Definition of bulky disease in early stage Hodgkin lymphoma in computed tomography era: Prognostic significance of measurements in the coronal and transverse planes Journal Article

   

Authors:	Kumar, A.; Burger, I. A.; Zhang, Z.; Drill, E. N.; Migliacci, J. C.; Ng, A.; LaCasce, A.; Wall, D.; Witzig, T. E.; Ristow, K.; Yahalom, J.; Moskowitz, C. H.; Zelenetz, A. D.
Article Title:	Definition of bulky disease in early stage Hodgkin lymphoma in computed tomography era: Prognostic significance of measurements in the coronal and transverse planes
Abstract:	Disease bulk is an important prognostic factor in early stage Hodgkin lymphoma, but its definition is unclear in the computed tomography era. This retrospective analysis investigated the prognostic significance of bulky disease measured in transverse and coronal planes on computed tomography imaging. Early stage Hodgkin lymphoma patients (n=185) treated with chemotherapy with or without radiotherapy from 2000-2010 were included. The longest diameter of the largest lymph node mass was measured in transverse and coronal axes on pre-treatment imaging. The optimal cut off for disease bulk was maximal diameter greater than 7 cm measured in either the transverse or coronal plane. Thirty patients with maximal transverse diameter of 7 cm or under were found to have bulk in coronal axis. The 4-year overall survival was 96.5% (CI: 93.3%, 100%) and 4-year relapse-free survival was 86.8% (CI: 81.9%, 92.1%) for all patients. Relapse-free survival at four years for bulky patients was 80.5% (CI: 73%, 88.9%) compared to 94.4% (CI: 89.1%, 100%) for non-bulky; Cox HR 4.21 (CI: 1.43, 12.38) (P=0.004). In bulky patients, relapse-free survival was not impacted in patients treated with chemoradiotherapy; however, it was significantly lower in patients treated with chemotherapy alone. In an independent validation cohort of 38 patients treated with chemotherapy alone, patients with bulky disease had an inferior relapse-free survival [at 4 years, 71.1% (CI: 52.1%, 97%) vs. 94.1% (CI: 83.6%, 100%), Cox HR 5.27 (CI: 0.62, 45.16); P=0.09]. Presence of bulky disease on multidimensional computed tomography imaging is a significant prognostic factor in early stage Hodgkin lymphoma. Coronal reformations may be included for routine Hodgkin lymphoma staging evaluation. In future, our definition of disease bulk may be useful in identifying patients who are most appropriate for chemotherapy alone. © 2016 Ferrata Storti Foundation.
Journal Title:	Haematologica
Volume:	101
Issue:	10
ISSN:	0390-6078
Publisher:	Ferrata Storti Foundation
Date Published:	2016-09-30
Start Page:	1237
End Page:	1243
Language:	English
DOI:	10.3324/haematol.2016.141846
PROVIDER:	scopus
PMCID:	PMC5046653
PUBMED:	27390360
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-84989352657&partnerID=40&md5=cd2ad439c836d4f8c142540ea8099d44
Notes:	Article -- Export Date: 2 November 2016 -- Source: Scopus

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