title: Interim PET After Two ABVD Cycles in Early-Stage Hodgkin Lymphoma: Outcomes Following the Continuation of Chemotherapy Plus Radiotherapy.
abstract: OBJECTIVE
  This multicenter retrospective study was designed to evaluate the prognostic role of interim fluorodeoxyglucose-labeled positron emission tomography (i-FDG-PET) in a cohort of patients affected with early-stage Hodgkin lymphoma (HL) treated initially with adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) chemotherapy followed by radiation therapy, and to assess the role of chemotherapy continuation plus radiation therapy for i-FDG-PET-positive patients.
  
  
  METHODS
  Data from 257 patients were retrieved from 4 hematology and radiation oncology departments. Inclusion criteria were stage I to IIAB HL, "intention-to-treat" AVBD plus radiation therapy, and FDG-PET at diagnosis and after the first 2 ABVD cycles. All i-FDG-PET scans underwent blinded local review by using the Deauville 5-point scoring system; patients were stratified as negative or positive using 2 Deauville score cutoff values, ≥3 or ≥4.
  
  
  RESULTS
  Median follow-up time was 56 months (range: 9-163 months); 5-year overall survival (OS) and disease-specific survival (DSS) for the whole cohort were 97.5% and 98.3%, respectively. Five-year progression-free survival (PFS) was 95.6%. After i-FDG-PET revision, 43 of 257 patients (16.7%) had a positive i-FDG-PET (Deauville scores: 3-5). Five-year PFS rates for i-FDG-PET-negative and i-FDG-PET-positive patients were 98.1% and 83.7%, respectively, if using a Deauville score cutoff of 3, and 97.7% and 78.6%, respectively, if using a cutoff of 4 (P=.0001). Five-year OS for i-FDG-PET-negative and i-FDG-PET-positive patients was 98.5% and 93.0%, respectively, if using a cutoff of 3, and 98.6% and 89.3%, respectively, if using a cutoff of 4 (P=.029 and P=.002). At univariate regression analysis, i-FDG-PET positivity was associated with worse OS and PFS. At multivariate analysis, performed only for PFS, i-FDG-PET positivity confirmed its negative impact (P=.002).
  
  
  CONCLUSIONS
  i-FDG-PET is prognostic for PFS and OS in early-stage HL patients treated with combined modality therapy; the continuation of chemotherapy followed by radiation therapy is able to obtain durable, complete remission in most i-FDG-PET-positive patients.
authors.affiliation: Radiotherapy Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Simontacchi
authors.affiliation: Department of Oncology, University of Torino, Torino, Italy. Electronic address: andreariccardo.filippi@unito.it.
authors.forename: Andrea Riccardo
authors.initials: AR
authors.lastname: Filippi
authors.affiliation: Radiation Oncology Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Ciammella
authors.affiliation: Radiation Oncology Department, University and Spedali Civili, Brescia, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Buglione
authors.affiliation: Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute, Florence, Italy.
authors.forename: Calogero
authors.initials: C
authors.lastname: Saieva
authors.affiliation: Radiation Oncology Department, University and Spedali Civili, Brescia, Italy.
authors.forename: Stefano Maria
authors.initials: SM
authors.lastname: Magrini
authors.affiliation: Radiotherapy Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Livi
authors.affiliation: Radiation Oncology Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Iotti
authors.affiliation: Hematology Unit, Città della Salute e della Scienza Hospital, Torino, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Botto
authors.affiliation: Nuclear Medicine Department, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Vaggelli
authors.affiliation: Hematology Unit, University and Spedali Civili, Brescia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Re
authors.affiliation: Hematology Unit, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Merli
authors.affiliation: Department of Oncology, University of Torino, Torino, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Ricardi
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D003606:Dacarbazine / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods* / Q000401:mortality; D019275:Radiopharmaceuticals; D011879:Radiotherapy Dosage; D061089:Radiotherapy, Image-Guided; D012044:Regression Analysis; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin