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Positron emission tomography score has greater prognostic significance than pretreatment risk stratification in early-stage Hodgkin lymphoma in the UK RAPID study

Positron emission tomography score has greater prognostic significance than pretreatment risk stratification in early-stage Hodgkin lymphoma in the UK RAPID study
Positron emission tomography score has greater prognostic significance than pretreatment risk stratification in early-stage Hodgkin lymphoma in the UK RAPID study

PURPOSE Accurate stratification of patients is an important goal in Hodgkin lymphoma (HL), but the role of pretreatment clinical risk stratification in the context of positron emission tomography (PET) -adapted treatment is unclear. We performed a subsidiary analysis of the RAPID trial to assess the prognostic value of pretreatment risk factors and PET score in determining outcomes. PATIENTS AND METHODS Patients with stage IA to IIA HL and no mediastinal bulk underwent PET assessment after three cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine; 143 PET-positive patients (PET score, 3 to 5) received a fourth doxorubicin, bleomycin, vinblastine, and dacarbazine cycle and involved-field radiotherapy, and 419 patients in complete metabolic remission were randomly assigned to receive involved-field radiotherapy (n = 208) or no additional treatment (n = 211). Cox regression was used to investigate the association between PET score and pretreatment risk factors with HL-specific event-free survival (EFS). RESULTS High PET score was associated with inferior EFS, before (P, .001) and after adjustment (P = .01) for baseline risk stratification. Only patients with a postchemotherapy PET score of 5 (uptake $ three times maximum liver uptake) had an increased risk of progression or HL-related death (hazard ratio, 9.4 v score of 3; 95% CI, 2.8 to 31.3 and hazard ratio, 6.7 v score of 4; 95% CI, 1.4 to 31.7). Patients with a PET score of 5 also had inferior progression-free and overall survival. There was no association between European Organisation for Research and Treatment of Cancer or German Hodgkin Study Group risk group and EFS, before or after adjusting for PET score (all P . .4). CONCLUSION In RAPID, a positive PET scan did not carry uniform prognostic weight; only a PET score of 5 was associated with inferior outcomes. This suggests that in future trials involving patients without B symptoms or mediastinal bulk, a score of 5 rather than a positive PET result should be used to guide treatment escalation in early-stage HL.

0732-183X
1732-1741
Barrington, Sally F.
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Phillips, Elizabeth H.
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Counsell, Nicholas
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Hancock, Barry
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Pettengell, Ruth
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Johnson, Peter
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Townsend, William
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Culligan, Dominic
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Popova, Bilyana
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Clifton-Hadley, Laura
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McMillan, Andrew
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Hoskin, Peter
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O'Doherty, Michael J.
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Illidge, Tim
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Radford, John
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Barrington, Sally F.
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Phillips, Elizabeth H.
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Counsell, Nicholas
bc2d8598-2106-4202-97e2-33ed7f18daa5
Hancock, Barry
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Pettengell, Ruth
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Johnson, Peter
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Townsend, William
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Culligan, Dominic
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Popova, Bilyana
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Clifton-Hadley, Laura
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McMillan, Andrew
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Hoskin, Peter
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O'Doherty, Michael J.
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Illidge, Tim
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Radford, John
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Barrington, Sally F., Phillips, Elizabeth H., Counsell, Nicholas, Hancock, Barry, Pettengell, Ruth, Johnson, Peter, Townsend, William, Culligan, Dominic, Popova, Bilyana, Clifton-Hadley, Laura, McMillan, Andrew, Hoskin, Peter, O'Doherty, Michael J., Illidge, Tim and Radford, John (2019) Positron emission tomography score has greater prognostic significance than pretreatment risk stratification in early-stage Hodgkin lymphoma in the UK RAPID study. Journal of Clinical Oncology, 37 (20), 1732-1741. (doi:10.1200/JCO.18.01799).

Record type: Article

Abstract

PURPOSE Accurate stratification of patients is an important goal in Hodgkin lymphoma (HL), but the role of pretreatment clinical risk stratification in the context of positron emission tomography (PET) -adapted treatment is unclear. We performed a subsidiary analysis of the RAPID trial to assess the prognostic value of pretreatment risk factors and PET score in determining outcomes. PATIENTS AND METHODS Patients with stage IA to IIA HL and no mediastinal bulk underwent PET assessment after three cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine; 143 PET-positive patients (PET score, 3 to 5) received a fourth doxorubicin, bleomycin, vinblastine, and dacarbazine cycle and involved-field radiotherapy, and 419 patients in complete metabolic remission were randomly assigned to receive involved-field radiotherapy (n = 208) or no additional treatment (n = 211). Cox regression was used to investigate the association between PET score and pretreatment risk factors with HL-specific event-free survival (EFS). RESULTS High PET score was associated with inferior EFS, before (P, .001) and after adjustment (P = .01) for baseline risk stratification. Only patients with a postchemotherapy PET score of 5 (uptake $ three times maximum liver uptake) had an increased risk of progression or HL-related death (hazard ratio, 9.4 v score of 3; 95% CI, 2.8 to 31.3 and hazard ratio, 6.7 v score of 4; 95% CI, 1.4 to 31.7). Patients with a PET score of 5 also had inferior progression-free and overall survival. There was no association between European Organisation for Research and Treatment of Cancer or German Hodgkin Study Group risk group and EFS, before or after adjusting for PET score (all P . .4). CONCLUSION In RAPID, a positive PET scan did not carry uniform prognostic weight; only a PET score of 5 was associated with inferior outcomes. This suggests that in future trials involving patients without B symptoms or mediastinal bulk, a score of 5 rather than a positive PET result should be used to guide treatment escalation in early-stage HL.

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Accepted/In Press date: 5 April 2019
e-pub ahead of print date: 21 May 2019
Published date: 10 July 2019

Identifiers

Local EPrints ID: 433111
URI: http://eprints.soton.ac.uk/id/eprint/433111
ISSN: 0732-183X
PURE UUID: f571b9be-541e-41c2-b7ac-211237085ad2
ORCID for Peter Johnson: ORCID iD orcid.org/0000-0003-2306-4974

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Date deposited: 08 Aug 2019 16:30
Last modified: 26 Nov 2021 02:41

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Contributors

Author: Sally F. Barrington
Author: Elizabeth H. Phillips
Author: Nicholas Counsell
Author: Barry Hancock
Author: Ruth Pettengell
Author: Peter Johnson ORCID iD
Author: William Townsend
Author: Dominic Culligan
Author: Bilyana Popova
Author: Laura Clifton-Hadley
Author: Andrew McMillan
Author: Peter Hoskin
Author: Michael J. O'Doherty
Author: Tim Illidge
Author: John Radford

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