scholarly journals ADVANCED HODGKIN LYMPHOMA: A NEW ERA OF THERAPY

2014 ◽  
Vol 6 (1) ◽  
pp. e2014063 ◽  
Author(s):  
Eldad J Dann
Keyword(s):  
Hodgkin Lymphoma ◽  
Prognostic Score ◽  
Progression Free Survival ◽  
Initial Therapy ◽  
Free Survival ◽  
New Era ◽  
Interim Pet ◽  
Pet Ct ◽  
Multiple Issues ◽  
International Prognostic Score

Therapy of advanced Hodgkin lymphoma (HL) is a rapidly changing field due to a lot of currently emerging data. Treatment approaches are presently based on either the Kairos principle of giving aggressive therapy upfront and considering de-escalation of therapy if the interim PET/CT is negative or the Chronos principle of starting with ABVD followed by escalation of therapy for patients with positive interim PET/CT. The International Prognostic Score (IPS) is still valid for decision-making regarding the type of initial therapy, since patients with a high score do have an inferior progression free survival (PFS) with ABVD compared to those with a low score. Escalated BEACOPP administered upfront improves PFS; however, increase in the overall survival (OS) has not been confirmed yet, and this therapy is accompanied by elevated toxicity and fertility impairment. Completion of ongoing and currently initiated trials could elucidate multiple issues related to the management of HL patients.  

scholarly journals Childhood Hodgkin International Prognostic Score (CHIPS) Predicts event-free survival in Hodgkin Lymphoma: A Report from the Children's Oncology Group

2016 ◽  
Vol 64 (4) ◽  
pp. e26278 ◽  
Author(s):  
Cindy L. Schwartz ◽  
Lu Chen ◽  
Kathleen McCarten ◽  
Suzanne Wolden ◽  
Louis S. Constine ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Prognostic Score ◽  
Oncology Group ◽  
Event Free Survival ◽  
Free Survival ◽  
International Prognostic Score

Not All Positive Interim PET/CT Scans Are Reliably Predictive for Progression Free Survival in Hodgkin Lymphoma (HL) Patients. A Proposed Model for a Functional Scoring Scale.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1452-1452
Author(s):  
Eldad J. Dann ◽  
Ada Tamir ◽  
Ron Epelbaum ◽  
Irit Avivi ◽  
Menachem Ben-Shachar ◽  
...  
Keyword(s):  
Scoring System ◽  
Progression Free Survival ◽  
Scoring Systems ◽  
Ct Scans ◽  
Free Survival ◽  
Residual Mass ◽  
Fdg Uptake ◽  
Interim Pet ◽  
Visual Scoring ◽  
Pet Ct

