Five-year follow-up of SWOG S0816: Limitations and values of a PET-adapted approach with stage III/IV Hodgkin lymphoma

Deborah M. Stephens, Hongli Li, Heiko Scho¨der, David J. Straus, Craig H. Moskowitz, Michael LeBlanc, Lisa M. Rimsza, Nancy L. Bartlett, Andrew M. Evens, Ann S. LaCasce, Paul M. Barr, Michael V. Knopp, Eric D. Hsi, John P. Leonard, Brad S. Kahl, Sonali M. Smith, Jonathan W. Friedberg

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2 Scopus citations

Abstract

Patients with advanced-stage Hodgkin lymphoma (HL) demonstrated excellent 2-year progression-free survival (PFS) after receiving positron emission tomography (PET)- adapted therapy on SWOG S0816. Patients received 2 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Patients achieving complete response (CR) on PET scan following cycle 2 of ABVD (PET2) continued 4 additional cycles of ABVD. Patients not achieving CR on PET2 were switched to escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP) for 6 cycles. After a median follow-up of 5.9 years, a subset of 331 eligible patients with central review of PET2 was analyzed. PET2 was negative in 82% and positive in 18%. For all patients, the estimated 5-year PFS and OS was 74% (95% confidence interval [CI], 69%-79%) and 94% (95% CI, 91%-96%), respectively. For PET22 and PET21 patients, the 5-year PFS was 76% (95% CI, 70%-81%) and 66% (95% CI, 52%-76%), respectively. Seven (14%) and 6 (2%) patients reported second cancers after treatment with eBEACOPP and ABVD, respectively (P = .001). Long-term OS of HL patients treated on S0816 remains high. Nearly 25% of PET22 patients experienced relapse events, demonstrating limitations ABVD therapy and of the negative predictive value of PET2. In PET2+ patients who received eBEACOPP, PFS was favorable, but was associated with a high rate of second malignancies compared with historical controls. Our results emphasize the importance of long-term follow-up, and the need for more efficacious and less toxic therapeutic approaches for advanced-stage HL patients. This trial was registered at www.clinicaltrials.gov as #NCT00822120.

Original languageEnglish (US)
Pages (from-to)1238-1246
Number of pages9
JournalBlood
Volume134
Issue number15
DOIs
StatePublished - Oct 10 2019

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ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Stephens, D. M., Li, H., Scho¨der, H., Straus, D. J., Moskowitz, C. H., LeBlanc, M., Rimsza, L. M., Bartlett, N. L., Evens, A. M., LaCasce, A. S., Barr, P. M., Knopp, M. V., Hsi, E. D., Leonard, J. P., Kahl, B. S., Smith, S. M., & Friedberg, J. W. (2019). Five-year follow-up of SWOG S0816: Limitations and values of a PET-adapted approach with stage III/IV Hodgkin lymphoma. Blood, 134(15), 1238-1246. https://doi.org/10.1182/blood.2019000719