title: Normalization of pre-ASCT, FDG-PET imaging with second-line, non-cross-resistant, chemotherapy programs improves event-free survival in patients with Hodgkin lymphoma.
abstract: We previously reported that remission duration < 1 year, extranodal disease, and B symptoms before salvage chemotherapy (SLT) can stratify relapsed or refractory Hodgkin lymphoma (HL) patients into favorable and unfavorable cohorts. In addition, pre-autologous stem cell transplant (ASCT) (18)FDG-PET response to SLT predicts outcome. This phase 2 study uses both pre-SLT prognostic factors and post-SLT FDG-PET response in a risk-adapted approach to improve PFS after high-dose radio-chemotherapy (HDT) and ASCT. The first SLT uses 2 cycles of ICE in a standard or augmented dose (ICE/aICE), followed by restaging FDG-PET scan. Patients with a negative scan received a transplant. If the FDG-PET scan remained positive, patients received 4 biweekly doses of gemcitabine, vinorelbine, and liposomal doxorubicin. Patients without evidence of disease progression proceeded to HDT/ASCT; those with progressive disease were study failures. At a median follow-up of 51 months, EFS analyzed by intent to treat as well as for transplanted patients is 70% and 79%, respectively. Patients transplanted with negative FDG-PET, pre-HDT/ASCT after 1 or 2 SLT programs, had an EFS of > 80%, versus 28.6% for patients with a positive scan (P < .001). This prospective study provides evidence that the goal of SLT in patients with Hodgkin lymphoma should be a negative FDG-PET scan before HDT/ASCT.
authors.affiliation: Lymphoma Disease Management Team, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. moskowic@mskcc.org
authors.forename: Craig H
authors.initials: CH
authors.lastname: Moskowitz
authors.forename: Matt J
authors.initials: MJ
authors.lastname: Matasar
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Zelenetz
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Nimer
authors.forename: John
authors.initials: J
authors.lastname: Gerecitano
authors.forename: Paul
authors.initials: P
authors.lastname: Hamlin
authors.forename: Steven
authors.initials: S
authors.lastname: Horwitz
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Moskowitz
authors.forename: Ariela
authors.initials: A
authors.lastname: Noy
authors.forename: Lia
authors.initials: L
authors.lastname: Palomba
authors.forename: Miguel-Angel
authors.initials: MA
authors.lastname: Perales
authors.forename: Carol
authors.initials: C
authors.lastname: Portlock
authors.forename: David
authors.initials: D
authors.lastname: Straus
authors.forename: Jocelyn C
authors.initials: JC
authors.lastname: Maragulia
authors.forename: Heiko
authors.initials: H
authors.lastname: Schoder
authors.forename: Joachim
authors.initials: J
authors.lastname: Yahalom
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002138:Calibration; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm / Q000502:physiology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D059039:Standard of Care; D033581:Stem Cell Transplantation / Q000379:methods* / Q000592:standards; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods / Q000592:standards; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18