Abstract Interim PET-CT is used to predict the progression-free survival in HL (Gallamini, JCO 2007). However, what constitutes a functionally positive interim PET-CT has not been established. Does a single focus of reduced residual uptake predict and justify an escalation of therapy? In this study, 96 patients [47 females, 49 males; median age 30 (17–57) years] with HL (stage I -3, II- 50, III-18, IV-25), treated at the Rambam Medical Center (Haifa, Israel) since 2001 were evaluated. Prior to the interim PET, patients received 2 cycles of ABVD (33) or BEACOPP (41) or escalated BEACOPP (EB) (22). While an interim PET-CT was performed on all patients, only patients receiving BEACOPP had a planned escalation or reduction of therapy (for the escalated BEACOPP group) following the interim PET-CT as part of the protocol. The 4-year progression-free survival (PFS) and overall survival (OS) of 96 HL patients were better for negative interim PET-CT (93% and 98%) than for positive studies. The analysis for predictive PFS, by PET-CT is based on a static binary score which defines response depending on the presence or absence of any abnormal uptake on interim study. Thus, 24 patients had a positive interim PET-CT, in 11 of whom, the therapy was escalated and 3 had continued therapy with EB. Three patients in the escalated group and two who were not escalated progressed. Nineteen of the 24 patients with a positive interim PET responded fully. However, not all positive PET-CT scans were the same; there was a difference in the number of residual sites and intensity, which led us to propose the following functional model as outlined in Table 1. Table 1. Dynamic Scoring of PET-CT for Interim Analysis of HL Score # of residual foci: compared with baseline Intensity of uptake 0 0 0 1 1 reduced 2 >1 but less than baseline reduced 3 unchanged reduced 4 unchanged or increased number same or increased This model was compared with the scoring system suggested by the Consensus of the Imaging Subcommittee (Juweid, JCO 2007) where any residual mass < 2cm with an abnormal FDG uptake, a residual mass ≥ 2 cm, or an abnormal FDG uptake moderately increased above that of the mediastinum are considered positive. In the proposed dynamic model, patients with an interim PET-CT score of 0–2 are functionally similar; a PET-CT with a positive predictive value would only be a score of 3 or greater. The results of using this model for all the 96 patients are presented in Table 2. Of note, the specificity of the current model was significantly better than in both static scoring systems (p = 0.0001). Table 2. Comparison of PET-CT Performance by 3 Scoring Systems Performance Static visual assessment % (n) Scoring system: Consensus Imaging Subcommittee % (n) Visual dynamic score: current study % (n) PPV 21% (5/24) 19% (4/21) 50% (3/6) NPV 94% (68/72) 93% (70/75) 93% (84/90) Sensitivity 55% (5/9) 44% (4/9) 33% (3/9) Specificity 78% (68/87) 80% (70/87) 96% (84/87) In conclusion: Interim PET-CT is a useful tool for predicting prognosis in patients with HL. A dynamic visual scoring method, which reflects the functional dynamics of response in comparison to pre-treatment findings, may be a better indicator of resistant disease than static visual scoring systems. Based on the model proposed, a score of ≥3 should be considered as a cutoff point. Such a model needs to be prospectively validated in larger clinical trials.

Risk-adapted BEACOPP regimen can reduce the cumulative dose of chemotherapy for standard and high-risk Hodgkin lymphoma with no impairment of outcome

Blood ◽  
2006 ◽  
Vol 109 (3) ◽  
pp. 905-909 ◽  
Author(s):  
Eldad J. Dann ◽  
Rachel Bar-Shalom ◽  
Ada Tamir ◽  
Nissim Haim ◽  
Menachem Ben-Shachar ◽  
...  
Keyword(s):  
Remission Rate ◽  
Prognostic Score ◽  
Progression Free Survival ◽  
Risk Groups ◽  
Event Free Survival ◽  
Free Survival ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Negative Scan

Abstract Therapy of Hodgkin disease (HD) is designed to prolong progression-free survival and minimize toxicity. The best regimen to achieve this has not yet been defined. A total of 108 patients with newly diagnosed HD and adverse prognostic factors were prospectively studied between 1999 and 2004. They were assigned to therapy according to defined risk stratification. Patients were defined depending on the International Prognostic Score (IPS). Those with IPS of 3 or higher received 2 cycles of escalated therapy, including bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP [EB]). All others received 2 cycles of standard BEACOPP (SB). Subsequent therapy was prospectively assigned following 2 cycles according to results of early interim 67Ga or positron emission tomography/computed tomography (PET/CT). Following a positive interim scan, 4 cycles of EB were administered, whereas 4 cycles of SB were given to patients with a negative scan. The complete remission rate, the 5-year event-free survival (EFS), and overall survival (OS) rates were 97%, 85% and 90%, respectively. Relapse or progression occurred in 27% of patients with interim positive PET/CT versus 2.3% of negative scans (P < .02). Early interim fluorine-18 2-fluoro-2-deoxy-d-glucose (FDG)–PET/CT is a useful tool for adjustment of chemotherapy on an individual basis. Similar EFS and OS rates were observed for patients in both risk groups.

scholarly journals Can We Improve the Predictive Value of Interim PET/CT Using a New Prognostic Model for Advanced Hodgkin Lymphoma?

