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 www.clinicaltrials.gov 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
DOI/URL:
Notes: --- - "Export Date: 2 April 2012" - "CODEN: BLOOA" - "Source: Scopus"
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MSK Authors
  1. Joachim Yahalom
    395 Yahalom
  2. Carol Portlock
    178 Portlock
  3. Craig Moskowitz
    372 Moskowitz
  4. Ariela Noy
    205 Noy
  5. Maria Lia Palomba
    121 Palomba
  6. Steven M Horwitz
    351 Horwitz
  7. Heiko Schoder
    285 Schoder
  8. Andrew D Zelenetz
    550 Zelenetz
  9. Stephen D Nimer
    342 Nimer
  10. Miguel-Angel Perales
    365 Perales
  11. Alison Moskowitz
    141 Moskowitz
  12. Paul Hamlin
    170 Hamlin
  13. Matthew J Matasar
    119 Matasar
  14. David J Straus
    205 Straus