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Hodgkin lymphoma: the clinical value of postchemotherapy PET scores

A positive PET scan does not carry uniform prognostic weight in Hodgkin's lymphoma (HL), suggest results from the National Cancer Research Institute’s Randomised Phase III Trial to Determine the Role of FDG-PET Imaging in Clinical Stages IA/IIA Hodgkin’s Disease (RAPID) study.

A new analysis of the study data, published in the Journal of Clinical Oncology, suggests only patients with a postchemotherapy PET score of 5 have an increased risk of disease progression or HL-specific death.

In RAPID, patients aged 16-75 years with newly diagnosed, histologically confirmed stage IA to IIA HL and no mediastinal bulk underwent PET assessment after three cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). A PET score of 5 was defined as ≥3 times the maximum liver uptake, and uptake greater than the mediastinum was considered to represent a positive PET result.

High PET score was shown to be associated with inferior event-free survival (EFS), before (P<0.001) and after adjustment (P=0.01) for baseline risk stratification.

Only patients with a postchemotherapy PET score of 5 had an increased risk of progression or HL-related death. Patients with a PET score of 5 also had inferior progression-free and overall survival.

There was no association between European Organisation for Research and Treatment of Cancer or German Hodgkin Study Group risk group and EFS, before or after adjusting for PET score (all P>0.4). Based on the findings, the authors advise that future trials involving HL patients without B symptoms or mediastinal bulk should use a PET score of 5 rather than a positive PET result to guide treatment escalation in early-stage HL.


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