Interim PET after Two ABVD Cycles in Early-Stage Hodgkin Lymphoma: Outcomes Following the Continuation of Chemotherapy Plus Radiotherapy

Gabriele Simontacchi, Andrea Riccardo Filippi, Patrizia Ciammella, Michela Buglione, Calogero Saieva, Stefano Maria Magrini, Lorenzo Livi, Cinzia Iotti, Barbara Botto, Luca Vaggelli, Alessandro Re, Francesco Merli, Umberto Ricardi

Research output: Contribution to journalArticle

Abstract

Purpose This multicenter retrospective study was designed to evaluate the prognostic role of interim fluorodeoxyglucose-labeled positron emission tomography (i-FDG-PET) in a cohort of patients affected with early-stage Hodgkin lymphoma (HL) treated initially with adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) chemotherapy followed by radiation therapy, and to assess the role of chemotherapy continuation plus radiation therapy for i-FDG-PET-positive patients. Methods and Materials Data from 257 patients were retrieved from 4 hematology and radiation oncology departments. Inclusion criteria were stage I to IIAB HL, "intention-to-treat" AVBD plus radiation therapy, and FDG-PET at diagnosis and after the first 2 ABVD cycles. All i-FDG-PET scans underwent blinded local review by using the Deauville 5-point scoring system; patients were stratified as negative or positive using 2 Deauville score cutoff values, ≥3 or ≥4. Results Median follow-up time was 56 months (range: 9-163 months); 5-year overall survival (OS) and disease-specific survival (DSS) for the whole cohort were 97.5% and 98.3%, respectively. Five-year progression-free survival (PFS) was 95.6%. After i-FDG-PET revision, 43 of 257 patients (16.7%) had a positive i-FDG-PET (Deauville scores: 3-5). Five-year PFS rates for i-FDG-PET-negative and i-FDG-PET-positive patients were 98.1% and 83.7%, respectively, if using a Deauville score cutoff of 3, and 97.7% and 78.6%, respectively, if using a cutoff of 4 (P=.0001). Five-year OS for i-FDG-PET-negative and i-FDG-PET-positive patients was 98.5% and 93.0%, respectively, if using a cutoff of 3, and 98.6% and 89.3%, respectively, if using a cutoff of 4 (P=.029 and P=.002). At univariate regression analysis, i-FDG-PET positivity was associated with worse OS and PFS. At multivariate analysis, performed only for PFS, i-FDG-PET positivity confirmed its negative impact (P=.002). Conclusions i-FDG-PET is prognostic for PFS and OS in early-stage HL patients treated with combined modality therapy; the continuation of chemotherapy followed by radiation therapy is able to obtain durable, complete remission in most i-FDG-PET-positive patients.

Original languageEnglish
Pages (from-to)1077-1083
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume92
Issue number5
DOIs
Publication statusPublished - Aug 1 2015

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Dacarbazine
Vinblastine
Bleomycin
chemotherapy
Hodgkin Disease
Positron-Emission Tomography
Doxorubicin
radiation therapy
positrons
Radiotherapy
tomography
Drug Therapy
cycles
progressions
Disease-Free Survival
cut-off
Survival
hematology
Combined Modality Therapy
Radiation Oncology

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research
  • Medicine(all)

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Interim PET after Two ABVD Cycles in Early-Stage Hodgkin Lymphoma : Outcomes Following the Continuation of Chemotherapy Plus Radiotherapy. / Simontacchi, Gabriele; Filippi, Andrea Riccardo; Ciammella, Patrizia; Buglione, Michela; Saieva, Calogero; Magrini, Stefano Maria; Livi, Lorenzo; Iotti, Cinzia; Botto, Barbara; Vaggelli, Luca; Re, Alessandro; Merli, Francesco; Ricardi, Umberto.

In: International Journal of Radiation Oncology Biology Physics, Vol. 92, No. 5, 01.08.2015, p. 1077-1083.

