PET Response-adapted Therapy in Advanced-stage Hodgkin Lymphoma Appears Beneficial

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Patients with advanced-stage Hodgkin lymphoma who were at high risk for treatment failure as determined by interim PET response.
Patients with advanced-stage Hodgkin lymphoma who were at high risk for treatment failure as determined by interim PET response.

Patients with advanced-stage Hodgkin lymphoma who were at high risk for treatment failure as determined by interim positron emission tomography (PET) response appeared to benefit from early treatment intensification with autologous hematopoietic cell transplantation (HCT), a study published in the Journal of Clinical Oncology has shown.1

Because it has been yet to be confirmed if PET evaluation performed early during first-line therapy in patients with advanced-stage Hodgkin lymphoma is beneficial, researchers sought to evaluate where PET response-adapted therapy is effective in this setting.

For the phase 2 study, researchers enrolled 519 patients with advanced-stage de novo Hodgkin lymphoma who received initial treatment with ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine). If patients showed a positive PET evaluation after 2 cycles of chemotherapy, they were switched to early ifosfamide-containing salvage treatment followed by HCT.

Of the 512 evaluable patients, 103 were PET-positive after 2 cycles. Among them, 81 then received the salvage regimen with HCT, 15 remained on ABVD per physician's decision, 5 received an alternative treatment, and 2 were excluded due to a diagnostic error.

Results showed that that 2-year progression-free survival rate was 76% for PET-positive patients after 2 cycles regardless of the salvage treatment they received. PET-negative patients had a 2-year progression-free survival rate of 81%.

RELATED: Lenalidomide May Be Effective for Lymphoma Ineligible for Intensive Chemo, HCT

“Patients with advanced-stage Hodgkin lymphoma for whom treatment was at high risk of failing appear to benefit from early treatment intensification with autologous transplantation, as indicated by the possibility of successful salvage treatment in more than 70% of PET2-positive patients through obtaining the same 2-year progression-free survival as the PET2-negative subgroup,” the authors concluded.

Reference

  1. Zinzani PL, Broccoli A, Gioia DM, et al. Interim positron emission tomography response–adapted therapy in advanced-stage Hodgkin lymphoma: final results of the phase II part of the HD0801 study [published online ahead of print February 16, 2016]. J Clin Oncol. doi: 10.1200/JCO.2015.63.0699.

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