Originally published as JCO Early Release 10.1200/JCO.2007.11.6525 on July 23 2007

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Early Interim 2-[¹⁸F]Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography Is Prognostically Superior to International Prognostic Score in Advanced-Stage Hodgkin's Lymphoma: A Report From a Joint Italian-Danish Study

Andrea Gallamini, Martin Hutchings, Luigi Rigacci, Lena Specht, Francesco Merli, Mads Hansen, Caterina Patti, Annika Loft, Francesco Di Raimondo, Francesco D'Amore, Alberto Biggi, Umberto Vitolo, Caterina Stelitano, Rosario Sancetta, Livio Trentin, Stefano Luminari, Emilio Iannitto, Simonetta Viviani, Ivana Pierri, Alessandro Levis

From the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, Azienda Ospedaliera Melacrino, Reggio Calabria; Hematology Department, Ospedale S. Giovanni e Paolo ASL 12, Venezia; Experimental Medicine Department, Università di Padova, Padova; Oncology Department, Università di Modena e Reggio Emilia, Modena; Onco-hematology Department, Istituto Nazionale Tumori, Milano; Università di Genova, Genova; Hematology Department, Azienda Ospedaliera S. Antonio e Biagio, Alessandria, Italy; and the Departments of Oncology, Clinical Physiology, Nuclear Medicine, and Positron Emission Tomography, Copenhagen University Hospital, Copenhagen, Denmark

Address reprint requests to Andrea Gallamini, MD, Hematology Department, Azienda Ospedaliera S. Croce e Carle, Via M. Coppino, 26, 12100 Cuneo, Italy; e-mail: andrea.gallamini{at}agx.it

Purpose: Starting from November 2001, 260 newly diagnosed patients with Hodgkin's lymphoma (HL) were consecutively enrolled in parallel Italian and Danish prospective trials to evaluate the prognostic role of an early interim 2-[¹⁸F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) scan and the International Prognostic Score (IPS) in advanced HL, treated with conventional ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy.

Patients and Methods: Most patients (n = 190) presented with advanced disease (stages IIB through IVB), whereas 70 presented in stage IIA with adverse prognostic factors. All but 11 patients were treated with standard ABVD therapy followed by consolidation radiotherapy in case of bulky presentation or residual tumor mass. Conventional radiologic staging was performed at baseline. FDG-PET scan was performed at baseline and after two courses of ABVD (PET-2). No treatment change was allowed on the basis of the PET-2 results.

Results: After a median follow-up of 2.19 years (range, 0.32 to 5.18 years), 205 patients were in continued complete remission and two patients were in partial remission. Forty-three patients progressed during therapy or immediately after, whereas 10 patients relapsed. The 2-year progression-free survival for patients with positive PET-2 results was 12.8% and for patients with negative PET-2 results was 95.0% (P < .0001). In univariate analysis, the treatment outcome was significantly associated with PET-2 (P < .0001), stage IV (P < .0001), WBC more than 15,000 (P < .0001), lymphopenia (P < .001), IPS as a continuous variable (P < .0001), extranodal involvement (P < .0001), and bulky disease (P = .012). In multivariate analyses, only PET-2 turned out to be significant (P < .0001).

Conclusion: PET-2 overshadows the prognostic value of IPS and emerges as the single most important tool for planning of risk-adapted treatment in advanced HL.

published online ahead of print at www.jco.org on July 23, 2007.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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