Interim [¹⁸F]fluorodeoxyglucose positron emission tomography imaging in stage I–II non-bulky Hodgkin lymphoma: would using combined positron emission tomography and computed tomography criteria better predict response than each test alone?

Abstract

Our objective was to validate the International Harmonization Project (IHP) positron emission tomography (PET) response criteria and correlate with the Deauville criteria and diagnostic computed tomography-based (dCT) lesion size changes. All patients were recruited prospectively to the Cancer and Leukemia Group B (CALGB) 50203 trial for the treatment of stage I–II, non-bulky Hodgkin lymphoma (HL). [¹⁸F]Fluorodeoxyglucose (FDG) PET and dCT were performed at baseline and after two doxorubicin, vinblastine and gemcitabine (AVG) cycles (PET-2, dCT-2) in 88 patients. IHP and Deauville criteria and percent decrease in the sum of the products of the perpendicular diameters (%SPPD) after two cycles were correlated with progression-free survival (PFS). After a median follow-up of 3.3 years, 23.9% of patients relapsed/progressed (3-year PFS 77%). By IHP, the 2-year PFS was 88% and 54% for PET-2 negative and positive groups, respectively (p = 0.0009). Similar results were obtained for Deauville criteria. In a univariate analysis, PET-2 predicted PFS better than %SPPD, and in a combinatorial analysis, in the PET-2 positive group, a negative dCT-2 increased PFS by 27–35%. However, some confidence intervals were large due to small sample sizes. In conclusion, IHP and Deauville criteria-based interpretation of PET-2 was strongly associated with 2-year PFS. The combined analysis of PET-2 with dCT-2 suggested a better predictive value for PFS compared to either test alone. Further studies are under way to confirm these findings.

Keywords::

• Lymphoma and Hodgkin disease
• therapy response
• interim PET/CT

Acknowledgements

This study was supported by the CALGB (National Cancer Institute) with partial support from Eli Lilly and Company.

The research for CALGB 50203 was supported, in part, by grants from the National Cancer Institute (CA31946) to the Cancer and Leukemia Group B (Monica M. Bertagnolli, MD, Chair) and to the CALGB Statistical Center (Daniel Sargent, PhD). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute.

The study was also supported by the following grants from the National Cancer Institute: CA04457 to Mount Sinai School of Medicine (L.K.); CA77651 to Memorial Sloan-Kettering Cancer Center (H.S., D.J.S); CA33601 to CALGB Statistical Center, Duke University Medical Center (J.L.J., S.-H.J.); CA77658 to The Ohio State University Medical Center (N.C.H.); CA32291 to Dana-Farber/Partners Cancer Care (A.S.L., G.P.C.); CA77440 to Washington University School of Medicine (N.L.B.); CA77597 to Georgetown University Hospital (B.D.C).

Dr. Straus acknowledges partial support of the Lymphoma Foundation, Adam Spector Fund for Hodgkin's Research and The Ernest & Jeanette Dicker Charitable Foundation.

The following institutions participated in this study:

Christiana Care Health Services, Inc., CCOP, Wilmington, DE – Stephen Grubbs, MD, supported by CA45418; Dana-Farber Cancer Institute, Boston, MA – Harold J. Burstein, MD, PhD, supported by CA32291; Georgetown University Medical Center, Washington, DC – Minetta C. Liu, MD, supported by CA77597; Cancer Centers of the Carolinas, Greenville, SC – Jeffrey K. Giguere, MD, supported by CA29165; Hematology-Oncology Associates of Central New York, CCOP, Syracuse, NY – Jeffrey Kirshner, MD, supported by CA45389; Kansas City Community Clinical Oncology Program, CCOP, Kansas City, MO – Rakesh Gaur, MD; Massachusetts General Hospital, Boston, MA – Jeffrey W. Clark, MD, supported by CA32291; Memorial Sloan-Kettering Cancer Center, New York, NY – Clifford A. Hudis, MD, supported by CA77651; Northern Indiana Cancer Research Consortium, CCOP, South Bend, IN – Rafat Ansari, MD, supported by CA86726; Roswell Park Cancer Institute, Buffalo, NY – Ellis Levine, MD, supported by CA59518; Southeast Cancer Control Consortium, Inc., CCOP, Goldsboro, NC – James N. Atkins, MD, supported by CA45808; State University of New York Upstate Medical University, Syracuse, NY – Stephen L. Graziano, MD, supported by CA21060; The Ohio State University Medical Center, Columbus, OH – Clara D. Bloomfield, MD, supported by CA77658; University of California at San Francisco, San Francisco, CA – Charles J. Ryan, MD, supported by CA60138; University of Chicago, Chicago, IL – Hedy L. Kindler, MD, supported by CA41287; University of Iowa, Iowa City, IA – Daniel A. Vaena, MD, supported by CA47642; University of Maryland Greenebaum Cancer Center, Baltimore, MD – Martin Edelman, MD, supported by CA31983; University of Nebraska Medical Center, Omaha, NE – Anne Kessinger, MD, supported by CA77298; University of North Carolina at Chapel Hill, Chapel Hill, NC – Thomas C. Shea, MD, supported by CA47559; University of Vermont, Burlington, VT – Steven M. Grunberg, MD, supported by CA77406; Wake Forest University School of Medicine, Winston-Salem, NC – David D. Hurd, MD, supported by CA03927; Walter Reed Army Medical Center, Washington, DC – Brendan M. Weiss, MD, supported by CA26806; Washington University School of Medicine, St. Louis, MO – Nancy Bartlett, MD, supported by CA77440; Weill Medical College of Cornell University, New York, NY – John Leonard, MD, supported by CA07968.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article at www.informahealthcare.com/lal.