Real-World Use of Positron Emission Tomography-Computed Tomography and Reported Deauville Scores in Advanced-Stage Classic Hodgkin Lymphoma: A Community Oncology Practice Perspective

Abstract

Purpose: To evaluate the use of interim positron emission tomography-computed tomography (PET-CT) scans and Deauville 5-point scale (5PS) score reporting for stage III/IV classic Hodgkin lymphoma (cHL) treated frontline (1L) in community oncology settings.

Methods: This retrospective, observational study included adults with stage III/IV cHL initiating 1L doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine, or an escalated dosing regimen of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone within the US Oncology Network between January 2017 and October 2019. Data were collected from electronic health records and chart reviews and summarized descriptively.

Results: A total of 262 patients were included; 48.9% were age 39 years or younger. Most were male (57%), White (59%), had an International Prognostic Score <4 (76%), and received 1L ABVD (74%). Forty-nine percent of patients had stage III and 51% had stage IV cHL. Of 258 patients with ≥1 PET-CT scan, 71% (n = 184) had an interim scan and 64% received ≥1 scan at an off-site location. Of patients treated 1L with ABVD who received a baseline and interim scan, Deauville 5PS scores were not documented for 45% of patients; in 90% of these cases, a standardized uptake value (SUV) was reported.

Conclusion: In community oncology settings, under-reporting of Deauville 5PS scores for interim PET-CT scans was observed. In the absence of Deauville 5PS scores, SUV results were generally provided. These results highlight educational opportunities that exist for PET-adapted ABVD, including consistency in reporting/utilization of Deauville 5PS scores to de-escalate or escalate treatment.

FIG 1.

Study attrition. ^aStudy observation period: January 1, 2017-January 31, 2020. ^bStudy identification period: January 1, 2017-October 31, 2019. ^cExcept nonmelanoma skin cancer or ductal carcinoma in situ. 1L, frontline; A + AVD, brentuximab vedotin + doxorubicin, vinblastine, and dacarbazine; ABVD, doxorubicin, bleomycin, vinblastine, and dacarbazine; BEACOPP, escalated dosing regimen of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone; cHL, classic Hodgkin lymphoma; USON, US Oncology Network.

FIG 2.

PET-CT use stratified by treatment regimen. ^aBEACOPP not included because of small population (n = 2). 1L, frontline; 5PS, 5-point scale; A + AVD, brentuximab vedotin + doxorubicin, vinblastine, and dacarbazine; ABVD, doxorubicin, bleomycin, vinblastine, and dacarbazine; AVD, doxorubicin, vinblastine, and dacarbazine; BEACOPP, escalated dosing regimen of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone; PET-CT, positron emission tomography-computed tomography.

FIG A1.

Study design. ^aQualifying treatments: ABVD, A + AVD, or BEACOPP. ^bThe last physical encounter was considered the last visit. A + AVD, brentuximab vedotin + doxorubicin, vinblastine, dacarbazine; ABVD, doxorubicin, bleomycin, vinblastine, and dacarbazine; BEACOPP, escalated dosing regimen of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone; cHL, classic Hodgkin lymphoma; USON, US Oncology Network.