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3001-3001
Author(s):  
Eldad J. Dann ◽  
Osnat Bairey ◽  
Rachel Bar-Shalom ◽  
Tanya Mashiach ◽  
Elinor Barzilai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radiation Therapy ◽  
Disease Progression ◽  
Hodgkin Lymphoma ◽  
Lymphocyte Count ◽  
Prognostic Score ◽  
Univariate Analysis ◽  
Disease Stage ◽  
Interim Pet ◽  
Pet Ct

Abstract Introduction: The treatment of advanced Hodgkin lymphoma (HL) has undergone many changes in recent years. The original International Prognostic Score (IPS) introduced by Hasenclever et al (1998) was based on a cohort of 1618 patients (pts) mainly treated with MOPP-ABV or ABVD between the years 1983 and 1992. One third (33%) of those pts also underwent involved field radiation therapy (IFRT). Staging was based on CT. The 5-y freedom from progression (FFP) results ranged between 84% and 42%, depending on the presence of 0-≥5 risk factors. The IPS has been validated in a number of studies and settings. Currently, staging is based on baseline PET/CT, which upgrades the disease stage in 15% and downgrades it in 5% of pts compared to CT scan. Positive interim PET/CT (PET-2) is predictive of an inferior prognosis in pts with early and advanced HL. Based on these findings, several studies have used a positive PET-2 as an indication for therapy escalation. However, the majority of relapses still occur in pts with negative PET-2, highlighting the need for additional prognostic markers. We evaluated baseline factors and lab results in a prospectively collected database of pts enrolled in a multicenter clinical trial (NCT00392314) where treatment was modified based on PET-2 results. The current study aimed to develop a model for refined prediction of HL progression risk in advance-disease pts with negative PET-2, using baseline risk factors. Methods: Pts with advanced classic Hodgkin lymphoma (HL) were stratified according to their baseline IPS; treatment was modified according to PET-2 results. Pts with IPS 0-2 initially received 2 ABVD cycles and those with IPS ≥ 3 received 2 cycles of escalated BEACOPP (EB). In the former group, if PET-2 was positive without evidence of disease progression, therapy was escalated to EB with involved site radiation therapy (ISRT) given to residual masses. If PET-2 was negative in both IPS strata, 4 additional ABVD cycles were administered. We evaluated whether traditional IPS parameters continued to predict relapse when treatment was modified based on PET-2 results, and assessed the need for new cutoffs based on ROC curves using univariate and multivariate Cox proportional hazard models. Results: Of 185 enrolled pts, 33 (18%) experienced disease progression and 27 (15%) had a positive PET-2. The 5-y PFS for the whole group, PET-2 negative and PET-2 positive subgroups was 80%, 82% and 68%, respectively (p=0.07). Eight of 33 (28%) relapsed pts had a positive Deauville score (≥3). On univariate analysis of traditional IPS parameters, male gender, age >45, stage IV disease were not found to be associated with a significantly increased hazard ratio (HR) for progression. New cutoffs for lymphocyte count and albumin level predictive of relapse were determined. The following parameters were significantly (P<0.006) associated with lower PFS on univariate analysis: albumin <3.5gm/dL, hemoglobin <10.5 gm/dL, lymphocyte count <1400 or <11% of white blood cell (WBC) count. On multivariate analysis, albumin <3.5gm/dL, lymphocyte count <1400 or <11% of WBC remained significantly associated with relapse, with adjusted HRs of 2.2 (95% CI 1.1-4.5; P<0.03) and 2.6 (95% CI 1.1-6.2; P<0.025), respectively. Hence, a score was constructed using 0, 1 or 2 of these factors. Pts with 0-1 or 2 new risk factors and negative PET-2 had a relapse rate (RR) of 10% and 42%, respectively (HR=4.7; 95% CI 4.7-11), while in pts with positive PET-2 the RR was 30% (Table 1). However, one should bear in mind that pts with IPS 0-2 initiated therapy with ABVDx2 and those with IPS≥3 initiated therapy with EBx2. Conclusions: The current analysis, using data prospectively collected during a phase II study but analyzed retrospectively after pts had been stratified by IPS, suggests a scoring model that could refine the IPS-based identification of pts at a higher risk for disease progression, even if their PET-2 is negative. The findings imply that pts with 2 new risk factors (19% of pts) may need to initiate more intensive therapy than ABVD. However, given the retrospective nature of the analysis, its results should be interpreted with caution. The model needs to be verified in an independent cohort of pts with advanced HL using uniform treatment protocols. Table 1 Table 1. Disclosures Bairey: Janssen: Consultancy.

