Pre-transplant FDG-PET-based survival model in relapsed and refractory Hodgkin's lymphoma: outcome after high-dose chemotherapy and auto-SCT

S Akhtar, AS Al-Sugair, M Abouzied, Y Alkadhi… - Bone marrow …, 2013 - nature.com
S Akhtar, AS Al-Sugair, M Abouzied, Y Alkadhi, M Dingle, M Abdelsalam, H Soudy
Bone marrow transplantation, 2013nature.com
Hodgkin's lymphoma (HL) patients with positive 18 F-fluorodeoxyglucose positron emission
tomography (FDG-PET) post salvage chemotherapy or before high-dose chemotherapy and
auto-SCT (HDC ASCT) have inferior outcomes. We reviewed 21 prognostic factors before
salvage chemotherapy (at relapse/progression) and integrated post salvage FDG-PET
results to develop a prognostic model for post HDC ASCT outcome. We used Fine and Gray
method for competing risk analysis and regression model for risks assessment and outcome …
Abstract
Hodgkin’s lymphoma (HL) patients with positive 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) post salvage chemotherapy or before high-dose chemotherapy and auto-SCT (HDC ASCT) have inferior outcomes. We reviewed 21 prognostic factors before salvage chemotherapy (at relapse/progression) and integrated post salvage FDG-PET results to develop a prognostic model for post HDC ASCT outcome. We used Fine and Gray method for competing risk analysis and regression model for risks assessment and outcome. One hundred and forty-one patients had post salvage FDG-PET before HDC ASCT (median age 25.5 years); male/female 55%: 45%, relapsed/refractory 43%: 57%, median follow-up 33 months. Multivariate analysis identified HL International Prognostic Score⩾ 3 (P= 0.001; hazard ratio (HR): 3.7 (1.6–8.3)) and post salvage positive FDG-PET (P= 0.011; HR: 3.4 (1.3–8.9)) with higher hazard of disease-specific death (model P= 0.0001). Cumulative incidence of disease-specific death with 0, 1, 2 risk factors was 7%: 29%: 52%, respectively (P= 0.00003). For disease-specific event (persistent, progressive or relapsed disease), mediastinal involvement (P= 0.024; HR: 2.7 (1.14–6.5)), B symptoms (P= 0.027; HR: 2.1 (1.09–4.2)) and positive post salvage FDG-PET (P= 0.001; HR: 3.3 (1.7–6.7)) were significant (model P=< 0.00001). Cumulative incidence of disease-specific event with 0, 1, 2, 3 risk factors was 8%: 31%: 50%: 75%, respectively (P= 0.0000006). Patients with higher scores have higher risk of treatment failure. They are potential candidates for newer therapies along with HDC ASCT.
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