title: CD68+ cell count, early evaluation with PET and plasma TARC levels predict response in Hodgkin lymphoma.
abstract: Early response evaluation with [(18) F]fluordeoxyglucose (FDG) positron emission tomography after 2 cycles of chemotherapy (interim PET) has been indicated as the strongest predictor for outcome in classical Hodgkin lymphoma (HL). We studied the prognostic role of the number of tumor-infiltrating CD68+ cells and of the plasma levels of TARC (thymus and activation-regulated chemokine) in the context of interim PET in 102 patients with classical HL treated with Adriamycin, Bleomycin, Vinblastine, Dacarbazine (ABVD). After 2 ABVD cycles, interim PET according to Deauville criteria was negative (score 0-3) in 85 patients and positive (score 4-5) in 15 patients (2 patients technically not evaluable). TARC levels were elevated in 89% of patients at diagnosis, and decreased after 2 cycles in 82% of patients. Persistently elevated TARC levels in 18% of patients were significantly associated with a positive PET result (P = 0.007). Strong predictors for progression-free survival (PFS) were a negative interim PET (85% vs. 28%, P < 0.0001) and CD68+ cell counts <5% (89% vs. 67%, P = 0.006), while TARC levels at diagnosis and at interim evaluation had no prognostic role. In multivariate analysis, interim PET, CD68+ cell counts and presence of B-symptoms were independently associated with PFS. We conclude that although TARC levels are a biomarker for early response evaluation, they cannot substitute for interim PET as outcome predictor in HL. The evaluation of CD68 counts and B-symptoms at diagnosis may help to identify low-risk patients regardless positive interim PET.
authors.affiliation: Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Annarosa
authors.initials: A
authors.lastname: Cuccaro
authors.affiliation: Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Annunziata
authors.affiliation: Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Cupelli
authors.affiliation: Institute of Pathology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Martini
authors.affiliation: Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Calcagni
authors.affiliation: Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Vittoria
authors.initials: V
authors.lastname: Rufini
authors.affiliation: Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Giachelia
authors.affiliation: Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Bartolomei
authors.affiliation: Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Galli
authors.affiliation: Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Alò
authors.affiliation: Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Maria T
authors.initials: MT
authors.lastname: Voso
authors.affiliation: Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Leone
authors.affiliation: Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giordano
authors.affiliation: Institute of Pathology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Luigi M
authors.initials: LM
authors.lastname: Larocca
authors.affiliation: Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hohaus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015703:Antigens, CD / Q000378:metabolism*; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016175:B-Lymphocyte Subsets / Q000166:cytology / Q000378:metabolism; D002452:Cell Count; D054414:Chemokine CCL17 / Q000097:blood*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D016246:Lymphocytes, Tumor-Infiltrating / Q000166:cytology* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D054414:Chemokine CCL17; D019788:Fluorodeoxyglucose F18; C106230:CCL17 protein, human; C067980:CD68 antigen, human; D000097382:CD68 Molecule
keywords: CD68+ tumor-infiltrating macrophages; Hodgkin lymphoma; TARC; interim PET; prognosis