Background

Nowadays treatment for advanced stage Hodgkin lymphoma (LH) remains controversial. ABVD therapy has been historically the standard of care, later on, more sustained dose / intensity regimens like BEACOPP have emerged and improved progression-free survival of patients through better initial control of the disease but without significant overall survival profit due to potentially increased immediate and delayed toxicity. More recently, PET directed strategy with escalation or de-escalation protocols based on the response to the early PET-CT have shown promising results in finding the best way to balance optimal control of the disease with lesser treatment related toxicity.

We report here our experiment of treatment escalation in case of positive PET-CT after 2 cycles of ABVD (PET-CT 2) as first-line therapy patients with advanced Hodgkin lymphoma.

Methods

Between 2008 and 2016, 102 patients with Hodgkin lymphoma underwent PET-CT evaluation at diagnosis and after 2 cycles of treatment, 50 had advanced disease (Stage III or IV of Ann Arbor) among witch, 47 received ABVD, 2 BEACOPP and 1 VABEM as initial therapy. The metabolic responses were assessed according to the Deauville criteria.

Results

Before initiating treatment, the prognosis of the patients was intermediate for 24 patients (48%) and unfavorable for 20 (40%), the median of age was 48 years (min-max: 19-85). Escalated treatment was needed for the 11 patients (22%) refractory to ABVD protocol. The median PFS was 66 months (47-85) and median overall survival (OS) was not achieved; OS at 60 months was 65%. We found no difference in survival between patients with negative PET-CT and those with positive PET-CT, who have benefited from an escalation of treatment.

Conclusion

This study evaluated escalating first-line treatment ABVD for advanced stage Hodgkin lymphoma patients with positive PET-CT 2. This management aims to reduce the toxicity of intensive treatments when good control of the disease is asserted. One goal of our study is also to identify the higher risk patients for whom more intensive treatment could be used as first-line treatment.

Disclosures

Leleu: Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Merck: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Pierre Fabre: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees.

Topics:
computed tomography/positron emission tomography imaging, hodgkin's disease, bleomycin/dacarbazine/doxorubicin/vinblastine protocol, toxic effect, deauville five point scale, delayed toxicity, positron-emission tomography, pet animal

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2017 by The American Society of Hematology
2017
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