Research output: Contribution to journalArticle

Simontacchi, Gabriele ; Filippi, Andrea Riccardo ; Ciammella, Patrizia ; Buglione, Michela ; Saieva, Calogero ; Magrini, Stefano Maria ; Livi, Lorenzo ; Iotti, Cinzia ; Botto, Barbara ; Vaggelli, Luca ; Re, Alessandro ; Merli, Francesco ; Ricardi, Umberto. / Interim PET after Two ABVD Cycles in Early-Stage Hodgkin Lymphoma : Outcomes Following the Continuation of Chemotherapy Plus Radiotherapy. In: International Journal of Radiation Oncology Biology Physics. 2015 ; Vol. 92, No. 5. pp. 1077-1083.
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title = "Interim PET after Two ABVD Cycles in Early-Stage Hodgkin Lymphoma: Outcomes Following the Continuation of Chemotherapy Plus Radiotherapy",
abstract = "Purpose This multicenter retrospective study was designed to evaluate the prognostic role of interim fluorodeoxyglucose-labeled positron emission tomography (i-FDG-PET) in a cohort of patients affected with early-stage Hodgkin lymphoma (HL) treated initially with adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) chemotherapy followed by radiation therapy, and to assess the role of chemotherapy continuation plus radiation therapy for i-FDG-PET-positive patients. Methods and Materials Data from 257 patients were retrieved from 4 hematology and radiation oncology departments. Inclusion criteria were stage I to IIAB HL, {"}intention-to-treat{"} AVBD plus radiation therapy, and FDG-PET at diagnosis and after the first 2 ABVD cycles. All i-FDG-PET scans underwent blinded local review by using the Deauville 5-point scoring system; patients were stratified as negative or positive using 2 Deauville score cutoff values, ≥3 or ≥4. Results Median follow-up time was 56 months (range: 9-163 months); 5-year overall survival (OS) and disease-specific survival (DSS) for the whole cohort were 97.5{\%} and 98.3{\%}, respectively. Five-year progression-free survival (PFS) was 95.6{\%}. After i-FDG-PET revision, 43 of 257 patients (16.7{\%}) had a positive i-FDG-PET (Deauville scores: 3-5). Five-year PFS rates for i-FDG-PET-negative and i-FDG-PET-positive patients were 98.1{\%} and 83.7{\%}, respectively, if using a Deauville score cutoff of 3, and 97.7{\%} and 78.6{\%}, respectively, if using a cutoff of 4 (P=.0001). Five-year OS for i-FDG-PET-negative and i-FDG-PET-positive patients was 98.5{\%} and 93.0{\%}, respectively, if using a cutoff of 3, and 98.6{\%} and 89.3{\%}, respectively, if using a cutoff of 4 (P=.029 and P=.002). At univariate regression analysis, i-FDG-PET positivity was associated with worse OS and PFS. At multivariate analysis, performed only for PFS, i-FDG-PET positivity confirmed its negative impact (P=.002). Conclusions i-FDG-PET is prognostic for PFS and OS in early-stage HL patients treated with combined modality therapy; the continuation of chemotherapy followed by radiation therapy is able to obtain durable, complete remission in most i-FDG-PET-positive patients.",
author = "Gabriele Simontacchi and Filippi, {Andrea Riccardo} and Patrizia Ciammella and Michela Buglione and Calogero Saieva and Magrini, {Stefano Maria} and Lorenzo Livi and Cinzia Iotti and Barbara Botto and Luca Vaggelli and Alessandro Re and Francesco Merli and Umberto Ricardi",
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T1 - Interim PET after Two ABVD Cycles in Early-Stage Hodgkin Lymphoma

