Positron emission tomography score has greater prognostic significance than pretreatment risk stratification in early-stage Hodgkin lymphoma in the UK RAPID study
Hoskin, Peter J
Illidge, Timothy M
Radford, John A
AffiliationKing's College London and Guy's and St Thomas' PET Centre, Kings College London, King's Health Partners, London
MetadataShow full item record
AbstractPURPOSE: Accurate stratification of patients is an important goal in Hodgkin lymphoma (HL), but the role of pretreatment clinical risk stratification in the context of positron emission tomography (PET) -adapted treatment is unclear. We performed a subsidiary analysis of the RAPID trial to assess the prognostic value of pretreatment risk factors and PET score in determining outcomes. PATIENTS AND METHODS: Patients with stage IA to IIA HL and no mediastinal bulk underwent PET assessment after three cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine; 143 PET-positive patients (PET score, 3 to 5) received a fourth doxorubicin, bleomycin, vinblastine, and dacarbazine cycle and involved-field radiotherapy, and 419 patients in complete metabolic remission were randomly assigned to receive involved-field radiotherapy (n = 208) or no additional treatment (n = 211). Cox regression was used to investigate the association between PET score and pretreatment risk factors with HL-specific event-free survival (EFS). RESULTS: High PET score was associated with inferior EFS, before (P < .001) and after adjustment (P = .01) for baseline risk stratification. Only patients with a postchemotherapy PET score of 5 (uptake ? three times maximum liver uptake) had an increased risk of progression or HL-related death (hazard ratio, 9.4 v score of 3; 95% CI, 2.8 to 31.3 and hazard ratio, 6.7 v score of 4; 95% CI, 1.4 to 31.7). Patients with a PET score of 5 also had inferior progression-free and overall survival. There was no association between European Organisation for Research and Treatment of Cancer or German Hodgkin Study Group risk group and EFS, before or after adjusting for PET score (all P > .4). CONCLUSION: In RAPID, a positive PET scan did not carry uniform prognostic weight; only a PET score of 5 was associated with inferior outcomes. This suggests that in future trials involving patients without B symptoms or mediastinal bulk, a score of 5 rather than a positive PET result should be used to guide treatment escalation in early-stage HL.
CitationBarrington SF, Phillips EH, Counsell N, Hancock B, Pettengell R, Johnson P, et al. Positron emission tomography score has greater prognostic significance than pretreatment risk stratification in early-stage Hodgkin lymphoma in the UK RAPID study. J Clin Oncol. 2019.
JournalJournal of Clincal Oncology
- Eight Cycles of ABVD Versus Four Cycles of BEACOPPescalated Plus Four Cycles of BEACOPPbaseline in Stage III to IV, International Prognostic Score ≥ 3, High-Risk Hodgkin Lymphoma: First Results of the Phase III EORTC 20012 Intergroup Trial.
- Authors: Carde P, Karrasch M, Fortpied C, Brice P, Khaled H, Casasnovas O, Caillot D, Gaillard I, Bologna S, Ferme C, Lugtenburg PJ, Morschhauser F, Aurer I, Coiffier B, Meyer R, Seftel M, Wolf M, Glimelius B, Sureda A, Mounier N
- Issue date: 2016 Jun 10
- Modification of initial therapy in early and advanced Hodgkin lymphoma, based on interim PET/CT is beneficial: a prospective multicentre trial of 355 patients.
- Authors: Dann EJ, Bairey O, Bar-Shalom R, Mashiach T, Barzilai E, Kornberg A, Akria L, Tadmor T, Filanovsky K, Abadi U, Kagna O, Ruchlemer R, Abdah-Bortnyak R, Goldschmidt N, Epelbaum R, Horowitz NA, Lavie D, Ben-Yehuda D, Shpilberg O, Paltiel O
- Issue date: 2017 Sep
- 18F-FDG PET after 2 cycles of ABVD predicts event-free survival in early and advanced Hodgkin lymphoma.
- Authors: Cerci JJ, Pracchia LF, Linardi CC, Pitella FA, Delbeke D, Izaki M, Trindade E, Soares J Jr, Buccheri V, Meneghetti JC
- Issue date: 2010 Sep
- Positron emission tomography-adapted therapy for first-line treatment in individuals with Hodgkin lymphoma.
- Authors: Sickinger MT, von Tresckow B, Kobe C, Engert A, Borchmann P, Skoetz N
- Issue date: 2015 Jan 9
- Results of a trial of PET-directed therapy for early-stage Hodgkin's lymphoma.
- Authors: Radford J, Illidge T, Counsell N, Hancock B, Pettengell R, Johnson P, Wimperis J, Culligan D, Popova B, Smith P, McMillan A, Brownell A, Kruger A, Lister A, Hoskin P, O'Doherty M, Barrington S
- Issue date: 2015 Apr 23