FDG PET in response evaluation of bulky masses in paediatric Hodgkin’s lymphoma (HL) patients enrolled in the Italian AIEOP-LH2004 trial

Italy AIEOP Hodgkin Lymphoma Study Group, Egesta Lopci, Maurizio Mascarin, Arnoldo Piccardo, Angelo Castello, Caterina Elia, Luca Guerra, Eugenio Borsatti, Alessandra Sala, Alessandra Todesco, Pietro Zucchetta, Piero Farruggia, Angelina Cistaro, Salvatore Buffardi, Patrizia Bertolini, Maurizio Bianchi, Maria Luisa Moleti, Feisal Bunkheila, Paolo Indolfi, Franca FagioliAlberto Garaventa, Roberta Burnelli

Research output: Contribution to journalArticle

Abstract

Purpose: We present the results of an investigation of the role of FDG PET in response evaluation of bulky masses in paediatric patients with Hodgkin’s lymphoma (HL) enrolled in the Italian AIEOP-LH2004 trial. Methods: We analysed data derived from 703 patients (388 male, 315 female; mean age 13 years) with HL and enrolled in 41 different Italian centres from March 2004 to September 2012, all treated with the AIEOP-LH2004 protocol. The cohort comprised 309 patients with a bulky mass, of whom 263 were evaluated with FDG PET at baseline and after four cycles of chemotherapy. Responses were determined according to combined functional and morphological criteria. Patients were followed up for a mean period of 43 months and for each child we calculated time-to-progression (TTP) and relapse rates considering clinical monitoring, and instrumental and histological data as the reference standard. Statistical analyses were performed for FDG PET and morphological responses with respect to TTP. Multivariate analysis was used to define independent predictive factors. Results: Overall, response evaluation revealed 238 PET-negative patients (90.5%) and 25 PET-positive patients (9.5%), with a significant difference in TTP between these groups (mean TTP: 32.67 months for negative scans, 23.8 months for positive scans; p <0.0001, log-rank test). In the same cohort, computed tomography showed a complete response (CR) in 85 patients (32.3%), progressive disease (PD) in 6 patients (2.3%), and a partial response (PR) in 165 patients (62.7%), with a significant difference in TTP between patients with CR and patients with PD (31.1 months and 7.9 months, respectively; p <0.001, log-rank test). Similarly, there was a significant difference in relapse rates between PET-positive and PET-negative patients (p = 0000). In patients with PR, there was also a significant difference in TTP between PET-positive and PET-negative patients (24.6 months and 34.9 months, respectively; p <0.0001). In the multivariate analysis with correction for multiple testing, only the PET result was an independent predictive factor in both the entire cohort of patients and the subgroup showing PR on CT (p <0.01). Conclusion: After four cycles of chemotherapy, FDG PET response assessment in paediatric HL patients with a bulky mass is a good predictor of TTP and disease outcome. Moreover, in patients with a PR on CT, PET was able to differentiate those with a longer TTP. In paediatric HL patients with a bulky mass and in patients with a PR on CT, response on FDG PET was an independent predictive factor.
Original languageEnglish
Pages (from-to)97-106
Number of pages10
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume46
Issue number1
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Hodgkin Disease
Pediatrics
Multivariate Analysis
Recurrence
Drug Therapy

Keywords

  • Bulky masses
  • FDG PET
  • Hodgkin’s lymphoma
  • Interim evaluation
  • Paediatric
  • Response assessment

Cite this

FDG PET in response evaluation of bulky masses in paediatric Hodgkin’s lymphoma (HL) patients enrolled in the Italian AIEOP-LH2004 trial. / AIEOP Hodgkin Lymphoma Study Group, Italy; Lopci, Egesta; Mascarin, Maurizio; Piccardo, Arnoldo; Castello, Angelo; Elia, Caterina; Guerra, Luca; Borsatti, Eugenio; Sala, Alessandra; Todesco, Alessandra; Zucchetta, Pietro; Farruggia, Piero; Cistaro, Angelina; Buffardi, Salvatore; Bertolini, Patrizia; Bianchi, Maurizio; Moleti, Maria Luisa; Bunkheila, Feisal; Indolfi, Paolo; Fagioli, Franca; Garaventa, Alberto; Burnelli, Roberta.