T2 - Outcomes Following the Continuation of Chemotherapy Plus Radiotherapy

AU - Simontacchi, Gabriele

AU - Filippi, Andrea Riccardo

AU - Ciammella, Patrizia

AU - Buglione, Michela

AU - Saieva, Calogero

AU - Magrini, Stefano Maria

AU - Livi, Lorenzo

AU - Iotti, Cinzia

AU - Botto, Barbara

AU - Vaggelli, Luca

AU - Re, Alessandro

AU - Merli, Francesco

AU - Ricardi, Umberto

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Purpose This multicenter retrospective study was designed to evaluate the prognostic role of interim fluorodeoxyglucose-labeled positron emission tomography (i-FDG-PET) in a cohort of patients affected with early-stage Hodgkin lymphoma (HL) treated initially with adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) chemotherapy followed by radiation therapy, and to assess the role of chemotherapy continuation plus radiation therapy for i-FDG-PET-positive patients. Methods and Materials Data from 257 patients were retrieved from 4 hematology and radiation oncology departments. Inclusion criteria were stage I to IIAB HL, "intention-to-treat" AVBD plus radiation therapy, and FDG-PET at diagnosis and after the first 2 ABVD cycles. All i-FDG-PET scans underwent blinded local review by using the Deauville 5-point scoring system; patients were stratified as negative or positive using 2 Deauville score cutoff values, ≥3 or ≥4. Results Median follow-up time was 56 months (range: 9-163 months); 5-year overall survival (OS) and disease-specific survival (DSS) for the whole cohort were 97.5% and 98.3%, respectively. Five-year progression-free survival (PFS) was 95.6%. After i-FDG-PET revision, 43 of 257 patients (16.7%) had a positive i-FDG-PET (Deauville scores: 3-5). Five-year PFS rates for i-FDG-PET-negative and i-FDG-PET-positive patients were 98.1% and 83.7%, respectively, if using a Deauville score cutoff of 3, and 97.7% and 78.6%, respectively, if using a cutoff of 4 (P=.0001). Five-year OS for i-FDG-PET-negative and i-FDG-PET-positive patients was 98.5% and 93.0%, respectively, if using a cutoff of 3, and 98.6% and 89.3%, respectively, if using a cutoff of 4 (P=.029 and P=.002). At univariate regression analysis, i-FDG-PET positivity was associated with worse OS and PFS. At multivariate analysis, performed only for PFS, i-FDG-PET positivity confirmed its negative impact (P=.002). Conclusions i-FDG-PET is prognostic for PFS and OS in early-stage HL patients treated with combined modality therapy; the continuation of chemotherapy followed by radiation therapy is able to obtain durable, complete remission in most i-FDG-PET-positive patients.

AB - Purpose This multicenter retrospective study was designed to evaluate the prognostic role of interim fluorodeoxyglucose-labeled positron emission tomography (i-FDG-PET) in a cohort of patients affected with early-stage Hodgkin lymphoma (HL) treated initially with adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) chemotherapy followed by radiation therapy, and to assess the role of chemotherapy continuation plus radiation therapy for i-FDG-PET-positive patients. Methods and Materials Data from 257 patients were retrieved from 4 hematology and radiation oncology departments. Inclusion criteria were stage I to IIAB HL, "intention-to-treat" AVBD plus radiation therapy, and FDG-PET at diagnosis and after the first 2 ABVD cycles. All i-FDG-PET scans underwent blinded local review by using the Deauville 5-point scoring system; patients were stratified as negative or positive using 2 Deauville score cutoff values, ≥3 or ≥4. Results Median follow-up time was 56 months (range: 9-163 months); 5-year overall survival (OS) and disease-specific survival (DSS) for the whole cohort were 97.5% and 98.3%, respectively. Five-year progression-free survival (PFS) was 95.6%. After i-FDG-PET revision, 43 of 257 patients (16.7%) had a positive i-FDG-PET (Deauville scores: 3-5). Five-year PFS rates for i-FDG-PET-negative and i-FDG-PET-positive patients were 98.1% and 83.7%, respectively, if using a Deauville score cutoff of 3, and 97.7% and 78.6%, respectively, if using a cutoff of 4 (P=.0001). Five-year OS for i-FDG-PET-negative and i-FDG-PET-positive patients was 98.5% and 93.0%, respectively, if using a cutoff of 3, and 98.6% and 89.3%, respectively, if using a cutoff of 4 (P=.029 and P=.002). At univariate regression analysis, i-FDG-PET positivity was associated with worse OS and PFS. At multivariate analysis, performed only for PFS, i-FDG-PET positivity confirmed its negative impact (P=.002). Conclusions i-FDG-PET is prognostic for PFS and OS in early-stage HL patients treated with combined modality therapy; the continuation of chemotherapy followed by radiation therapy is able to obtain durable, complete remission in most i-FDG-PET-positive patients.

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