The continuation of chemotherapy followed by radiation may obtain durable complete remission in early stage Hodgkin Lymphoma patients with a positive FDG-Positron Emission Tomography after the first two ABVD Cycles
Menée à partir de données portant sur 257 patients atteints d'un lymphome hodgkinien de stade I-IIAB (durée médiane de suivi : 56 mois), cette étude montre que prolonger une chimiothérapie et lui ajouter une radiothérapie peut permettre une rémission complète durable chez les patients présentant une maladie résiduelle (détectée par tomographie numérique par émission de positrons à base de fluorodésoxyglucose) après deux cycles de chimiothérapie par ABVD
Purpose : This multicenter retrospective study was designed with the aims to: a) evaluate the prognostic role of interim-FDG-PET (i-FDG-PET) in a cohort of patients affected with early stage HL treated upfront with ABVD chemotherapy followed by radiotherapy, and b) assess the role of chemotherapy continuation plus radiotherapy for i-FDG-PET positive patients. Methods and Materials : data of 257 patients were retrieved from 4 Hematology/Radiation Oncology Departments. Inclusion criteria were: stage I-IIAB HL, "intention-to-treat" AVBD plus radiotherapy, 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/positive using two Deauville score cut-offs (≥3 or ≥4). Results : Median follow-up time was 56 months (range 9-163); 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, 43/257 (16,7%) patients 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% if using a Deauville score cut-off of 3, and 97.7% and 78.6% if using a cut-off of 4, respectively (p=0.0001). Five-year OS for i-FDG-PET negative and i-FDG-PET positive patients was 98.5% and 93.0% if using a cut-off of 3 and 98.6% and 89.3% if using a cut-off of 4, respectively (p=0.029 and p=0.002) respectively. At univariate regression analysis i-FDG-PET positivity was associated with worse OS and PFS. At multivariable analysis, performed only for PFS, i-FDG-PET positivity confirmed its negative impact (p=0.002). 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 radiotherapy is able to obtain durable complete remission in the majority of i-FDG-PET positive patients.
http://www.redjournal.org/article/S0360-3016(15)00421-6/abstract 2015