scholarly journals Should a Bulky Mediastinal Mass ≥7cm in the Longest Dimension be Considered an Adverse Prognostic Factor in Patients with Advanced Hodgkin Lymphoma and Negative Interim PET/CT?

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4051-4051
Author(s):  
Eldad J Dann ◽  
Rebeca Lopez-Alonso ◽  
Shunan Qi ◽  
Tania Mashiach ◽  
Michal Weiler-Sagie ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Hodgkin Lymphoma ◽  
Mediastinal Mass ◽  
Reference Group ◽  
Free Survival ◽  
Adverse Prognostic Factor ◽  
Interim Pet ◽  
Mediastinal Masses ◽  
Pet Ct ◽  
Mass Size

Introduction: Nowadays, treatment decision making in advanced Hodgkin lymphoma (ad-HL) is based on pre-therapy risk factors and interim PET/CT (PET-2) results, used as a platform for therapy modification. In the past, a bulky mediastinal mass (BMM) was not found to be a significant risk factor and was not included in the final version of the International Prognostic Score (IPS) system (Hasenclever, NEJM 1998). The current study aimed to assess the effect of BMM presence on relapse-free survival (RFS) in patients (pts) with ad-HL and to determine the optimal cutoff of the mass size for outcome prediction in the PET/CT era. Methods: The Israeli Hodgkin Lymphoma Study Group selected to initiate therapy with standard BEACOPP (SB: bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) or ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) in HL pts with IPS 0-2 and with intensified therapy using escalated BEACOPP (EB: bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone) in pts with IPS ≥3. Treatment was modified according to PET-2 results. To pts with negative PET-2 another 4 cycles of SB/ABVD were administered. PET-2 positive pts received 4 EB cycles followed by radiation therapy (Dann, Blood 2007). In the present study, disease bulkiness, assessed using baseline PET/CT, was retrospectively evaluated in a cohort of HL pts. The data included measurements of the longest diameter of either the biggest single mass or a conglomerate of lymph node masses in the transverse or coronal plane in the PET/CT image. Prognostic values of mediastinal mass cutoffs of ≥5 cm, ≥7 cm, >10 cm for RFS and progression-free survival (PFS) were compared. Results: One hundred and ninety six pts (female/male: 46/54%) with ad-HL [stage IIB - 28, stage III - 74, stage IV - 94; IPS 0-2 - 104; IPS 3-7 - 92; median age 31 years (16-85)] treated at the Rambam Health Care Campus (n=121) and Memorial Sloan Kettering Cancer Center (n=75) between 2000-2016 