TY - JOUR
T1 - Prognostic significance of baseline metabolic tumor volume in relapsed and refractory Hodgkin lymphoma
AU - Moskowitz, Alison J.
AU - Schöder, Heiko
AU - Gavane, Somali
AU - Thoren, Katie L.
AU - Fleisher, Martin
AU - Yahalom, Joachim
AU - McCall, Susan J.
AU - Cadzin, Briana R.
AU - Fox, Stephanie Y.
AU - Gerecitano, John
AU - Grewal, Ravinder
AU - Hamlin, Paul A.
AU - Horwitz, Steven M.
AU - Kumar, Anita
AU - Matasar, Matthew
AU - Ni, Andy
AU - Noy, Ariela
AU - Palomba, M. Lia
AU - Perales, Miguel Angel
AU - Portlock, Carol S.
AU - Sauter, Craig
AU - Straus, David
AU - Younes, Anas
AU - Zelenetz, Andrew D.
AU - Moskowitz, Craig H.
N1 - Funding Information:
This work was supported by Seattle Genetics; a Core grant from the National Institutes of Health, National Cancer Institute (P30 CA 008748); and the Adam R. Spector Hodgkin Lymphoma Fund.
Publisher Copyright:
© 2017 by The American Society of Hematology.
PY - 2017/11/16
Y1 - 2017/11/16
N2 - Identification of prognostic factors for patients with relapsed/refractory Hodgkin lymphoma (HL) is essential for optimizing therapy with risk-adapted approaches. In our phase 2 study of positron emission tomography (PET)–adapted salvage therapy with brentuximab vedotin (BV) and augmented ifosfamide, carboplatin, and etoposide (augICE), we assessed clinical factors, quantitative PET assessments, and cytokine and chemokine values. Transplant-eligible patients with relapsed/refractory HL received 2 (cohort 1) or 3 (cohort 2) cycles of weekly BV; PET-negative patients (Deauville score £2) proceeded to autologous stem cell transplantation (ASCT) whereas PET-positive patients received augICE before ASCT. Serum cytokine and chemokine levels were measured at baseline and after BV. Metabolic tumor volume (MTV) and total lesion glycolysis were measured at baseline, after BV, and after augICE. Sixty-five patients enrolled (45, cohort 1; 20, cohort 2); 49 (75%) achieved complete response and 64 proceeded to ASCT. Three-year overall survival and event-free survival (EFS) were 95% and 82%, respectively. Factors predictive for EFS by multivariable analysis were baseline MTV (bMTV) (P < .001) and refractory disease (P 5 .003). Low bMTV (<109.5 cm3) and relapsed disease identified a favorable group (3-year EFS, 100%). For patients who received a transplant, bMTV and pre-ASCT PET were independently prognostic; 3-year EFS for pre-ASCT PET-positive patients with low bMTV was 86%. In this phase 2 study of PET-adapted therapy with BV and augICE for relapsed/refractory HL, bMTV and refractory disease were independent prognostic factors for EFS. Furthermore, bMTV improved the predictive power of pre-ASCT PET. Future studies should optimize efficacy and tolerability of salvage therapy by stratifying patients according to risk factors such as bMTV.
AB - Identification of prognostic factors for patients with relapsed/refractory Hodgkin lymphoma (HL) is essential for optimizing therapy with risk-adapted approaches. In our phase 2 study of positron emission tomography (PET)–adapted salvage therapy with brentuximab vedotin (BV) and augmented ifosfamide, carboplatin, and etoposide (augICE), we assessed clinical factors, quantitative PET assessments, and cytokine and chemokine values. Transplant-eligible patients with relapsed/refractory HL received 2 (cohort 1) or 3 (cohort 2) cycles of weekly BV; PET-negative patients (Deauville score £2) proceeded to autologous stem cell transplantation (ASCT) whereas PET-positive patients received augICE before ASCT. Serum cytokine and chemokine levels were measured at baseline and after BV. Metabolic tumor volume (MTV) and total lesion glycolysis were measured at baseline, after BV, and after augICE. Sixty-five patients enrolled (45, cohort 1; 20, cohort 2); 49 (75%) achieved complete response and 64 proceeded to ASCT. Three-year overall survival and event-free survival (EFS) were 95% and 82%, respectively. Factors predictive for EFS by multivariable analysis were baseline MTV (bMTV) (P < .001) and refractory disease (P 5 .003). Low bMTV (<109.5 cm3) and relapsed disease identified a favorable group (3-year EFS, 100%). For patients who received a transplant, bMTV and pre-ASCT PET were independently prognostic; 3-year EFS for pre-ASCT PET-positive patients with low bMTV was 86%. In this phase 2 study of PET-adapted therapy with BV and augICE for relapsed/refractory HL, bMTV and refractory disease were independent prognostic factors for EFS. Furthermore, bMTV improved the predictive power of pre-ASCT PET. Future studies should optimize efficacy and tolerability of salvage therapy by stratifying patients according to risk factors such as bMTV.
UR - http://www.scopus.com/inward/record.url?scp=85034049140&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85034049140&partnerID=8YFLogxK
U2 - 10.1182/blood-2017-06-788877
DO - 10.1182/blood-2017-06-788877
M3 - Article
C2 - 28874350
AN - SCOPUS:85034049140
VL - 130
SP - 2196
EP - 2203
JO - Blood
JF - Blood
SN - 0006-4971
IS - 20
ER -