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

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gallamini, A. Articles by Levis, A. Search for Related Content PubMed PubMed Citation Articles by Gallamini, A. Articles by Levis, A. Social Bookmarking                            What's this?

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.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				J. Markova, C. Kobe, M. Skopalova, K. Klaskova, K. Dedeckova, A. Plutschow, H. T. Eich, M. Dietlein, A. Engert, and T. Kozak FDG-PET for assessment of early treatment response after four cycles of chemotherapy in patients with advanced-stage Hodgkin's lymphoma has a high negative predictive value Ann. Onc., July 1, 2009; 20(7): 1270 - 1274. [Abstract] [Full Text] [PDF]

				D.J. Sher, P.M. Mauch, A. Van Den Abbeele, A.S. LaCasce, J. Czerminski, and A.K. Ng Prognostic significance of mid- and post-ABVD PET imaging in Hodgkin's lymphoma: the importance of involved-field radiotherapy Ann. Onc., June 18, 2009; (2009) mdp071v1. [Abstract] [Full Text] [PDF]

				M. Meignan, E. Itti, S. Bardet, J. Lumbroso, V. Edeline, P. Olivier, T. V. Borght, O. Reman, G. Karcher, O. Mundler, et al. Development and Application of a Real-Time On-Line Blinded Independent Central Review of Interim Pet Scans to Determine Treatment Allocation in Lymphoma Trials J. Clin. Oncol., June 1, 2009; 27(16): 2739 - 2741. [Full Text] [PDF]

				M. Hutchings and S. F. Barrington PET/CT for Therapy Response Assessment in Lymphoma J. Nucl. Med., May 1, 2009; 50(Suppl_1): 21S - 30S. [Abstract] [Full Text] [PDF]

				T. Terasawa, J. Lau, S. Bardet, O. Couturier, T. Hotta, M. Hutchings, T. Nihashi, and H. Nagai Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography for Interim Response Assessment of Advanced-Stage Hodgkin's Lymphoma and Diffuse Large B-Cell Lymphoma: A Systematic Review J. Clin. Oncol., April 10, 2009; 27(11): 1906 - 1914. [Abstract] [Full Text] [PDF]

				B. Cheson The Case Against Heavy PETing J. Clin. Oncol., April 10, 2009; 27(11): 1742 - 1743. [Full Text] [PDF]

				E. Itti, C. Lin, J. Dupuis, G. Paone, D. Capacchione, A. Rahmouni, C. Haioun, and M. Meignan Prognostic Value of Interim 18F-FDG PET in Patients with Diffuse Large B-Cell Lymphoma: SUV-Based Assessment at 4 Cycles of Chemotherapy J. Nucl. Med., April 1, 2009; 50(4): 527 - 533. [Abstract] [Full Text] [PDF]

				E. Brusamolino, A. Bacigalupo, G. Barosi, G. Biti, P. G. Gobbi, A. Levis, M. Marchetti, A. Santoro, P. L. Zinzani, and S. Tura Classical Hodgkin's lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up Haematologica, April 1, 2009; 94(4): 550 - 565. [Abstract] [Full Text] [PDF]

				M. Federico, S. Luminari, E. Iannitto, G. Polimeno, L. Marcheselli, A. Montanini, A. La Sala, F. Merli, C. Stelitano, S. Pozzi, et al. ABVD Compared With BEACOPP Compared With CEC for the Initial Treatment of Patients With Advanced Hodgkin's Lymphoma: Results From the HD2000 Gruppo Italiano per lo Studio dei Linfomi Trial J. Clin. Oncol., February 10, 2009; 27(5): 805 - 811. [Abstract] [Full Text] [PDF]

				A. M. Carella, M. Bellei, P. Brice, C. Gisselbrecht, G. Visani, P. Colombat, F. Fabbiano, A. Donelli, S. Luminari, P. Feugier, et al. High-dose therapy and autologous stem cell transplantation versus conventional therapy for patients with advanced Hodgkin's lymphoma responding to front-line therapy: long-term results Haematologica, January 1, 2009; 94(1): 146 - 148. [Full Text] [PDF]

				C. Kobe, M. Dietlein, J. Franklin, J. Markova, A. Lohri, H. Amthauer, S. Klutmann, W. H. Knapp, J. M. Zijlstra, A. Bockisch, et al. Positron emission tomography has a high negative predictive value for progression or early relapse for patients with residual disease after first-line chemotherapy in advanced-stage Hodgkin lymphoma Blood, November 15, 2008; 112(10): 3989 - 3994. [Abstract] [Full Text] [PDF]

				I. Biasoli, P. Franchi-Rezgui, D. Sibon, J. Briere, E. de Kerviler, C. Thieblemont, V. Levy, C. Gisselbrecht, and P. Brice Analysis of factors influencing inclusion of 102 patients with stage III/IV Hodgkin's lymphoma in a randomized trial for first-line chemotherapy Ann. Onc., November 1, 2008; 19(11): 1915 - 1920. [Abstract] [Full Text] [PDF]

				C. Suh, Y.-K. Kang, J.-L. Roh, M. R. Kim, J. S. Kim, J. Huh, J. H. Lee, Y. J. Jang, and B.-J. Lee Prognostic Value of Tumor 18F-FDG Uptake in Patients with Untreated Extranodal Natural Killer/T-Cell Lymphomas of the Head and Neck J. Nucl. Med., November 1, 2008; 49(11): 1783 - 1789. [Abstract] [Full Text] [PDF]

				S. A. Jacobs, S. H. Swerdlow, J. Kant, K. A. Foon, R. Jankowitz, S. R. Land, N. DeMonaco, J. Joyce, J. L. Osborn, T. L. Evans, et al. Phase II Trial of Short-Course CHOP-R Followed by 90Y-ibritumomab Tiuxetan and Extended Rituximab in Previously Untreated Follicular Lymphoma Clin. Cancer Res., November 1, 2008; 14(21): 7088 - 7094. [Abstract] [Full Text] [PDF]

				A V Martin and B Sharma Positron emission tomography and CT in the management of lymphoma Imaging, September 1, 2008; 20(3): 169 - 175. [Abstract] [Full Text] [PDF]

				C. Plathow and W. A. Weber Tumor Cell Metabolism Imaging J. Nucl. Med., June 1, 2008; 49(Suppl_2): 43S - 63S. [Abstract] [Full Text] [PDF]

				T. C. Kwee, R. M. Kwee, and R. A. J. Nievelstein Imaging in staging of malignant lymphoma: a systematic review Blood, January 15, 2008; 111(2): 504 - 516. [Abstract] [Full Text] [PDF]

				PET and Prognosis in Hodgkin Lymphoma: Prospective Analysis Journal Watch Oncology and Hematology, September 18, 2007; 2007(918): 2 - 2. [Full Text]

				S. J. Horning Risk, Cure and Complications in Advanced Hodgkin Disease Hematology, January 1, 2007; 2007(1): 197 - 203. [Abstract] [Full Text] [PDF]