Normalization of pre-ASCT, FDG-PET imaging with second-line, non-cross-resistant, chemotherapy programs improves event-free survival in patients with Hodgkin lymphoma Journal Article

Authors: Moskowitz, C. H.; Matasar, M. J.; Zelenetz, A. D.; Nimer, S. D.; Gerecitano, J.; Hamlin, P.; Horwitz, S.; Moskowitz, A. J.; Noy, A.; Palomba, L.; Perales, M. A.; Portlock, C.; Straus, D.; Maragulia, J. C.; Schoder, H.; Yahalom, J.
Article Title: Normalization of pre-ASCT, FDG-PET imaging with second-line, non-cross-resistant, chemotherapy programs improves event-free survival in patients with Hodgkin lymphoma
Abstract: We previously reported that remission duration < 1 year, extranodal disease, and B symptoms before salvage chemotherapy (SLT) can stratify relapsed or refractory Hodgkin lymphoma (HL) patients into favorable and unfavorable cohorts. In addition, pre-autologous stem cell transplant (ASCT) 18FDG-PET response to SLT predicts outcome. This phase 2 study uses both pre-SLT prognostic factors and post-SLT FDG-PET response in a risk-adapted approach to improve PFS after high-dose radio-chemotherapy (HDT) and ASCT. The first SLT uses 2 cycles of ICE in a standard or augmented dose (ICE/aICE), followed by restaging FDG-PET scan. Patients with a negative scan received a transplant. If the FDG-PET scan remained positive, patients received 4 biweekly doses of gemcitabine, vinorelbine, and liposomal doxorubicin. Patients without evidence of disease progression proceeded to HDT/ ASCT; those with progressive disease were study failures. At a median follow-up of 51 months, EFS analyzed by intent to treat as well as for transplanted patients is 70% and 79%, respectively. Patients transplanted with negative FDG-PET, pre- HDT/ASCT after 1 or 2 SLT programs, had an EFS of > 80%, versus 28.6% for patients with a positive scan (P < .001). This prospective study provides evidence that the goal of SLT in patients with Hodgkin lymphoma should be a negative FDG-PET scan before HDT/ASCT. The study was registered at as NCT00255723. © 2012 by The American Society of Hematology.
Keywords: adult; cancer chemotherapy; cancer survival; controlled study; event free survival; treatment response; aged; salvage therapy; doxorubicin; cancer growth; drug safety; treatment planning; gemcitabine; cancer radiotherapy; radiation dose; cancer staging; positron emission tomography; carboplatin; phase 2 clinical trial; etoposide; esophagitis; randomized controlled trial; cyclophosphamide; autologous stem cell transplantation; herpes zoster; continuous infusion; radiation injury; prediction; carmustine; ifosfamide; hodgkin disease; febrile neutropenia; pneumonia; cancer inhibition; acute kidney failure; depression; myelodysplastic syndrome; fluorodeoxyglucose f 18; graft versus host reaction; clostridium difficile infection; mesna; navelbine; recombinant granulocyte colony stimulating factor; catheter infection; anaphylaxis; radiation pneumonia; lymph node irradiation; multiple organ failure; heart tamponade; catheter thrombosis; virus meningitis; cancer prognosis
Journal Title: Blood
Volume: 119
Issue: 7
ISSN: 0006-4971
Publisher: American Society of Hematology  
Date Published: 2012-02-16
Start Page: 1665
End Page: 1670
Language: English
DOI: 10.1182/blood-2011-10-388058
PROVIDER: scopus
PUBMED: 22184409
PMCID: PMC3790950
Notes: --- - "Export Date: 2 April 2012" - "CODEN: BLOOA" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Joachim Yahalom
    453 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
    407 Horwitz
  7. Heiko Schoder
    328 Schoder
  8. Andrew D Zelenetz
    599 Zelenetz
  9. Stephen D Nimer
    347 Nimer
  10. Miguel-Angel Perales
    452 Perales
  11. Alison Moskowitz
    178 Moskowitz
  12. Paul Hamlin
    186 Hamlin
  13. Matthew J Matasar
    149 Matasar
  14. David J Straus
    244 Straus
  15. Jocelyn C Maragulia
    100 Maragulia