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Publication Details

Title :

Interim Functional Imaging Is an Independent Predictor of Progression-free Survival in Advanced Classical Hodgkin Lymphoma – A Real-world Analysis

Journal:

Clin Lymphoma Myeloma Leuk.

Impact Factor:

2.308

Authors:

Damlaj M1, Al-Zahrani M2, Syed G3, Gmati G2, Alahmari B4, Pasha T5, Alhejazi A2, Alaskar A2.

Affiliations:

1 Division of Hematology & HCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia. Electronic address: damlajmo@ngha.med.sa.

2 Division of Hematology & HCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.

3 Department of Medical Imaging, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.

4 Division of Hematology & HCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center.

5 Division of Hematology & HCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.

Year of Publication:

2019

DOI:

10.1016/j.clml.2018.08.013

Abstract:

BACKGROUND:
Response-adapted therapy in advanced classical Hodgkin lymphoma (cHL) using interim functional imaging (IFI) is under active investigation.

PATIENTS AND METHODS:
We retrospectively examined patients with advanced cHL receiving 2 front-line regimens stratified by IFI results at our institution. Time to endpoint analysis was estimated using the method of Kaplan-Meier with log ranks. Cox regression modeling was computed for multivariable analysis.

RESULTS:
A total of 124 patients with advanced cHL with a median follow up of 40.9 months were included. A total of 84 (67.7%) received ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), whereas the remaining 40 (32.3%) received ABVD/eBEACOPP (escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone). A positive IFI was seen in 36 (29%) patients. The corresponding 3-year progression free survival (PFS) stratified by IFI was 81.7% (95% confidence interval [CI], 70.1%-88.8%) versus 48.3% (95% CI, 30.4%-64.1%) (P < .0001) for patients with negative or positive scan, respectively. Escalation to eBEACOPP from ABVD following a positive IFI resulted in a significantly higher 3-year PFS at 58.7% (95% CI, 0.3-0.79) versus 39.7% (95% CI, 0.18-0.61) respectively (P = .00015). Overall survival (OS) was similar across the groups (P = .44) irrespective of therapy received. At multivariable analysis, IFI was the only predictor of PFS with a hazard ratio of 4.6 (95% CI, 1.9-10.8; P = .0008) whereas therapy escalation had a hazard ratio of 0.66 (95% CI, 0.14-3.4; P = .62).

CONCLUSION:
IFI is an independent predictor of PFS in advanced cHL and can guide therapeutic decisions in the real world. Given the inferior outcome seen in patients with a positive IFI, novel approaches of therapy are warranted.