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" |