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Abstract

PURPOSE:

The clinical impact of positron emission tomography (PET) evaluation performed early during first-line therapy in patients with advanced-stage Hodgkin lymphoma, in terms of providing a rationale to shift patients who respond poorly onto a more intensive regimen (PET response-adapted therapy), remains to be confirmed.

PATIENTS AND METHODS:

The phase II part of the multicenter HD0801 study involved 519 patients with advanced-stage de novo Hodgkin lymphoma who received an initial treatment with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and who underwent an early ifosfamide-containing salvage treatment followed by stem-cell transplantation if they showed a positive PET evaluation after two cycles of chemotherapy (PET2). The primary end point was 2-year progression-free survival calculated for both PET2-negative patients (who completed a full six cycles of ABVD treatment) and PET2-positive patients. Overall survival was a secondary end point.

RESULTS:

In all, 103 of the 512 evaluable patients were PET2 positive. Among them, 81 received the scheduled salvage regimen with transplantation, 15 remained on ABVD (physician's decision, mostly because of minimally positive PET2), five received an alternative treatment, and two were excluded because of diagnostic error. On intention-to-treat analysis, the 2-year progression-free survival was 76% for PET2-positive patients (regardless of the salvage treatment they received) and 81% for PET2-negative patients.

CONCLUSION:

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. 

Author information

Zinzani PL1, Broccoli A2, Gioia DM2, Castagnoli A2, Ciccone G2, Evangelista A2, Santoro A2, Ricardi U2, Bonfichi M2, Brusamolino E2, Rossi G2, Anastasia A2, Zaja F2, Vitolo U2, Pavone V2, Pulsoni A2, Rigacci L2, Gaidano G2, Stelitano C2, Salvi F2, Rusconi C2, Tani M2, Freilone R2, Pregno P2, Borsatti E2, Sacchetti GM2, Argnani L2, Levis A2.​

1Pier Luigi Zinzani, Alessandro Broccoli, and Lisa Argnani, Institute of Hematology L. e A. Seràgnoli, Sant'Orsola-Malpighi University Hospital, Bologna; Daniela Maria Gioia and Alessandro Levis, Fondazione Italiana Linfomi Onlus; Flavia Salvi, S.S. Antonio e Biagio Hospital, Alessandria; Antonio Castagnoli, Azienda Ospedaliera di Prato, Prato; Giovannino Ciccone and Andrea Evangelista, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and Centro Prevenzione Oncologica Piemonte; Umberto Ricardi, University of Turin; Umberto Vitolo and Patrizia Pregno, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Roberto Freilone, Stabilimento Ospitaliero Ivrea, Turin; Armando Santoro, Ercole Brusamolino, and Antonella Anastasia, Istituto Clinico Humanitas; Chiara Rusconi, Azienda Ospedaliera Niguarda Cà Granda, Milan; Maurizio Bonfichi and Ercole Brusamolino, Istituto Di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo di Pavia, Pavia; Giuseppe Rossi and Antonella Anastasia, Spedali Civili, Brescia; Francesco Zaja, Santa Maria della Misericordia Hospital, Udine; Vincenzo Pavone, Azienda Ospedaliera Cardinal Panico, Tricase; Alessandro Pulsoni, Sapienza University, Rome; Luigi Rigacci, Azienda Ospedaliera Careggi, Florence; Gianluca Gaidano, Amedeo Avogadro University; Gian Mauro Sacchetti, University Hospital Maggiore della Carità, Novara; Caterina Stelitano, Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria; Monica Tani, Santa Maria delle Croci Hospital, Ravenna; and Eugenio Borsatti, Centro di Riferimento Oncologico, Aviano, Italy. pierluigi.zinzani@unibo.it.

2Pier Luigi Zinzani, Alessandro Broccoli, and Lisa Argnani, Institute of Hematology L. e A. Seràgnoli, Sant'Orsola-Malpighi University Hospital, Bologna; Daniela Maria Gioia and Alessandro Levis, Fondazione Italiana Linfomi Onlus; Flavia Salvi, S.S. Antonio e Biagio Hospital, Alessandria; Antonio Castagnoli, Azienda Ospedaliera di Prato, Prato; Giovannino Ciccone and Andrea Evangelista, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and Centro Prevenzione Oncologica Piemonte; Umberto Ricardi, University of Turin; Umberto Vitolo and Patrizia Pregno, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Roberto Freilone, Stabilimento Ospitaliero Ivrea, Turin; Armando Santoro, Ercole Brusamolino, and Antonella Anastasia, Istituto Clinico Humanitas; Chiara Rusconi, Azienda Ospedaliera Niguarda Cà Granda, Milan; Maurizio Bonfichi and Ercole Brusamolino, Istituto Di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo di Pavia, Pavia; Giuseppe Rossi and Antonella Anastasia, Spedali Civili, Brescia; Francesco Zaja, Santa Maria della Misericordia Hospital, Udine; Vincenzo Pavone, Azienda Ospedaliera Cardinal Panico, Tricase; Alessandro Pulsoni, Sapienza University, Rome; Luigi Rigacci, Azienda Ospedaliera Careggi, Florence; Gianluca Gaidano, Amedeo Avogadro University; Gian Mauro Sacchetti, University Hospital Maggiore della Carità, Novara; Caterina Stelitano, Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria; Monica Tani, Santa Maria delle Croci Hospital, Ravenna; and Eugenio Borsatti, Centro di Riferimento Oncologico, Aviano, Italy.