Normalization of pre-ASCT, FDG-PET imaging with second-line, non-cross-resistant, chemotherapy programs improves event-free survival in patients with Hodgkin lymphoma

Craig Moskowitz, Matt J. Matasar, Andrew D. Zelenetz, Stephen D Nimer, John Gerecitano, Paul Hamlin, Steven Horwitz, Alison J. Moskowitz, Ariela Noy, Lia Palomba, Miguel Angel Perales, Carol Portlock, David Straus, Jocelyn C. Maragulia, Heiko Schoder, Joachim Yahalom

Research output: Contribution to journalArticle

142 Citations (Scopus)

Abstract

We previously reported that remission duration < 1 year, extranodal disease, and B symptoms before salvage chemotherapy (SLT) can stratify relapsed or refractory Hodgkin lymphoma (HL) patients into favorable and unfavorable cohorts. In addition, pre-autologous stem cell transplant (ASCT) 18FDG-PET response to SLT predicts outcome. This phase 2 study uses both pre-SLT prognostic factors and post-SLT FDG-PET response in a risk-adapted approach to improve PFS after high-dose radio-chemotherapy (HDT) and ASCT. The first SLT uses 2 cycles of ICE in a standard or augmented dose (ICE/aICE), followed by restaging FDG-PET scan. Patients with a negative scan received a transplant. If the FDG-PET scan remained positive, patients received 4 biweekly doses of gemcitabine, vinorelbine, and liposomal doxorubicin. Patients without evidence of disease progression proceeded to HDT/ ASCT; those with progressive disease were study failures. At a median follow-up of 51 months, EFS analyzed by intent to treat as well as for transplanted patients is 70% and 79%, respectively. Patients transplanted with negative FDG-PET, pre- HDT/ASCT after 1 or 2 SLT programs, had an EFS of > 80%, versus 28.6% for patients with a positive scan (P < .001). This prospective study provides evidence that the goal of SLT in patients with Hodgkin lymphoma should be a negative FDG-PET scan before HDT/ASCT. The study was registered at www.clinicaltrials.gov as NCT00255723.

Original languageEnglish
Pages (from-to)1665-1670
Number of pages6
JournalBlood
Volume119
Issue number7
DOIs
StatePublished - Feb 16 2012
Externally publishedYes

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Chemotherapy
Hodgkin Disease
Disease-Free Survival
Imaging techniques
Drug Therapy
Positron-Emission Tomography
Prospective Studies

ASJC Scopus subject areas

  • Hematology
  • Biochemistry
  • Cell Biology
  • Immunology

Cite this

Normalization of pre-ASCT, FDG-PET imaging with second-line, non-cross-resistant, chemotherapy programs improves event-free survival in patients with Hodgkin lymphoma. / Moskowitz, Craig; Matasar, Matt J.; Zelenetz, Andrew D.; Nimer, Stephen D; Gerecitano, John; Hamlin, Paul; Horwitz, Steven; Moskowitz, Alison J.; Noy, Ariela; Palomba, Lia; Perales, Miguel Angel; Portlock, Carol; Straus, David; Maragulia, Jocelyn C.; Schoder, Heiko; Yahalom, Joachim.

In: Blood, Vol. 119, No. 7, 16.02.2012, p. 1665-1670.

