title: Positron emission tomography response at the time of autologous stem cell transplantation predicts outcome of patients with relapsed and/or refractory Hodgkin's lymphoma responding to prior salvage therapy.
abstract: BACKGROUND
  High-dose chemotherapy followed by autologous stem cell transplantation is the standard treatment for relapsed and/or refractory Hodgkin's lymphoma although half of patients relapse after transplantation. Predictive factors, such as relapse within 12 months, Ann-Arbor stage at relapse, and relapse in previously irradiated fields are classically used to identify patients with poor outcome. Recently, 18-fluorodeoxyglucose positron emission tomography has emerged as a new method for providing information to predict outcome. The aim of this study was to confirm the predictive value of positron emission tomography status after salvage therapy and to compare single versus tandem autologous stem cell transplantation in patients with relapsed and/or refractory Hodgkin's lymphoma.
  
  
  METHODS
  We report a series of 111 consecutive patients with treatment-sensitive relapsed and/or treatment-refractory Hodgkin's lymphoma who achieved complete (positron emission tomography-negative group) or partial remission (positron emission tomography-positive group) at positron emission tomography evaluation after salvage chemotherapy and who underwent single or tandem autologous stem cell transplantation.
  
  
  RESULTS
  Five-year overall and progression-free survival rates were 81% and 64%, respectively. There were significant differences in 5-year progression-free survival (79% versus 23%; P<0.001) and 5-year overall survival (90% versus 55%, P=0.001) between the positron emission tomography-negative and -positive groups, respectively. A complete response, as determined by positron emission tomography evaluation, after salvage therapy predicted significantly better 5-year overall survival rates in both intermediate (91% versus 50%; P=0.029) and unfavorable (89% versus 58%; P=0.026) risk subgroup analyses. In the positron emission tomography-positive subgroup, tandem transplantation improved 5-year progression-free survival from 0% (in the single transplantation group) to 43% (P=0.034). Multivariate analysis showed that positron emission tomography status (hazard ratio: 5.26 [2.57-10.73]) and tandem transplantation (hazard ratio: 0.39 [0.19-0.78]) but not risk factors at relapse (hazard ratio: 1.77 [0.80-3.92]) significantly influenced progression-free survival, while only tomography status significantly influenced overall survival (hazard ratio: 4.03 [1.38-11.75]).
  
  
  CONCLUSIONS
  In patients with relapsed/refractory Hodgkin's lymphoma responding to prior salvage therapy, positron emission tomography response at time of autologous stem cell transplantation favorably influences outcome and enables identification of patients requiring single or tandem transplantation.
authors.affiliation: Hematology Department, Transplantation & Cell Therapy Program, Institut Paoli Calmettes, Marseille, France.
authors.forename: Raynier
authors.initials: R
authors.lastname: Devillier
authors.forename: Diane
authors.initials: D
authors.lastname: Coso
authors.forename: Luca
authors.initials: L
authors.lastname: Castagna
authors.forename: Isabelle
authors.initials: I
authors.lastname: Brenot Rossi
authors.forename: Antonella
authors.initials: A
authors.lastname: Anastasia
authors.forename: Arturo
authors.initials: A
authors.lastname: Chiti
authors.forename: Vadim
authors.initials: V
authors.lastname: Ivanov
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Schiano
authors.forename: Armando
authors.initials: A
authors.lastname: Santoro
authors.forename: Christian
authors.initials: C
authors.lastname: Chabannon
authors.forename: Monica
authors.initials: M
authors.lastname: Balzarotti
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
authors.forename: Reda
authors.initials: R
authors.lastname: Bouabdallah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006689:Hodgkin Disease / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome