Early Interim 2-[ <sup>18</sup> F]Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography Is Prognostically Superior to International Prognostic Score in Advanced-Stage Hodgkin's Lymphoma: A Report From a Joint Italian-Danish Study
Andrea GallaminiFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, AziendaMartin HutchingsFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, AziendaLuigi RigacciFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, AziendaLena SpechtFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, AziendaFrancesco MerliFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, AziendaMads HansenFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, AziendaCaterina PattiFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, AziendaAnnika LoftFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, AziendaFrancesco Di RaimondoFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, AziendaFrancesco d’AmoreFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, AziendaAlberto BiggiFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, AziendaUmberto VitoloFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, AziendaCaterina StelitanoFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, AziendaRosario SancettaFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, AziendaLivio TrentinFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, AziendaStefano LuminariFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, AziendaEmilio IannittoFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, AziendaSimonetta VivianiFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, AziendaIvana PierriFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, AziendaAlessandro LevisFrom the Departments of Hematology and Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo; Oncology Department, Università di Firenze, Firenze; Hematology Department, Arcispedale S. Maria Nuova, Reggio Emilia; Hematology Department, Azienda Ospedaliera Cervello, Palermo; Hematology Department, Università di Catania, Catania; Hematology Department, Aarhus University Hospital, Aarhus; Hematology Department, Azienda Ospedaliera S. Giovanni Battista, Torino; Hematology Department, Azienda
2007en
ABI
Аннотация
PURPOSE: Starting from November 2001, 260 newly diagnosed patients with Hodgkin's lymphoma (HL) were consecutively enrolled in parallel Italian and Danish prospective trials to evaluate the prognostic role of an early interim 2-[(18)F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) scan and the International Prognostic Score (IPS) in advanced HL, treated with conventional ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy. PATIENTS AND METHODS: Most patients (n = 190) presented with advanced disease (stages IIB through IVB), whereas 70 presented in stage IIA with adverse prognostic factors. All but 11 patients were treated with standard ABVD therapy followed by consolidation radiotherapy in case of bulky presentation or residual tumor mass. Conventional radiologic staging was performed at baseline. FDG-PET scan was performed at baseline and after two courses of ABVD (PET-2). No treatment change was allowed on the basis of the PET-2 results. RESULTS: After a median follow-up of 2.19 years (range, 0.32 to 5.18 years), 205 patients were in continued complete remission and two patients were in partial remission. Forty-three patients progressed during therapy or immediately after, whereas 10 patients relapsed. The 2-year progression-free survival for patients with positive PET-2 results was 12.8% and for patients with negative PET-2 results was 95.0% (P < .0001). In univariate analysis, the treatment outcome was significantly associated with PET-2 (P < .0001), stage IV (P < .0001), WBC more than 15,000 (P < .0001), lymphopenia (P < .001), IPS as a continuous variable (P < .0001), extranodal involvement (P < .0001), and bulky disease (P = .012). In multivariate analyses, only PET-2 turned out to be significant (P < .0001). CONCLUSION: PET-2 overshadows the prognostic value of IPS and emerges as the single most important tool for planning of risk-adapted treatment in advanced HL.
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