The presence of a bulky mediastinal mass of 7 cm or greater in diameter confers an adverse prognosis to patients with advanced Hodgkin lymphoma in case of negative interim PET/CT

Abstract

In the PET-adapted therapy era, a bulky mediastinal mass (BMM) is not considered a risk factor in patients with advanced-stage Hodgkin lymphoma (HL). The current retrospective study aimed to estimate the prognostic significance of BMM presence and size for disease-free survival (DFS) and determine the most accurate mass size cutoff (among 5 cm, 7 cm, 10 cm) to predict inferior DFS in such patients. The study included 196 advanced-HL patients treated at Rambam (n = 121) and Memorial Sloan Kettering Cancer Center (n = 75) between 2002 and 2016. At a median follow-up of 66.5 (1–222) months, 36 relapses occurred. In multivariate analysis, only the cutoff of 7 cm predicted inferior DFS and PFS (p < 0.007 and <0.038, respectively) in interim PET/CT (PET-2) negative (79%) patients. This study identifies the BMM size cutoff of 7 cm in any plane as most precise in predicting adverse prognosis in PET-2-negative patients with advanced-stage HL. More aggressive initial chemotherapy than ABVD improves such prognosis.

Keywords:

• Advanced-stage Hodgkin lymphoma
• interim PET/CT (PET-2)
• a bulky mediastinal mass
• disease-free survival

Acknowledgements

The authors would like to thank Elinor Barzilai for devoted data management and Sonia Kamenetsky for her devoted secretarial support.

Author contributions

R.L.-A.: performed research, interpreted the data, wrote the paper, approved the final version of the paper.

S.Q.: performed research, approved the final version of the paper.

T.M.: performed statistical analysis, approved the final version of the paper.

M.W.-S.: performed research, approved the final version of the paper.

J.Y.: performed research, approved the final version of the paper.

E.J.D.: designed and performed research, interpreted the data, wrote the paper, approved the final version of the paper.

Disclosure statement

No potential conflict of interest was reported by the author(s).