In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 46, No. 1, 01.01.2019, p. 97-106.

Research output: Contribution to journalArticle

AIEOP Hodgkin Lymphoma Study Group, I, Lopci, E, Mascarin, M, Piccardo, A, Castello, A, Elia, C, Guerra, L, Borsatti, E, Sala, A, Todesco, A, Zucchetta, P, Farruggia, P, Cistaro, A, Buffardi, S, Bertolini, P, Bianchi, M, Moleti, ML, Bunkheila, F, Indolfi, P, Fagioli, F, Garaventa, A & Burnelli, R 2019, 'FDG PET in response evaluation of bulky masses in paediatric Hodgkin’s lymphoma (HL) patients enrolled in the Italian AIEOP-LH2004 trial', European Journal of Nuclear Medicine and Molecular Imaging, vol. 46, no. 1, pp. 97-106. https://doi.org/10.1007/s00259-018-4155-4
AIEOP Hodgkin Lymphoma Study Group, Italy ; Lopci, Egesta ; Mascarin, Maurizio ; Piccardo, Arnoldo ; Castello, Angelo ; Elia, Caterina ; Guerra, Luca ; Borsatti, Eugenio ; Sala, Alessandra ; Todesco, Alessandra ; Zucchetta, Pietro ; Farruggia, Piero ; Cistaro, Angelina ; Buffardi, Salvatore ; Bertolini, Patrizia ; Bianchi, Maurizio ; Moleti, Maria Luisa ; Bunkheila, Feisal ; Indolfi, Paolo ; Fagioli, Franca ; Garaventa, Alberto ; Burnelli, Roberta. / FDG PET in response evaluation of bulky masses in paediatric Hodgkin’s lymphoma (HL) patients enrolled in the Italian AIEOP-LH2004 trial. In: European Journal of Nuclear Medicine and Molecular Imaging. 2019 ; Vol. 46, No. 1. pp. 97-106.
@article{f4615bfb79d141f08da9040e2512dcf6,
title = "FDG PET in response evaluation of bulky masses in paediatric Hodgkin’s lymphoma (HL) patients enrolled in the Italian AIEOP-LH2004 trial",
abstract = "Purpose: We present the results of an investigation of the role of FDG PET in response evaluation of bulky masses in paediatric patients with Hodgkin’s lymphoma (HL) enrolled in the Italian AIEOP-LH2004 trial. Methods: We analysed data derived from 703 patients (388 male, 315 female; mean age 13 years) with HL and enrolled in 41 different Italian centres from March 2004 to September 2012, all treated with the AIEOP-LH2004 protocol. The cohort comprised 309 patients with a bulky mass, of whom 263 were evaluated with FDG PET at baseline and after four cycles of chemotherapy. Responses were determined according to combined functional and morphological criteria. Patients were followed up for a mean period of 43 months and for each child we calculated time-to-progression (TTP) and relapse rates considering clinical monitoring, and instrumental and histological data as the reference standard. Statistical analyses were performed for FDG PET and morphological responses with respect to TTP. Multivariate analysis was used to define independent predictive factors. Results: Overall, response evaluation revealed 238 PET-negative patients (90.5{\%}) and 25 PET-positive patients (9.5{\%}), with a significant difference in TTP between these groups (mean TTP: 32.67 months for negative scans, 23.8 months for positive scans; p <0.0001, log-rank test). In the same cohort, computed tomography showed a complete response (CR) in 85 patients (32.3{\%}), progressive disease (PD) in 6 patients (2.3{\%}), and a partial response (PR) in 165 patients (62.7{\%}), with a significant difference in TTP between patients with CR and patients with PD (31.1 months and 7.9 months, respectively; p <0.001, log-rank test). Similarly, there was a significant difference in relapse rates between PET-positive and PET-negative patients (p = 0000). In patients with PR, there was also a significant difference in TTP between PET-positive and PET-negative patients (24.6 months and 34.9 months, respectively; p <0.0001). In the multivariate analysis with correction for multiple testing, only the PET result was an independent predictive factor in both the entire cohort of patients and the subgroup showing PR on CT (p <0.01). Conclusion: After four cycles of chemotherapy, FDG PET response assessment in paediatric HL patients with a bulky mass is a good predictor of TTP and disease outcome. Moreover, in patients with a PR on CT, PET was able to differentiate those with a longer TTP. In paediatric HL patients with a bulky mass and in patients with a PR on CT, response on FDG PET was an independent predictive factor.",
keywords = "Bulky masses, FDG PET, Hodgkin’s lymphoma, Interim evaluation, Paediatric, Response assessment",
author = "{AIEOP Hodgkin Lymphoma Study Group}, Italy and Egesta Lopci and Maurizio Mascarin and Arnoldo Piccardo and Angelo Castello and Caterina Elia and Luca Guerra and Eugenio Borsatti and Alessandra Sala and Alessandra Todesco and Pietro Zucchetta and Piero Farruggia and Angelina Cistaro and Salvatore Buffardi and Patrizia Bertolini and Maurizio Bianchi and Moleti, {Maria Luisa} and Feisal Bunkheila and Paolo Indolfi and Franca Fagioli and Alberto Garaventa and Roberta Burnelli",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s00259-018-4155-4",
language = "English",
volume = "46",
pages = "97--106",
journal = "European Journal of Nuclear Medicine and Molecular Imaging",
issn = "1619-7070",
publisher = "Springer Verlag",
number = "1",

