Adaptation Strategies In Response Research Articles

Farm adaptive business strategies in crisis management: COVID-19

The global COVID-19 pandemic significantly impacted businesses worldwide, with rural businesses being no exception. This study examines the effects of the global crisis on upland farmers in England. It builds on the under-researched area of constrained rural entrepreneurship. Institutional theory is applied as a theoretical lens to understand how crisis events shape the constrained institutional contexts in which farm businesses strategically navigate. Using a qualitative, multiple case study approach, we explore how different farmers, traditionalist and entrepreneurial, have strategically responded to the aftermath of crisis-influenced constraints. Our findings highlight the importance of business strategy—particularly farm diversification—in helping farmers navigate these challenges. We provide a conceptual framework, the Farm Crisis Adaptation Framework, (FCAF) that theorizes farmer adaptation strategies in response to crisis situations. Our findings indicate a greater needed for rural policymakers to help develop the strategic entrepreneurship skillsets of farmers—helping farmers to future-proof their businesses against uncertainties. Moreover, investment is needed in the local and regional economy, establishing a conducive environment supportive of farm development strategies.

The current landscape of frontline large B-cell lymphoma trials.

At least 25-35% of patients with large B cell lymphoma (LBCL) are not cured with frontline treatment, with generally poor subsequent outcomes. This motivates ongoing and intense interest in improving the frontline treatment of this disease. R-CHOP has remained the standard of care for 20 years despite dozens of trials aiming to improve upon this regimen, and only recently has a novel regimen (Pola-R-CHP) challenged its supremacy. Fortunately, at least 15 promising randomized trials evaluating new treatments in frontline LBCL treatment are underway. They differ not only in the therapy evaluated in the experimental arm, but in the choice of control arm, primary endpoint, and patient selection strategy, with some targeting specific biologic subtypes, some focusing on specific high-risk patient populations, and others enrolling older or frail patients. Novel response-adapted strategies leveraging circulating tumor DNA are also underway. While this variety of approaches provides a welcome increase in the overall likelihood of success, it will also present challenges if several of these trials are successful and we must choose among multiple potential treatment options that were not all tested in the same fashion. In this review, we summarize the main ongoing frontline randomized trials and discuss some of the questions that we will face in interpreting and applying their results in clinical practice in the next few years.

Analisa Strategis Kesiapan Operasional TNI Angkatan Laut dalam Menghadapi Dinamika Lingkungan Maritim

Indonesia, as the largest archipelagic nation globally, faces significant strategic challenges in its maritime domain. The Indonesian Navy's preparedness is paramount in safeguarding the nation's interests amid evolving geopolitical dynamics, resource competition, and maritime security threats such as piracy and terrorism. This paper examines the role and importance of the Operational Ready Force (ORF) within Indonesia's maritime defence strategy. By employing strategic analysis, the study evaluates the Navy's operational readiness, focusing on resource allocation, technological advancements, and international cooperation necessary to enhance the ORF's effectiveness. The research utilizes a comprehensive methodology, including literature review, official documents, and expert interviews, to provide an in-depth understanding of the Indonesian Navy's readiness to address dynamic maritime environments. The paper also explores the strategic implications of global, regional, and national maritime developments, emphasizing the necessity for an adaptive and resilient maritime strategy. The findings suggest that ORF is crucial in bolstering the Indonesian Navy's capabilities, enabling rapid and effective responses to maritime threats while protecting national sovereignty. The study concludes with recommendations for further development of ORF, ensuring Indonesia's continued maritime security and regional stability through integrated technology, strengthened international collaboration, and adaptive threat response strategies.

3490: Risk-adapted and response-adapted strategies for stage 3 NSCLC

3490: Risk-adapted and response-adapted strategies for stage 3 NSCLC

Assessing the impact of Land Use Land Cover changes on land surface temperature over Kigali, Rwanda in the past three decades