were included in the analysis. Mediastinal masses ≥5 cm, ≥7 cm and >10 cm were observed in 125 (63%), 82 (42%), 36 (18%) pts, respectively. PET-2 was negative in 79% of pts. At a median follow-up of 66.5 (1-222) months [80 (4-222) for pts without disease progression and 12 (1-62) for those with relapse or progression], estimated 5-year RFS and PFS for the entire group were 82% and 79%, respectively. A mass of up to 7 cm was found in 62 % of pts (n=123); 22% (n=44) had a mass measuring between 7 and 9.9 cm and 15% (n=29) had a mass ≥10 cm. Mediastinal masses were prevalent in 126/196 (64%) pts; in 58 (30%) of them the mediastinal mass, while being biggest, did not exceed 7 cm, and 68 (34%) had BMM of ≥7 cm. We found no effect of bulky disease, either mediastinal or non-mediastinal, on the outcome of the PET-2 positive group. Univariate analysis showed that in pts with negative PET-2, BMM ≥7 cm was a significant adverse prognostic factor for both 5-year RFS and PFS (HR 2.85; 95% CI 1.09-7.41; p=0.032 and HR 2.86; 95% CI 1.1-7.45; p=0.032, respectively). Outcome comparison of PET-2 negative pts with BMM (≥7 cm) to pts with negative PET-2 and either non-mediastinal or mediastinal non-bulky (<7cm) masses (reference group) revealed an inferior 5-year RFS of 73% versus 89% (HR 2.97; 95% CI 1.37-6.42; p=0.006) in the former group. Of note, both groups received an ABVD/SB regimen. HR for RFS was insignificant when a mass size cutoff of ≥5 cm or >10 cm was used. The HR for RFS was particularly high in the comparison between the subgroup of PET-2 negative pts with IPS 0-2 and BMM (≥7 cm) and those with IPS 0-2 in the reference group, demonstrating a 5-year RFS of 59% versus 89% with HR of 4.20 (95% CI 1.59-11.05; p=0.004). PET-2 negative pts with IPS 3-7 and BMM (≥7 cm) did not have an inferior outcome compared to pts with IPS 3-7 from the reference group (5-year RFS of 82% versus 89%). Notably, the two groups were treated with an EB-containing regimen. Our results indicate that BMM is an important adverse prognostic factor predominantly for pts with IPS 0-2. Multivariate Cox regression analysis identified BMM ≥7 cm as the most significant adverse prognostic factor for RFS (Table 1; Fig. 1). Conclusions: In PET-2 negative pts with ad-HL, mediastinal masses ≥7 cm in any plane are associated with the highest risk for HL progression. These findings should be incorporated in a new prognostic scoring system upon more extensive evaluation in a larger cohort. Disclosures No relevant conflicts of interest to declare.