}

TY - JOUR

T1 - FDG PET in response evaluation of bulky masses in paediatric Hodgkin’s lymphoma (HL) patients enrolled in the Italian AIEOP-LH2004 trial

AU - AIEOP Hodgkin Lymphoma Study Group, Italy

AU - Lopci, Egesta

AU - Mascarin, Maurizio

AU - Piccardo, Arnoldo

AU - Castello, Angelo

AU - Elia, Caterina

AU - Guerra, Luca

AU - Borsatti, Eugenio

AU - Sala, Alessandra

AU - Todesco, Alessandra

AU - Zucchetta, Pietro

AU - Farruggia, Piero

AU - Cistaro, Angelina

AU - Buffardi, Salvatore

AU - Bertolini, Patrizia

AU - Bianchi, Maurizio

AU - Moleti, Maria Luisa

AU - Bunkheila, Feisal

AU - Indolfi, Paolo

AU - Fagioli, Franca

AU - Garaventa, Alberto

AU - Burnelli, Roberta

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: We present the results of an investigation of the role of FDG PET in response evaluation of bulky masses in paediatric patients with Hodgkin’s lymphoma (HL) enrolled in the Italian AIEOP-LH2004 trial. Methods: We analysed data derived from 703 patients (388 male, 315 female; mean age 13 years) with HL and enrolled in 41 different Italian centres from March 2004 to September 2012, all treated with the AIEOP-LH2004 protocol. The cohort comprised 309 patients with a bulky mass, of whom 263 were evaluated with FDG PET at baseline and after four cycles of chemotherapy. Responses were determined according to combined functional and morphological criteria. Patients were followed up for a mean period of 43 months and for each child we calculated time-to-progression (TTP) and relapse rates considering clinical monitoring, and instrumental and histological data as the reference standard. Statistical analyses were performed for FDG PET and morphological responses with respect to TTP. Multivariate analysis was used to define independent predictive factors. Results: Overall, response evaluation revealed 238 PET-negative patients (90.5%) and 25 PET-positive patients (9.5%), with a significant difference in TTP between these groups (mean TTP: 32.67 months for negative scans, 23.8 months for positive scans; p <0.0001, log-rank test). In the same cohort, computed tomography showed a complete response (CR) in 85 patients (32.3%), progressive disease (PD) in 6 patients (2.3%), and a partial response (PR) in 165 patients (62.7%), with a significant difference in TTP between patients with CR and patients with PD (31.1 months and 7.9 months, respectively; p <0.001, log-rank test). Similarly, there was a significant difference in relapse rates between PET-positive and PET-negative patients (p = 0000). In patients with PR, there was also a significant difference in TTP between PET-positive and PET-negative patients (24.6 months and 34.9 months, respectively; p <0.0001). In the multivariate analysis with correction for multiple testing, only the PET result was an independent predictive factor in both the entire cohort of patients and the subgroup showing PR on CT (p <0.01). Conclusion: After four cycles of chemotherapy, FDG PET response assessment in paediatric HL patients with a bulky mass is a good predictor of TTP and disease outcome. Moreover, in patients with a PR on CT, PET was able to differentiate those with a longer TTP. In paediatric HL patients with a bulky mass and in patients with a PR on CT, response on FDG PET was an independent predictive factor.

