Outcome-based interpretation of early interim PET in advanced-stage Hodgkin lymphoma

Carsten Kobe, Helen Goergen, Christian Baues, Georg Kuhnert, Conrad-Amadeus Voltin, Josée Zijlstra, Otto Hoekstra, Jasmin Mettler, Alexander Drzezga, Andreas Engert, Peter Borchmann, Markus Dietlein

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

The HD18 study for patients with newly diagnosed advanced-stage Hodgkin lymphoma (HL) used positron emission tomography (PET) after 2 cycles (PET-2) of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone in escalated doses (eBEACOPP) to guide further treatment. Here, we analyzed the impact of PET-2 results in the context of eBEACOPP according to the Deauville score (DS) in patients treated within the HD18 trial. Residual tissue was visually compared with reference regions according to DS. We analyzed the association between PET-2 uptake and baseline characteristics, progression-free survival (PFS), and overall survival (OS). One thousand five patients (52%) had DS1 or DS2, 471 (24%) had DS3, and 469 (24%) DS4. PET-2 uptake was associated with baseline risk factors large mediastinal mass, extranodal disease, and high International Prognostic Score (P < .0001 each). Among 722 patients receiving standard therapy with 6 cycles of eBEACOPP, 3-year PFS rates were 92.2%, 95.9%, and 87.6% with DS1-2, DS3, and DS4, respectively. Univariate hazard ratio (HR) for PFS in patients with DS4 vs DS1-3 was 2.3 (1.3-3.8; P = .002). DS4 was the only factor remaining significant for PFS in a multivariate analysis including the associated baseline risk factors. Three-year OS rates were 97.6% for DS1-2, 99.0% for DS3, and 96.8% for DS4, with a univariate HR for DS4 vs DS1-3 of 2.6 (1.0-6.6; P = .04). Residual uptake above that in the liver at PET-2 (ie, DS4) is an important risk factor regarding survival outcomes for patients treated with eBEACOPP upfront. We thus recommend DS4 as the cutoff value for PET-2 positivity. This trial was registered at www.clinicaltrials.gov as #NCT00515554.
Original languageEnglish
Pages (from-to)2273-2279
Number of pages7
JournalBlood
Volume132
Issue number21
DOIs
Publication statusPublished - 2018

Cite this

Kobe, C., Goergen, H., Baues, C., Kuhnert, G., Voltin, C-A., Zijlstra, J., ... Dietlein, M. (2018). Outcome-based interpretation of early interim PET in advanced-stage Hodgkin lymphoma. Blood, 132(21), 2273-2279. https://doi.org/10.1182/blood-2018-05-852129
Kobe, Carsten ; Goergen, Helen ; Baues, Christian ; Kuhnert, Georg ; Voltin, Conrad-Amadeus ; Zijlstra, Josée ; Hoekstra, Otto ; Mettler, Jasmin ; Drzezga, Alexander ; Engert, Andreas ; Borchmann, Peter ; Dietlein, Markus. / Outcome-based interpretation of early interim PET in advanced-stage Hodgkin lymphoma. In: Blood. 2018 ; Vol. 132, No. 21. pp. 2273-2279.
@article{07e748ea20c3414cbdad78f4b08b45e3,
title = "Outcome-based interpretation of early interim PET in advanced-stage Hodgkin lymphoma",
abstract = "The HD18 study for patients with newly diagnosed advanced-stage Hodgkin lymphoma (HL) used positron emission tomography (PET) after 2 cycles (PET-2) of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone in escalated doses (eBEACOPP) to guide further treatment. Here, we analyzed the impact of PET-2 results in the context of eBEACOPP according to the Deauville score (DS) in patients treated within the HD18 trial. Residual tissue was visually compared with reference regions according to DS. We analyzed the association between PET-2 uptake and baseline characteristics, progression-free survival (PFS), and overall survival (OS). One thousand five patients (52{\%}) had DS1 or DS2, 471 (24{\%}) had DS3, and 469 (24{\%}) DS4. PET-2 uptake was associated with baseline risk factors large mediastinal mass, extranodal disease, and high International Prognostic Score (P < .0001 each). Among 722 patients receiving standard therapy with 6 cycles of eBEACOPP, 3-year PFS rates were 92.2{\%}, 95.9{\%}, and 87.6{\%} with DS1-2, DS3, and DS4, respectively. Univariate hazard ratio (HR) for PFS in patients with DS4 vs DS1-3 was 2.3 (1.3-3.8; P = .002). DS4 was the only factor remaining significant for PFS in a multivariate analysis including the associated baseline risk factors. Three-year OS rates were 97.6{\%} for DS1-2, 99.0{\%} for DS3, and 96.8{\%} for DS4, with a univariate HR for DS4 vs DS1-3 of 2.6 (1.0-6.6; P = .04). Residual uptake above that in the liver at PET-2 (ie, DS4) is an important risk factor regarding survival outcomes for patients treated with eBEACOPP upfront. We thus recommend DS4 as the cutoff value for PET-2 positivity. This trial was registered at www.clinicaltrials.gov as #NCT00515554.",
author = "Carsten Kobe and Helen Goergen and Christian Baues and Georg Kuhnert and Conrad-Amadeus Voltin and Jos{\'e}e Zijlstra and Otto Hoekstra and Jasmin Mettler and Alexander Drzezga and Andreas Engert and Peter Borchmann and Markus Dietlein",
note = "Copyright {\circledC} 2018 American Society of Hematology.",
year = "2018",
doi = "10.1182/blood-2018-05-852129",
language = "English",
volume = "132",
pages = "2273--2279",
journal = "Blood",
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Kobe, C, Goergen, H, Baues, C, Kuhnert, G, Voltin, C-A, Zijlstra, J, Hoekstra, O, Mettler, J, Drzezga, A, Engert, A, Borchmann, P & Dietlein, M 2018, 'Outcome-based interpretation of early interim PET in advanced-stage Hodgkin lymphoma' Blood, vol. 132, no. 21, pp. 2273-2279. https://doi.org/10.1182/blood-2018-05-852129

Outcome-based interpretation of early interim PET in advanced-stage Hodgkin lymphoma. / Kobe, Carsten; Goergen, Helen; Baues, Christian; Kuhnert, Georg; Voltin, Conrad-Amadeus; Zijlstra, Josée; Hoekstra, Otto; Mettler, Jasmin; Drzezga, Alexander; Engert, Andreas; Borchmann, Peter; Dietlein, Markus.

In: Blood, Vol. 132, No. 21, 2018, p. 2273-2279.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Outcome-based interpretation of early interim PET in advanced-stage Hodgkin lymphoma

AU - Kobe, Carsten

AU - Goergen, Helen

AU - Baues, Christian

AU - Kuhnert, Georg

AU - Voltin, Conrad-Amadeus

AU - Zijlstra, Josée

AU - Hoekstra, Otto

AU - Mettler, Jasmin

AU - Drzezga, Alexander

AU - Engert, Andreas

AU - Borchmann, Peter

AU - Dietlein, Markus

N1 - Copyright © 2018 American Society of Hematology.

PY - 2018

Y1 - 2018

N2 - The HD18 study for patients with newly diagnosed advanced-stage Hodgkin lymphoma (HL) used positron emission tomography (PET) after 2 cycles (PET-2) of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone in escalated doses (eBEACOPP) to guide further treatment. Here, we analyzed the impact of PET-2 results in the context of eBEACOPP according to the Deauville score (DS) in patients treated within the HD18 trial. Residual tissue was visually compared with reference regions according to DS. We analyzed the association between PET-2 uptake and baseline characteristics, progression-free survival (PFS), and overall survival (OS). One thousand five patients (52%) had DS1 or DS2, 471 (24%) had DS3, and 469 (24%) DS4. PET-2 uptake was associated with baseline risk factors large mediastinal mass, extranodal disease, and high International Prognostic Score (P < .0001 each). Among 722 patients receiving standard therapy with 6 cycles of eBEACOPP, 3-year PFS rates were 92.2%, 95.9%, and 87.6% with DS1-2, DS3, and DS4, respectively. Univariate hazard ratio (HR) for PFS in patients with DS4 vs DS1-3 was 2.3 (1.3-3.8; P = .002). DS4 was the only factor remaining significant for PFS in a multivariate analysis including the associated baseline risk factors. Three-year OS rates were 97.6% for DS1-2, 99.0% for DS3, and 96.8% for DS4, with a univariate HR for DS4 vs DS1-3 of 2.6 (1.0-6.6; P = .04). Residual uptake above that in the liver at PET-2 (ie, DS4) is an important risk factor regarding survival outcomes for patients treated with eBEACOPP upfront. We thus recommend DS4 as the cutoff value for PET-2 positivity. This trial was registered at www.clinicaltrials.gov as #NCT00515554.

AB - The HD18 study for patients with newly diagnosed advanced-stage Hodgkin lymphoma (HL) used positron emission tomography (PET) after 2 cycles (PET-2) of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone in escalated doses (eBEACOPP) to guide further treatment. Here, we analyzed the impact of PET-2 results in the context of eBEACOPP according to the Deauville score (DS) in patients treated within the HD18 trial. Residual tissue was visually compared with reference regions according to DS. We analyzed the association between PET-2 uptake and baseline characteristics, progression-free survival (PFS), and overall survival (OS). One thousand five patients (52%) had DS1 or DS2, 471 (24%) had DS3, and 469 (24%) DS4. PET-2 uptake was associated with baseline risk factors large mediastinal mass, extranodal disease, and high International Prognostic Score (P < .0001 each). Among 722 patients receiving standard therapy with 6 cycles of eBEACOPP, 3-year PFS rates were 92.2%, 95.9%, and 87.6% with DS1-2, DS3, and DS4, respectively. Univariate hazard ratio (HR) for PFS in patients with DS4 vs DS1-3 was 2.3 (1.3-3.8; P = .002). DS4 was the only factor remaining significant for PFS in a multivariate analysis including the associated baseline risk factors. Three-year OS rates were 97.6% for DS1-2, 99.0% for DS3, and 96.8% for DS4, with a univariate HR for DS4 vs DS1-3 of 2.6 (1.0-6.6; P = .04). Residual uptake above that in the liver at PET-2 (ie, DS4) is an important risk factor regarding survival outcomes for patients treated with eBEACOPP upfront. We thus recommend DS4 as the cutoff value for PET-2 positivity. This trial was registered at www.clinicaltrials.gov as #NCT00515554.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/30166329

U2 - 10.1182/blood-2018-05-852129

DO - 10.1182/blood-2018-05-852129

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JO - Blood

JF - Blood

SN - 0006-4971

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