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.
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).