AB - Purpose: We present the results of an investigation of the role of FDG PET in response evaluation of bulky masses in paediatric patients with Hodgkin’s lymphoma (HL) enrolled in the Italian AIEOP-LH2004 trial. Methods: We analysed data derived from 703 patients (388 male, 315 female; mean age 13 years) with HL and enrolled in 41 different Italian centres from March 2004 to September 2012, all treated with the AIEOP-LH2004 protocol. The cohort comprised 309 patients with a bulky mass, of whom 263 were evaluated with FDG PET at baseline and after four cycles of chemotherapy. Responses were determined according to combined functional and morphological criteria. Patients were followed up for a mean period of 43 months and for each child we calculated time-to-progression (TTP) and relapse rates considering clinical monitoring, and instrumental and histological data as the reference standard. Statistical analyses were performed for FDG PET and morphological responses with respect to TTP. Multivariate analysis was used to define independent predictive factors. Results: Overall, response evaluation revealed 238 PET-negative patients (90.5%) and 25 PET-positive patients (9.5%), with a significant difference in TTP between these groups (mean TTP: 32.67 months for negative scans, 23.8 months for positive scans; p <0.0001, log-rank test). In the same cohort, computed tomography showed a complete response (CR) in 85 patients (32.3%), progressive disease (PD) in 6 patients (2.3%), and a partial response (PR) in 165 patients (62.7%), with a significant difference in TTP between patients with CR and patients with PD (31.1 months and 7.9 months, respectively; p <0.001, log-rank test). Similarly, there was a significant difference in relapse rates between PET-positive and PET-negative patients (p = 0000). In patients with PR, there was also a significant difference in TTP between PET-positive and PET-negative patients (24.6 months and 34.9 months, respectively; p <0.0001). In the multivariate analysis with correction for multiple testing, only the PET result was an independent predictive factor in both the entire cohort of patients and the subgroup showing PR on CT (p <0.01). Conclusion: After four cycles of chemotherapy, FDG PET response assessment in paediatric HL patients with a bulky mass is a good predictor of TTP and disease outcome. Moreover, in patients with a PR on CT, PET was able to differentiate those with a longer TTP. In paediatric HL patients with a bulky mass and in patients with a PR on CT, response on FDG PET was an independent predictive factor.

KW - Bulky masses

KW - FDG PET

KW - Hodgkin’s lymphoma

KW - Interim evaluation

KW - Paediatric

KW - Response assessment

U2 - 10.1007/s00259-018-4155-4

DO - 10.1007/s00259-018-4155-4

M3 - Article

VL - 46

SP - 97

EP - 106

JO - European Journal of Nuclear Medicine and Molecular Imaging

JF - European Journal of Nuclear Medicine and Molecular Imaging

SN - 1619-7070

IS - 1

ER -