Prognostic significance of baseline metabolic tumor volume in relapsed and refractory Hodgkin lymphoma Journal Article


Authors: Moskowitz, A. J.; Schöder, H.; Gavane, S.; Thoren, K. L.; Fleisher, M.; Yahalom, J.; McCall, S. J.; Cadzin, B. R.; Fox, S. Y.; Gerecitano, J.; Grewal, R.; Hamlin, P. A.; Horwitz, S. M.; Kumar, A.; Matasar, M.; Ni, A.; Noy, A.; Palomba, M. L.; Perales, M. A.; Portlock, C. S.; Sauter, C.; Straus, D.; Younes, A.; Zelenetz, A. D.; Moskowitz, C. H.
Article Title: Prognostic significance of baseline metabolic tumor volume in relapsed and refractory Hodgkin lymphoma
Abstract: Identification of prognostic factors for patients with relapsed/refractory Hodgkin lymphoma (HL) is essential for optimizing therapy with risk-adapted approaches. In our phase 2 study of positron emission tomography (PET)–adapted salvage therapy with brentuximab vedotin (BV) and augmented ifosfamide, carboplatin, and etoposide (augICE), we assessed clinical factors, quantitative PET assessments, and cytokine and chemokine values. Transplant-eligible patients with relapsed/refractory HL received 2 (cohort 1) or 3 (cohort 2) cycles of weekly BV; PET-negative patients (Deauville score £2) proceeded to autologous stem cell transplantation (ASCT) whereas PET-positive patients received augICE before ASCT. Serum cytokine and chemokine levels were measured at baseline and after BV. Metabolic tumor volume (MTV) and total lesion glycolysis were measured at baseline, after BV, and after augICE. Sixty-five patients enrolled (45, cohort 1; 20, cohort 2); 49 (75%) achieved complete response and 64 proceeded to ASCT. Three-year overall survival and event-free survival (EFS) were 95% and 82%, respectively. Factors predictive for EFS by multivariable analysis were baseline MTV (bMTV) (P < .001) and refractory disease (P 5 .003). Low bMTV (<109.5 cm3) and relapsed disease identified a favorable group (3-year EFS, 100%). For patients who received a transplant, bMTV and pre-ASCT PET were independently prognostic; 3-year EFS for pre-ASCT PET-positive patients with low bMTV was 86%. In this phase 2 study of PET-adapted therapy with BV and augICE for relapsed/refractory HL, bMTV and refractory disease were independent prognostic factors for EFS. Furthermore, bMTV improved the predictive power of pre-ASCT PET. Future studies should optimize efficacy and tolerability of salvage therapy by stratifying patients according to risk factors such as bMTV. © 2017 by The American Society of Hematology.
Keywords: adolescent; adult; cancer survival; controlled study; event free survival; aged; disease-free survival; middle aged; young adult; major clinical study; overall survival; disease course; mortality; salvage therapy; advanced cancer; cancer combination chemotherapy; cancer risk; cancer radiotherapy; disease free survival; cancer staging; positron emission tomography; antineoplastic agent; carboplatin; phase 2 clinical trial; tumor volume; etoposide; antineoplastic combined chemotherapy protocols; interleukin 10; cohort analysis; autologous stem cell transplantation; stem cell transplantation; ifosfamide; hodgkin disease; cytokine; blood; cytokines; chemokine; gamma interferon; tumor burden; positron-emission tomography; interleukin 6; transplantation, autologous; glycolysis; chemokines; tumor necrosis factor; thymus and activation regulated chemokine; patient preference; autotransplantation; antibody conjugate; immunoconjugates; procedures; cancer prognosis; drug effects; brentuximab vedotin; humans; prognosis; human; male; female; priority journal; article; relapsed refractory hodgkin lymphoma
Journal Title: Blood
Volume: 130
Issue: 20
ISSN: 0006-4971
Publisher: American Society of Hematology  
Date Published: 2017-11-16
Start Page: 2196
End Page: 2203
Language: English
DOI: 10.1182/blood-2017-06-788877
PUBMED: 28874350
PROVIDER: scopus
PMCID: PMC5691245
DOI/URL:
Notes: Article -- Export Date: 2 January 2018 -- Source: Scopus
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MSK Authors
  1. Joachim Yahalom
    449 Yahalom
  2. Carol Portlock
    198 Portlock
  3. Craig Moskowitz
    388 Moskowitz
  4. Ariela Noy
    224 Noy
  5. Maria Lia Palomba
    163 Palomba
  6. Steven M Horwitz
    406 Horwitz
  7. Ravinder K Grewal
    66 Grewal
  8. Heiko Schoder
    327 Schoder
  9. Craig Steven Sauter
    199 Sauter
  10. Andrew D Zelenetz
    599 Zelenetz
  11. Miguel-Angel Perales
    451 Perales
  12. Alison Moskowitz
    177 Moskowitz
  13. Paul Hamlin
    186 Hamlin
  14. Matthew J Matasar
    148 Matasar
  15. Martin Fleisher
    276 Fleisher
  16. David J Straus
    242 Straus
  17. Susan J McCall
    14 McCall
  18. Anita Kumar
    65 Kumar
  19. Anas Younes
    243 Younes
  20. Stephanie Yvonne Fox
    5 Fox
  21. Katie Lynn Thoren
    18 Thoren
  22. Ai   Ni
    82 Ni
  23. Briana R Cadzin
    1 Cadzin