Impact of Pretransplantation (18)F-Fluorodeoxyglucose-Positron Emission Tomography on Survival Outcomes after T Cell-Depleted Allogeneic Transplantation for Hodgkin Lymphoma.
Pretransplant (18)F-fluorodeoxyglucose (FDG) positron emission tomography status is an important prognostic factor for outcomes after autologous stem cell transplantation (SCT) in Hodgkin lymphoma (HL), but its impact on outcomes after allogeneic SCT remains unclear. We retrospectively evaluated outcomes after T cell-depleted allogeneic SCT of 116 patients with nonprogressive HL according to pretransplant Deauville scores. Endpoints were overall survival (OS), progression-free survival (PFS), relapse rate (RR), and nonrelapse-related mortality (NRM). OS, PFS, and RR did not differ significantly between the Deauville 1 to 2 and Deauville 3 to 5 cohorts (OS: 77.5% versus 67.3%, P = .49; PFS: 59.4% versus 55.7%, P = .43; RR: 20.9% versus 22.6%, P = .28 at 4 years). Differences in PFS remained statistically nonsignificant when comparisons were made between Deauville 1 to 3 and Deauville 4 to 5 cohorts (60.9% versus 51.4%, P = .10), and RR remained very similar (21.5% versus 23.8%, P = .42). Multivariate analyses demonstrated trends toward significance for an effect of Deauville score on PFS (hazard ratio 1.82 for Deauville 4 to 5, P = .06) and for number of lines of prior therapy on OS (hazard ratio 2.34 for >5 lines, P = .10). The latter effect appeared to be driven by higher NRM rather than increased RR. Our findings suggest that Deauville score before allogeneic SCT in patients with nonprogressive HL has a relatively modest impact on survival outcomes in comparison with the impact in autologous SCT and that predictive values for the individual patient remain low, indicating that residual FDG-avid disease should not preclude allogeneic SCT. Furthermore, our findings bring into question the importance of attainment of metabolic complete response in this setting if it is at the expense of increasing NRM risk.
Department of Haematology, University College London Hospitals NHS Trust, London, United Kingdom.
Yasmin
Y
Reyal
Department of Nuclear Medicine, University College London Hospitals NHS Trust, London, United Kingdom.
Irfan
I
Kayani
Department of Haematology, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom.
Adrian J C
AJC
Bloor
Department of Haematology, City Hospital, Nottingham University NHS Trust, Nottingham, United Kingdom.
Christopher P
CP
Fox
Department of Haematology, University College London Hospitals NHS Trust, London, United Kingdom.
Ronjon
R
Chakraverty
Department of Haematology, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom.
Ann-Marie
AM
Sjursen
Department of Haematology, University College London Hospitals NHS Trust, London, United Kingdom; Department of Haematology, University College London Cancer Institute, London, United Kingdom.
Adele K
AK
Fielding
Department of Radiology, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom.
Marcus
M
Ben Taylor
Department of Haematology, City Hospital, Nottingham University NHS Trust, Nottingham, United Kingdom.
Mark J
MJ
Bishton
Department of Haematology, University College London Hospitals NHS Trust, London, United Kingdom.
Emma C
EC
Morris
Department of Haematology, University College London Hospitals NHS Trust, London, United Kingdom.
Kirsty J
KJ
Thomson
Department of Haematology, City Hospital, Nottingham University NHS Trust, Nottingham, United Kingdom.
Nigel
N
Russell
Department of Haematology, University College London Hospitals NHS Trust, London, United Kingdom.
Stephen
S
Mackinnon
Department of Haematology, University College London Hospitals NHS Trust, London, United Kingdom; Department of Haematology, University College London Cancer Institute, London, United Kingdom. Electronic address: K.peggs@ucl.ac.uk.
Karl S
KS
Peggs
D000328:Adult; D000066491:Clinical Decision-Making; D005260:Female; D019788:Fluorodeoxyglucose F18; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006689:Hodgkin Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008212:Lymphocyte Depletion; D008297:Male; D018365:Neoplasm, Residual / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D049268:Positron-Emission Tomography / Q000379:methods / Q000401:mortality*; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D013601:T-Lymphocytes; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D019788:Fluorodeoxyglucose F18
Allogeneic transplantation; FDG-PET; Hodgkin lymphoma