Negative imaging after first-cycle chemotherapy predicts favorable outcome in Hodgkin’s Lymphoma

1. A negative FDG-PET/CT following one cycle of chemotherapy for Hodgkin’s lymphoma was strongly predictive of patients with more favorable outcomes.                                                               

Evidence Rating Level:  2 (Good) 

Study Rundown: Although the long-term survival rate for Hodgkin’s Lymphoma is high, chemotherapy treatment is associated with multiple cardiac and pulmonary morbidities, as well as secondary malignancies. Identification of patients who may benefit from adapted regimens to avoid unnecessary or ineffective treatment is an area of active research. Previous trials have demonstrated FDG-PET/CT following second and third chemotherapy cycles as potential prognostic factors. The purpose of this study was to evaluate the prognostic value of FDG-PET/CT following one cycle of chemotherapy.

At the conclusion of this prospective study, the authors found that patients with negative findings on PET scans following the first cycle of chemotherapy (PET1) had significantly increased progression free and overall survival compared to those with positive findings after PET1. PET1 demonstrated a higher negative predictive value and lower positive predictive value for progression free survival and end of treatment response. Based off these results, the authors suggested that negative FDG-PET following the first cycle of chemotherapy may help select patients for less intensive chemotherapy. It should be noted that this was an observational study, with further evaluation required before implementing its conclusions.

Click to read the study in JCO

Relevant Reading: Prognostic value of interim FDG-PET after two or three cycles of chemotherapy in Hodgkin lymphoma

In-Depth [prospective cohort]: This study was a prospective, multicenter, observational trial of 126 patients with Hodgkin’s Lymphoma. All patients underwent a PET/CT scan after one cycle of chemotherapy (PET1), while 89 underwent additional scanning after the second round (PET2). All scans were interpreted by two blinded, independent reviewers. The primary outcomes were progression-free survival, overall survival, and end of treatment response. Two year PFS for PET1 negative and positive patients was 94.1% and 40.8%, respectively. No PET1-negative patient was PET2 positive. The negative predictive values for PET1 and PET2 were 98.4% and 90.8% and the positive predictive values were 63.0% and 84.6%, respectively.

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Image: PD 

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