Abstract
Genome sharing between cancer and normal tissues might imply a similar susceptibility to chemotherapy toxicity. The present study aimed to investigate whether curative potential of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) is predicted by the metabolic response of normal tissues in patients with Hodgkin lymphoma (HL). METHODS: According to current guidelines, 86 patients with advanced-stage (IIB-IVB) HL, prospectively enrolled in the HD0607 trial (NCT00795613), underwent 18 F-fluorodeoyglucose PET/CT imaging at diagnosis and, at interim, after two ABVD courses, to decide regimen maintenance or its escalation. In both scans, myocardial FDG uptake was binarized according to its median value. Death and disease relapse were recorded to estimate progression-free survival (PFS) during a follow-up with median duration of 43.8 months (range 6.97–60). RESULTS: Four patients (4.6%) died, while six experienced disease relapse (7%). Complete switch-off of cancer lesions and cardiac lighting predicted a favorable outcome at Kaplan–Mayer analyses. The independent nature and additive predictive value of their risk prediction were confirmed by the multivariate Cox regression analysis. CONCLUSION: Susceptibility of HL lesions to chemotherapy is at least partially determined by factors featuring the host who developed it.
Highlights
Among the 782 subjects included in the original database, we selected the datasets of the 86 patients with image format compatible with the software used for analysis
The present data indicate that cardiac metabolic response to the first two ABVD courses predicted the anticancer effect of chemotherapy and stratified the five-year risk for the combined endpoint in Hodgkin lymphoma (HL) patients
Risk was predicted by a divergent response of FDG uptake in these two districts: favorable outcome was anticipated by the tumor switch-off as opposed to myocardial lighting
Summary
PET/CT criteria utilized for therapeutic decision are obviously focused on the response of number, size, and metabolic activity of lymphoma lesions This standardized procedure intrinsically allows the evaluation of chemotherapy effect on normal tissues, and on the heart [6]. The relevance of this assessment has been confirmed by the evidence that cardiac FDG uptake increases at interim PET in more than one half of HL patients and predicts the subsequent risk of developing cardiotoxicity [7,8]. It might indicate the susceptibility of any given patient to ABVD toxicity
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