title: Pre-transplant FDG-PET-based survival model in relapsed and refractory Hodgkin's lymphoma: outcome after high-dose chemotherapy and auto-SCT.
abstract: Hodgkin's lymphoma (HL) patients with positive (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) post salvage chemotherapy or before high-dose chemotherapy and auto-SCT (HDC ASCT) have inferior outcomes. We reviewed 21 prognostic factors before salvage chemotherapy (at relapse/progression) and integrated post salvage FDG-PET results to develop a prognostic model for post HDC ASCT outcome. We used Fine and Gray method for competing risk analysis and regression model for risks assessment and outcome. One hundred and forty-one patients had post salvage FDG-PET before HDC ASCT (median age 25.5 years); male/female 55%:45%, relapsed/refractory 43%:57%, median follow-up 33 months. Multivariate analysis identified HL International Prognostic Score 3 (P=0.001; hazard ratio (HR): 3.7 (1.6-8.3)) and post salvage positive FDG-PET (P=0.011; HR: 3.4 (1.3-8.9)) with higher hazard of disease-specific death (model P=0.0001). Cumulative incidence of disease-specific death with 0, 1, 2 risk factors was 7%:29%:52%, respectively (P=0.00003). For disease-specific event (persistent, progressive or relapsed disease), mediastinal involvement (P=0.024; HR: 2.7 (1.14-6.5)), B symptoms (P=0.027; HR: 2.1 (1.09-4.2)) and positive post salvage FDG-PET (P=0.001; HR: 3.3 (1.7-6.7)) were significant (model P=<0.00001). Cumulative incidence of disease-specific event with 0, 1, 2, 3 risk factors was 8%:31%:50%:75%, respectively (P=0.0000006). Patients with higher scores have higher risk of treatment failure. They are potential candidates for newer therapies along with HDC ASCT.
authors.affiliation: Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
authors.forename: S
authors.initials: S
authors.lastname: Akhtar
authors.forename: A S
authors.initials: AS
authors.lastname: Al-Sugair
authors.forename: M
authors.initials: M
authors.lastname: Abouzied
authors.forename: Y
authors.initials: Y
authors.lastname: Alkadhi
authors.forename: M
authors.initials: M
authors.lastname: Dingle
authors.forename: M
authors.initials: M
authors.lastname: Abdelsalam
authors.forename: H
authors.initials: H
authors.lastname: Soudy
authors.forename: A
authors.initials: A
authors.lastname: Darwish
authors.forename: A
authors.initials: A
authors.lastname: Eltigani
authors.forename: T A M
authors.initials: TA
authors.lastname: Elhassan
authors.forename: M
authors.initials: M
authors.lastname: Nabil-Ahmed
authors.forename: I
authors.initials: I
authors.lastname: Maghfoor
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery / Q000628:therapy; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18