Nowadays, there are different guidelines in diagnostics and PET-guided treatment of lymphomas. But questions about benefits and predictive role of PET-CT in pts with early-stage Hodgkin lymphoma (HL) still remain debatable. Here we report results of Ukrainian multicenter retrospective study about the role of PET-CT in early-stage HL pts.
56 patients, with stages I-II, were registered in the study between August 2012 and Feb 2018 in 9 Ukrainian hematological centers. Metabolic PET-CT imaging was performed according to standard protocols. The threshold of positivity was set for a residual uptake higher than the liver background (Deauville score (DS) 4and 5). Patients were treated with ABVD or BEACOPPesc regimens based on risk group. The primary endpoint was event-free survival (EFS), defined as disease progression or death from HL.
Median age of patients at diagnosis was 29 years (range 18-50), 16 (28,5%) male and 40 (71,5%) pts were female. Bulky disease (>10 cm in any dimension) were presented in 6/56 (10,7%) of pts, B symptoms - in 16/56 (28,5%) and extranodal disease had 4/56 (7%). Median follow-up was 24 months from diagnosis. Interim PET (PET2) was performed in 50 pts at 15.5 ±3 days (range, 5-26) after 2xABVD or 2xBEACOPP esc cycles. Interim PET-CT was assessed as DS 1-2 in 34 patients (60,7%), DS 3 in 11 (19,6%), DS 4-5 in 5 pts (8,8%). In total, disease progression was documented in 5/56 (9%). Among them, 2/5 (40%) patient were PET2-positive (PET2+) and 3/5 (60%) PET2-negative (PET2-), (p > 0.05). There were no registered deaths from the refractory disease. We did not find any significant difference between EFS rate in pts with PET2+ vs PET2- (log-rank test, p = 0.4). 47 pts have proceeded for end-of-treatment PET-CT (PET3). Results showed 3/47 pts (6,3%) were PET3+ and PET3- were 44/47 (93,7%), (p < 0,05). EFS was compared and assessed depending on DS. Achieved rate of 3-year EFS in pts with PET3 DS 1-2, DS 3 and DS 4-5 were 94,4%, 50% and 0%, respectively (p < 0.006).
End of treatment PET-CT plays an important role in patients with early-stage HL and could be a beneficial prognostic factor. However, there is still need for prospective confirmation of interim PET-CT as a prognostic factor.
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All authors have declared no conflicts of interest.