICE. Sixty-five patients enrolled (45, cohort 1; 20, cohort 2); 49 (75%) achieved complete response and 64 proceeded to ASCT. Three-year overall survival and event-free survival (EFS) were 95% and 82%, respectively. Factors predictive for EFS by multivariable analysis were baseline MTV (bMTV) (P < .001) and refractory disease (P = .003). Low bMTV (<109.5 cm3) and relapsed disease identified a favorable group (3-year EFS, 100%). For patients who received a transplant, bMTV and pre-ASCT PET were independently prognostic; 3-year EFS for pre-ASCT PET-positive patients with low bMTV was 86%. In this phase 2 study of PET-adapted therapy with BV and augICE for relapsed/refractory HL, bMTV and refractory disease were independent prognostic factors for EFS. Furthermore, bMTV improved the predictive power of pre-ASCT PET. Future studies should optimize efficacy and tolerability of salvage therapy by stratifying patients according to risk factors such as bMTV.

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Figures

Figure 1.
Figure 1.
Treatment pathway. (*) None of the Deauville 5 patients had new SUV-avid lesions.
Figure 2.
Figure 2.
Overall outcomes. (A) EFS for cohorts 1 and 2. (B) EFS and (C) OS for cohorts 1 and 2 combined.
Figure 3.
Figure 3.
EFS and baseline risk factors. (A) EFS for low (<109.5 cm3) or high (≥109.5 cm3) bMTV. (B) EFS with respect to bMTV and primary refractory disease. Outcomes for patients with 0, 1, or 2 risk factors are shown.
Figure 4.
Figure 4.
Impact of pre-ASCT PET and bMTV on EFS. (A) EFS for patients who received a transplant according to treatment (BV alone or BV followed by ICE) and pretransplant PET (PET positive defined as Deauville ≥4). (B) EFS according to pretransplant PET (PET positive defined as Deauville ≥4). (C) EFS according to bMTV and pretransplant PET (PET positive defined as Deauville ≥4). neg, negative; pos, positive.
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References

    1. Schmitz N, Pfistner B, Sextro M, et al. ; German Hodgkin’s Lymphoma Study Group; Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haematopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin’s disease: a randomised trial. Lancet. 2002;359(9323):2065-2071. - PubMed
    1. Linch DC, Winfield D, Goldstone AH, et al. Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin’s disease: results of a BNLI randomised trial. Lancet. 1993;341(8852):1051-1054. - PubMed
    1. Moskowitz CH, Matasar MJ, Zelenetz AD, et al. Normalization of pre-ASCT, FDG-PET imaging with second-line, non-cross-resistant, chemotherapy programs improves event-free survival in patients with Hodgkin lymphoma. Blood. 2012;119(7):1665-1670. - PMC - PubMed
    1. Josting A, Rudolph C, Reiser M, et al. ; Participating Centers. Time-intensified dexamethasone/cisplatin/cytarabine: an effective salvage therapy with low toxicity in patients with relapsed and refractory Hodgkin’s disease. Ann Oncol. 2002;13(10):1628-1635. - PubMed
    1. Bartlett NL, Niedzwiecki D, Johnson JL, et al. ; Cancer Leukemia Group B. Gemcitabine, vinorelbine, and pegylated liposomal doxorubicin (GVD), a salvage regimen in relapsed Hodgkin’s lymphoma: CALGB 59804. Ann Oncol. 2007;18(6):1071-1079. - PubMed

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