In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 30, No. 15_suppl ( 2012-05-20), p. 8046-8046
Abstract:
8046 Background: The high prognostic value of FDG-PET/CT performed after 2 cycles of chemotherapy for HIV negative Hodgkin lymphoma (HL) is well known. However, experience with PET in HIV-related HL needs to be further studied as nodal FDG uptake can be observed in various opportunistic infections and AIDS-related conditions. Methods: A total of 45 consecutive HL patients (pts) were enrolled in 10 centers from the GECAT. There were 42 males and 3 females. Median age was 46 yo, range [26;64]. Median CD4 count was 391/mm 3 , range [33;1191]. Viral load was negative in 38 pts (84%) and uncontrolled in 5 pts (11%). Forthy three pts (96%) received concomitant HAART. HL was staged III-IV in 25 pts. International Prognostic Index scored 3-5 in 24 pts. All PET studies were performed after 2 ABVD cycles. They were scored, blinded to treatment outcome, according to the 5-point Deauville visual scale. It was considered as negative when scored 1-3 (i.e tumor FDG uptake less or equal than liver uptake) and positive when scored 4-5 (i.e. more than liver uptake or new lesions). Chemotherapy was not modified : 4-8 cycles of ABVD, as initially planned. Results: Overall, 35 pts (78%) achieved a CR after the end of treatment. Three pts received Involved Field Radiation Therapy. At a median follow-up of 18 months, 3 pts relapsed and 2 of them died from HL. The 2 yr OS and PFS were estimated at 94 and 90%, respectively. PET after 2 cycles of ABVD was negative in 40 pts (89%) and positive in 5 pts (11%). Patients with negative PET had a significantly better outcome than those with positive PET in term of 2 yr PFS (94% vs 60%, P=0.005), and 2 yr OS (100% vs 60%, P=0.0002). The negative predictive value was estimated at 97% and specificity at 93%. All patients who were PET-negative after the 2nd cycle stayed PET-negative after the 4th cycle and entered a durable CR. Conclusions: This largest study in HIV-positive HL showed that interim PET could play a central role in driving risk-tailored treatment. In further studies, de-escalation strategies should be tested for patients responding after 2 cycles of ABVD and those not reponding should be managed with intensive salvage strategies.
Type of Medium:
Online Resource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/jco.2012.30.15_suppl.8046
Language:
English
Publisher:
American Society of Clinical Oncology (ASCO)
Publication Date:
2012
detail.hit.zdb_id:
2005181-5
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