The Childhood Hodgkin International Prognostic Score (CHIPS) for Predicting Event Free Survival in Pediatric and Adolescent Hodgkin Lymphoma,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3649-3649 ◽  
Author(s):  
Cindy Schwartz ◽  
Lu Chen ◽  
Louis Constine ◽  
Suzanne Wolden ◽  
Frank G Keller ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Conflicts Of Interest ◽  
Prognostic Score ◽  
Early Response ◽  
Intermediate Risk ◽  
Event Free Survival ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Excellent Outcome ◽  
International Prognostic Score

Abstract Abstract 3649 Purpose: To develop a method for predicting Event Free Survival (EFS) in Hodgkin Lymphoma (HL) using clinical factors known at diagnosis. Background: Although early response as measured by CT and/or PET scan has proven useful in the allocation of patients to therapy (eg. eliminating radiation or augmenting chemotherapy) (D Friedman, ASH 2010), stratification at diagnosis may allow earlier modification of treatment approach. The International Prognostic Score (D. Hasenclever, N Engl J Med, 1998) has been used effectively in adults with advanced stage disease, but includes predictors that may not be applicable to the pediatric and adolescent population. 1721 patients with intermediate risk HL (excludes IA and IIA without bulk disease and IIIB/IVB) were treated on AHOD0031, a Children's Oncology Group study using a dose dense, response based algorithm. 770 patients who were randomized or assigned to receive the same treatment (4 ABVE-PC and IFRT) serve as the basis for this report. Methods: Patients <21 years with intermediate risk HL were eligible for COG AHOD0031. The study evaluated the tailoring of treatment by early response to 2 ABVE-PC. Rapid early response (RER) was a 2-dimensional tumor reduction of >60% after 2 cycles of ABVE-PC. Complete response (CR) was a >80% 2-diminsional reduction by CT, and resolution of nuclear imaging abnormalities. RER who achieved CR after 2 additional ABVE-PC were randomized to +/− 21Gy. Slow early responders (SER) were randomized to +/− DECA in addition to the 4 ABVE-PC/21 Gy. Cox regression analysis was used to evaluate potential predictors of EFS (gender, age, race, stage, mediastinal mass, B symptoms, hemoglobin, sedimentation rate, albumen, histology). Continuous variables were dichotomized by clinical significance or quartiles of the population. Multivariable predictive modeling was performed using univariate predictors with a p<0.25. In instances of collinearity, the most robust variable was used. A stepwise selection algorithm was used to identify predictors with a p<0.15. Results: Four predictors (stage 4, large mediastinal adenopathy, albumen<3.5 and fever) were identified as predictive of adverse EFS. Since the Hazard Ratios were similar, the CHIPS (Childhood Hodgkin IPS) score was devised that gave 1 point for each of the 4 adverse predictors. EFS based on score was found to predict an excellent outcome of nearly 90% for those with CHIPS 0 or 1 (N=589) vs. 78% or 62% for those with CHIPS 2 or 3 respectively (N= 141 and 32). Conclusion: The CHIPS score identifies a subset of patients accounting for 22% of an intermediate risk population who are predicted to have an EFS <80%. Early augmentation of therapy may improve outcome for this cohort. After further validation of this approach in historical cohorts, future studies will evaluate the utility of the CHIPS in additional cohorts of newly diagnosed patients. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Modification of initial therapy in early and advanced Hodgkin lymphoma, based on interim PET/CT is beneficial: a prospective multicentre trial of 355 patients

2017 ◽  
Vol 178 (5) ◽  
pp. 709-718 ◽  
Author(s):  
Eldad J. Dann ◽  
Osnat Bairey ◽  
Rachel Bar-Shalom ◽  
Tanya Mashiach ◽  
Elinor Barzilai ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Multicentre Trial ◽  
Initial Therapy ◽  
Interim Pet ◽  
Pet Ct

Early Interim Negative FDG-PET/CT Is a High Predictive Factor for Progression-Free Survival in Hodgkin Lymphoma.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4589-4589
Author(s):  
Eldad J. Dann ◽  
Rachel Bar-Shalom ◽  
Ada Tamir ◽  
Nissim Haim ◽  
Irit Avivi ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Predictive Value ◽  
Fdg Pet ◽  
Response To Therapy ◽  
Study Group ◽  
Free Survival ◽  
Positive Study ◽  
Interim Pet ◽  
Pet Ct ◽  
Negative Study

