Patients with advanced Hodgkin lymphoma may benefit from positron-emission tomography-computed tomography (PET-CT) testing during therapy to guide treatment, according to a study published in The New England Journal of Medicine.1

Cases of advanced Hodgkin lymphoma are treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) as a standard of care, and 3-year progression-free and overall survival are typically high. It is open to question, however, whether each case of this disease requires the same intensity of treatment.

Researchers enrolled 1214 newly-diagnosed patients who were 18 years or older; each underwent a PET-CT scan at baseline and received 2 cycles of ABVD treatment. Interim PET-CT scans were then conducted on 1119 patients; the 937 (83.7%) patients who had stable or reduced disease were randomly assigned to continue ABVD or to continue without bleomycin (AVD group) for the remaining 3 cycles. The 172 patients with disease progression were assigned to receive bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP).

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Three-year progression-free and overall survival rates were as follows: ABVD: 85.7% and 97.2%; AVD: 84.4% and 97.6%; BEACOPP: 67.5% and 87.8%, respectively. There were 24 Hodgkin lymphoma-related deaths, and 62 deaths overall.

The authors concluded that results did not meet the non-inferiority margin, though patients who received AVD rather than ABVD were less likely to have pulmonary toxic effects.

Reference

  1. Johnson P, Federico M, Kirkwood A, Fosså A, Berkahn L, Carella A, et al. Adapted treatment guided by interim PET-CT scan in advanced Hodgkin’s lymphoma [published online ahead of print June 23, 2016]. N Engl J Med. doi: 10.1056/NEJMoa1510093.