Research output: Contribution to journalArticle

Moskowitz, C, Matasar, MJ, Zelenetz, AD, Nimer, SD, Gerecitano, J, Hamlin, P, Horwitz, S, Moskowitz, AJ, Noy, A, Palomba, L, Perales, MA, Portlock, C, Straus, D, Maragulia, JC, Schoder, H & Yahalom, J 2012, 'Normalization of pre-ASCT, FDG-PET imaging with second-line, non-cross-resistant, chemotherapy programs improves event-free survival in patients with Hodgkin lymphoma', Blood, vol. 119, no. 7, pp. 1665-1670. https://doi.org/10.1182/blood-2011-10-388058
Moskowitz, Craig ; Matasar, Matt J. ; Zelenetz, Andrew D. ; Nimer, Stephen D ; Gerecitano, John ; Hamlin, Paul ; Horwitz, Steven ; Moskowitz, Alison J. ; Noy, Ariela ; Palomba, Lia ; Perales, Miguel Angel ; Portlock, Carol ; Straus, David ; Maragulia, Jocelyn C. ; Schoder, Heiko ; Yahalom, Joachim. / Normalization of pre-ASCT, FDG-PET imaging with second-line, non-cross-resistant, chemotherapy programs improves event-free survival in patients with Hodgkin lymphoma. In: Blood. 2012 ; Vol. 119, No. 7. pp. 1665-1670.
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abstract = "We previously reported that remission duration < 1 year, extranodal disease, and B symptoms before salvage chemotherapy (SLT) can stratify relapsed or refractory Hodgkin lymphoma (HL) patients into favorable and unfavorable cohorts. In addition, pre-autologous stem cell transplant (ASCT) 18FDG-PET response to SLT predicts outcome. This phase 2 study uses both pre-SLT prognostic factors and post-SLT FDG-PET response in a risk-adapted approach to improve PFS after high-dose radio-chemotherapy (HDT) and ASCT. The first SLT uses 2 cycles of ICE in a standard or augmented dose (ICE/aICE), followed by restaging FDG-PET scan. Patients with a negative scan received a transplant. If the FDG-PET scan remained positive, patients received 4 biweekly doses of gemcitabine, vinorelbine, and liposomal doxorubicin. Patients without evidence of disease progression proceeded to HDT/ ASCT; those with progressive disease were study failures. At a median follow-up of 51 months, EFS analyzed by intent to treat as well as for transplanted patients is 70{\%} and 79{\%}, respectively. Patients transplanted with negative FDG-PET, pre- HDT/ASCT after 1 or 2 SLT programs, had an EFS of > 80{\%}, versus 28.6{\%} for patients with a positive scan (P < .001). This prospective study provides evidence that the goal of SLT in patients with Hodgkin lymphoma should be a negative FDG-PET scan before HDT/ASCT. The study was registered at www.clinicaltrials.gov as NCT00255723.",
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AU - Nimer, Stephen D

AU - Gerecitano, John

AU - Hamlin, Paul

AU - Horwitz, Steven

AU - Moskowitz, Alison J.

AU - Noy, Ariela

AU - Palomba, Lia

AU - Perales, Miguel Angel

AU - Portlock, Carol

AU - Straus, David

AU - Maragulia, Jocelyn C.

AU - Schoder, Heiko

AU - Yahalom, Joachim

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N2 - We previously reported that remission duration < 1 year, extranodal disease, and B symptoms before salvage chemotherapy (SLT) can stratify relapsed or refractory Hodgkin lymphoma (HL) patients into favorable and unfavorable cohorts. In addition, pre-autologous stem cell transplant (ASCT) 18FDG-PET response to SLT predicts outcome. This phase 2 study uses both pre-SLT prognostic factors and post-SLT FDG-PET response in a risk-adapted approach to improve PFS after high-dose radio-chemotherapy (HDT) and ASCT. The first SLT uses 2 cycles of ICE in a standard or augmented dose (ICE/aICE), followed by restaging FDG-PET scan. Patients with a negative scan received a transplant. If the FDG-PET scan remained positive, patients received 4 biweekly doses of gemcitabine, vinorelbine, and liposomal doxorubicin. Patients without evidence of disease progression proceeded to HDT/ ASCT; those with progressive disease were study failures. At a median follow-up of 51 months, EFS analyzed by intent to treat as well as for transplanted patients is 70% and 79%, respectively. Patients transplanted with negative FDG-PET, pre- HDT/ASCT after 1 or 2 SLT programs, had an EFS of > 80%, versus 28.6% for patients with a positive scan (P < .001). This prospective study provides evidence that the goal of SLT in patients with Hodgkin lymphoma should be a negative FDG-PET scan before HDT/ASCT. The study was registered at www.clinicaltrials.gov as NCT00255723.

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