Abstract The treatment of patients with Hodgkin lymphoma (HL) is currently based on pretreatment risk stratification aimed at reducing late therapy-related toxicity. Functional Gallium67 scintigraphy was previously used for an interim assessment of response to therapy. Recently, an interim FDG-PET was suggested as a prognostic parameter for a failure-free survival. Reported here is the significance of an interim PET when integrated into a therapeutic protocol and used for an interim risk assessment. A cohort of 89 patients with Hodgkin lymphoma treated in a single medical center since 2001 was evaluated. Three patients had stage I disease, 48 - stage II, 15 - stage III and 23 - had stage IV. Assessment of the patients using the International Prognostic Score (IPS) showed that 20% had early disease with no score evaluable, in 18% the score was 0–2 and 62% of patients had a score of 3–6. Twenty eight patients were treated with 6 cycles of ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) and 61 patients received BEACOPP combinations (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) for 6 cycles. Baseline PET/CT was performed in 87 patients while following 1st, 2nd or 3rd cycle of chemotherapy this test was repeated in 15, 70 and 4 patients, respectively. The 3-year failure-free survival (FFS) and the overall survival (OS) for patients with an interim negative study compared to those with an interim positive study were 95% versus 79% and 98% versus 89%, respectively. A subgroup of 11 patients who received escalated therapy following a positive interim PET had a 73% FFS. Three of these patients had primary progressive disease despite interim escalation of therapy. The 3-year negative predictive value of PET/CT was independent of patient risk group or chemotherapy used. Assessing the positive predictive value is difficult owing to the relatively small number of patients (19) as well as the dilemma of interpreting outcome therapy that was intensified based on the interim positive scintigraphy. Never-the-less, the data indicate that at least 27% of patients with a positive interim PET/CT will not be disease free at 3 years. The hazard ratio for a positive interim PET study is 6.2 CI (1.5–26), p=0.012. In conclusion, an interim negative PET/CT is highly predictive of prolonged FFS and OS. Prospective studies are needed to determine whether such an interim negative scan can be used to further reduce the dose intensity. An interim positive scan portends a poorer prognosis although the precise degree of predictability cannot be assessed from this study where therapy was escalated as a result of such scintigraphic findings. Interim PET 3-yr FFS 3-yr OS Median follow up - months n % Negative study: Group A (n=70) 67/70 95.3% 98.1% 29 (5–55) Positive study: Group B: Residual uptake (n=19) 14/19 79.0% 89.2% 36 (7–66) Escalation of therapy post positive study: Group C: (n=11) 8/11 72.7% 81.8% 37 Log rank test: Groups A vs B: 0.004 Groups A vs B: 0.05 Groups A vs C: 0.007 Groups A vs C: 0.008

scholarly journals Serum levels of TARC, MDC, IL-10, and soluble CD163 in Hodgkin lymphoma: a SWOG S0816 correlative study

Blood ◽  
2019 ◽  
Vol 133 (16) ◽  
pp. 1762-1765 ◽  
Author(s):  
Eric D. Hsi ◽  
Hongli Li ◽  
Andrew B. Nixon ◽  
Heiko Schöder ◽  
Nancy L. Bartlett ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Prognostic Score ◽  
Progression Free Survival ◽  
Serum Levels ◽  
Interleukin 10 ◽  
Serum Samples ◽  
Barr Virus ◽  
Soluble Cd163 ◽  
Interim Pet ◽  
Positron Emission

Abstract Serum soluble chemokines/cytokines produced by Hodgkin cells and the tumor microenvironment might be of value as biomarkers in classic Hodgkin lymphoma (cHL). We assessed serum thymus and activation-related chemokine (TARC), macrophage-derived chemokine (MDC), interleukin-10 (IL-10), and soluble CD163 (sCD163) levels at baseline, time of interim fluorodeoxyglucose positron emission tomography (PET), and after therapy in cHL patients treated on S0816, an intergroup phase 2 response-adapted study evaluating escalated therapy for interim PET (PET2)–positive patients (www.clinicaltrials.gov #NCT00822120). Epstein-Barr virus (EBV) status was assessed, and 559 serum samples were evaluated for TARC, MDC, IL-10, and sCD163 by immunoassay. EBV positivity correlated with higher sCD163 and IL-10 levels but lower TARC levels. While baseline biomarker levels were not associated with outcome, sCD163 levels at the time of PET2 were associated with favorable progression-free survival (PFS), adjusting for PET2 status. After therapy TARC, MDC, and IL-10 correlated with PFS and overall survival (OS) on univariable analysis, which remained significant adjusting for international prognostic score. When also adjusting for end-of-therapy PET results, TARC and IL-10 remained significantly associated with shorter PFS and OS. Exploratory analysis in PET2-negative patients showed that elevated posttherapy TARC and IL-10 levels were associated with PFS. Serum cytokine levels correlate with outcome in cHL and should be investigated further in risk-adapted cHL trials.

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