Abstract
Hodgkin lymphoma (HL) is a hematological malignancy with an excellent prognosis. However, we still need to identify those patients that could experience failed standard frontline chemotherapy. Tumor burden evaluation and standard decisions are based on Ann Arbor (AA) staging, but this approach may be insufficient in predicting outcomes. We aim to study new ways to assess tumor burden through volume-based PET parameters to improve the risk assessment of HL patients. We retrospectively analyzed 101 patients with HL from two hospitals in the Balearic Islands between 2011 and 2018. Higher metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were significantly associated with a higher incidence of III-IV AA stages, B-symptoms, hypoalbuminemia, lymphopenia, and higher IPS. Standardized uptake value (SUVmax) was significantly related to AA stage and hypoalbuminemia. We found that TLG or the combination of SUVmax, TLG, and MTV significantly improved the risk assessment when compared to AA staging. We conclude that TLG is the best single PET/CT-related tumor-load parameter that significantly improves HL risk assessment when compared to AA staging. If confirmed in a larger and validated sample, this information could be used to modify standard frontline therapy and justifies the inclusion of TLG inside an HL prognostic score.
Highlights
Hodgkin lymphoma (HL) is a hematological malignancy formed by malignant cells, so-called Reed–Sternberg cells (RSC), surrounded by an inflammatory microenvironment of reactive cells
In general, radiotherapy is administered to the following cases: patients with I-II Ann Arbor (AA) stages without risk factors ((European Organization for Research and Treatment of Cancer (EORTC) or German Hodgkin Score Group (GHSG) < 1)) with low risk of toxicity in the involved area might choose between 2 cycles of ABVD plus radiotherapy or 4 cycles of ABVD; patients with I–II AA stages with risk factors of EORTC or GHSG might choose between 4 cycles of ABVD plus radiotherapy or 6 cycles of ABVD; patients with III–IV stages received radiotherapy only if localized partial response (PR) in the interim or final PET/computed tomography (CT)
A total number of 101 patients with classic HL homogeneously treated with ABVD +/− RT were retrospectively analyzed at the time of diagnosis at Son Espases (n = 61) and Son Llatzer (n = 40) University Hospitals in Palma de Mallorca between August 2011 to November 2018
Summary
Hodgkin lymphoma (HL) is a hematological malignancy formed by malignant cells, so-called Reed–Sternberg cells (RSC), surrounded by an inflammatory microenvironment of reactive cells. The standard tool to assess disease burden is the Ann Arbor (AA) staging that classically categorizes HL in I to IV stages, considering the number of affected lymph nodes and/or extranodal sites and their location related to diaphragm as well as the presence or absence of B symptoms [1]. New ways to assess tumor burden, such as baseline fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT), detect active disease with higher sensitivity in comparison with computed tomography (CT) [2,4]. Standardized uptake value (SUV) is the most frequent semiquantitative PET metric used for measuring tumor glucose metabolism. It is defined as the ratio of the decay-corrected FDG concentration in a volume of interest (VOI) to the injected dose normalized to the patient’s body weight. SUVmax is defined as the maximum value of SUV in a VOI representing the highest metabolism in the tumor, and it is commonly used in response criteria in PET scans after treatment in oncology [5]
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