Five-year follow-up of SWOG S0816: Limitations and values of a PET-adapted approach with stage III/IV Hodgkin lymphoma Journal Article

Authors: Stephens, D. M.; Li, H.; Schöder, H.; Straus, D. J.; Moskowitz, C. H.; LeBlanc, M.; Rimsza, L. M.; Bartlett, N. L.; Evens, A. M.; LaCasce, A. S.; Barr, P. M.; Knopp, M. V.; Hsi, E. D.; Leonard, J. P.; Kahl, B. S.; Smith, S. M.; Friedberg, J. W.
Article Title: Five-year follow-up of SWOG S0816: Limitations and values of a PET-adapted approach with stage III/IV Hodgkin lymphoma
Abstract: Patients with advanced-stage Hodgkin lymphoma (HL) demonstrated excellent 2-year progression-free survival (PFS) after receiving positron emission tomography (PET)- adapted therapy on SWOG S0816. Patients received 2 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Patients achieving complete response (CR) on PET scan following cycle 2 of ABVD (PET2) continued 4 additional cycles of ABVD. Patients not achieving CR on PET2 were switched to escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP) for 6 cycles. After a median follow-up of 5.9 years, a subset of 331 eligible patients with central review of PET2 was analyzed. PET2 was negative in 82% and positive in 18%. For all patients, the estimated 5-year PFS and OS was 74% (95% confidence interval [CI], 69%-79%) and 94% (95% CI, 91%-96%), respectively. For PET22 and PET21 patients, the 5-year PFS was 76% (95% CI, 70%-81%) and 66% (95% CI, 52%-76%), respectively. Seven (14%) and 6 (2%) patients reported second cancers after treatment with eBEACOPP and ABVD, respectively (P = .001). Long-term OS of HL patients treated on S0816 remains high. Nearly 25% of PET22 patients experienced relapse events, demonstrating limitations ABVD therapy and of the negative predictive value of PET2. In PET2+ patients who received eBEACOPP, PFS was favorable, but was associated with a high rate of second malignancies compared with historical controls. Our results emphasize the importance of long-term follow-up, and the need for more efficacious and less toxic therapeutic approaches for advanced-stage HL patients. This trial was registered at as #NCT00822120. © 2019 American Society of Hematology. All rights reserved.
Keywords: adult; controlled study; major clinical study; overall survival; prednisone; neutropenia; doxorubicin; advanced cancer; diarrhea; gemcitabine; cancer radiotherapy; cancer staging; positron emission tomography; follow up; cancer grading; carboplatin; dacarbazine; melanoma; progression free survival; multiple cycle treatment; basal cell carcinoma; etoposide; peripheral neuropathy; cyclophosphamide; vincristine; deep vein thrombosis; bladder cancer; ifosfamide; procarbazine; vinblastine; hodgkin disease; drug dose escalation; prostate cancer; myelodysplastic syndrome; heart failure; long term care; bleomycin; second cancer; kidney cancer; predictive value; lung injury; human; male; female; priority journal; article
Journal Title: Blood
Volume: 134
Issue: 15
ISSN: 0006-4971
Publisher: American Society of Hematology  
Date Published: 2019-10-10
Start Page: 1238
End Page: 1246
Language: English
DOI: 10.1182/blood.2019000719
PUBMED: 31331918
PROVIDER: scopus
Notes: Source: Scopus
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MSK Authors
  1. Craig Moskowitz
    387 Moskowitz
  2. Heiko Schoder
    313 Schoder
  3. David J Straus
    230 Straus