Abstract
Early response evaluation with [18F]fluordeoxyglucose (FDG) positron emission tomography after 2 cycles of chemotherapy (interim PET) has been indicated as the strongest predictor for outcome in classical Hodgkin lymphoma (HL). We studied the prognostic role of the number of tumor‐infiltrating CD68+ cells and of the plasma levels of TARC (thymus and activation‐regulated chemokine) in the context of interim PET in 102 patients with classical HL treated with Adriamycin, Bleomycin, Vinblastine, Dacarbazine (ABVD). After 2 ABVD cycles, interim PET according to Deauville criteria was negative (score 0–3) in 85 patients and positive (score 4–5) in 15 patients (2 patients technically not evaluable). TARC levels were elevated in 89% of patients at diagnosis, and decreased after 2 cycles in 82% of patients. Persistently elevated TARC levels in 18% of patients were significantly associated with a positive PET result (P = 0.007). Strong predictors for progression‐free survival (PFS) were a negative interim PET (85% vs. 28%, P < 0.0001) and CD68+ cell counts <5% (89% vs. 67%, P = 0.006), while TARC levels at diagnosis and at interim evaluation had no prognostic role. In multivariate analysis, interim PET, CD68+ cell counts and presence of B‐symptoms were independently associated with PFS. We conclude that although TARC levels are a biomarker for early response evaluation, they cannot substitute for interim PET as outcome predictor in HL. The evaluation of CD68 counts and B‐symptoms at diagnosis may help to identify low‐risk patients regardless positive interim PET.
Highlights
The great majority of patients with Hodgkin lymphoma (HL) can be cured with chemotherapy or a combination of chemo and radiotherapy
We studied the prognostic role of the number of tumor-infiltrating CD68+ cells and of the plasma levels of thymus and activation- regulated chemokine (TARC) in the context of interim p ositron emission tomography (PET) in 102 patients with classical HL treated with Adriamycin, Bleomycin, Vinblastine, Dacarbazine (ABVD)
TARC levels decreased at interim PET in 57 patients, but persisted elevated (>162 U/mL) in 12 patients (18%) (Fig. 2)
Summary
The great majority of patients with Hodgkin lymphoma (HL) can be cured with chemotherapy or a combination of chemo and radiotherapy. There is, a proportion of patients, in particular those presenting with advanced stage disease, who will succumb to the disease [1]. Balancing the aggressiveness of treatment between disease control and risk of short-and long-term toxicity remains a challenge for treatment decisions in HL [2]. Aggressive treatment of advanced stage disease using the BEACOPP regimen has certainly improved disease-free survival, at the cost of infertility and risk of secondary organ damage and neoplasias [3,4,5,6,7]. CD68, TARC and PET in Hodgkin Lymphoma Classical clinical and laboratory risk factors at diagnosis appear to be of little help for treatment decisions in patients with advanced HL [8, 9].
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