Land use changes and urban activities cause environmental degradation and climate change. This study aims to assess the impacts of Land Use Land Cover (LULC) changes on land surface temperature (LST) in Kigali, Rwanda over the past three decades. The combined techniques of remote sensing and GIS were applied to generate good quality Landsat images, categorize land use classes and retrieve urban indices. The modified Mann-Kendall test and Sen’s slope estimator were used to analyze trends in LST. The results indicate that between 1990 and 2020, the extent of builtup and forest areas have increased at an average rate of 3.39 km2/year and 2.42 km2/year respectively, while open land has decreased at an average rate of 5.81 km2/year. In the same period, water bodies and wetlands showed minimal changes with an increase of 1.56 km2 and a decrease of 1.66 km2 for water bodies and wetlands respectively. The slope magnitudes of LST are predominantly positive (p ≤ 0.05) with a high increase observed in dry seasons (0.51 °C per decade for Tmin in JJA and 0.49 °C per decade for Tmax in JF). The positive correlations between LST and urban indices were observed in all studied subregions (all values are above 0.61, p ≤ 0.05). The findings of this study are useful for the development of future urban land use schemes and the adoption of mitigation and adaptation strategies in response to climate change.

Type 2 diabetes: a sacrifice program handling energy surplus

Abstract Type 2 diabetes mellitus (T2DM) is closely associated with obesity, while interactions between the two diseases remain to be fully elucidated. To this point, we offer this perspective to introduce a set of new insights into the interpretation of T2DM spanning the etiology, pathogenesis, and treatment approaches. These include a definition of T2DM as an energy surplus-induced diabetes characterized by the gradual decline of β cell insulin secretion function, which ultimately aims to prevent the onset of severe obesity through mechanisms of weight loss. The body employs three adaptive strategies in response to energy surplus: the first one is adipose tissue expansion to store the energy for weight gain under normal weight conditions; the second one is insulin resistance to slow down adipose tissue expansion and weight gain under overweight conditions; and the third one is the onset of T2DM following β cell failure to reverse the weight gain in obese conditions. The primary signaling molecules driving the compensatory responses are adenosine derivatives, such as adenosine triphosphate (ATP), acetyl coenzyme A (acetyl-CoA), and reduced nicotinamide adenine dinucleotide (NADH). These molecules exert their effects through allosteric, post-translational, and transcriptional regulation of metabolic pathways. The insights suggest that insulin resistance and T2DM are protective mechanisms in the defense against excessive adiposity to avert severe obesity. The perspective provides a unified framework explaining the interactions between the two diseases and opens new avenues in the study of T2DM.

Insights from local government managers: Navigating crises through organizational capacities and perceptions

AbstractRecent years have shown that strategic responses to crises by local governments (LGs) depend on the type of crisis, the institutional environment, but also internal capacities and sensemaking processes. However, such relationships have not been tested widely yet. Based on a survey of managers (n = 590) from cities with more than 15,000 inhabitants in France, Germany, Italy, and the United Kingdom, this study explores the role played by specific organizational capacities (critical thinking, bricolage, and financial capacities) and crisis perceptions (valence—i.e., threat vs. opportunity; and controllability) in shaping adaptive or regressive response strategies. Results show that these capacities are associated with how LGs' managers perceive crises and the type of responses adopted. Higher financial capacity, bricolage, and critical thinking are associated with stronger sense of organizational controllability, but they have different relationships with threat and opportunity perceptions. The study confirms the importance of distinguishing valence (threat and opportunity) from controllability perceptions.

Nonlinear impacts of climate anomalies on oil palm productivity

Oil palm contributes to various global needs as one of the most productive oil crops, but there exist ongoing concerns regarding its yield reductions and associated environmental impacts resulting from land conversion. This is the first detailed report investigating the nonlinear threats to estate-level oil palm yields posed by El Niño Southern Oscillation (ENSO) in the equatorial Pacific Ocean, a major driver of climate variability. Using the Malaysian Palm Oil Board administrative records on monthly performances reported by oil palm estates through the e-submissions portal spanning from January 2015 to June 2023, we focused on elucidating the impacts of ENSO on fresh fruit bunch yield, oil extraction rate, and oil yield. We found that both El Niño and La Niña conditions, characterized by extreme levels of ENSO indices cumulated over lags of 0–23 months prior to harvest, were associated with statistically significant reductions in yields. Lag association patterns unveiled that production risks were linked to pre-harvest exposure to extreme ENSO indices in various time windows. Subgroup analyses further revealed that the effects were pronounced in labor-intensive estates and those lacking fertilizer investments. This study underscores the necessity for adaptation strategies in response to future climate anomalies.

Water-suitable reclamation can mitigate the amplified agricultural water stress driven by climate change in arid inland basin

The escalation of water scarcity poses a significant challenge to the sustainability of irrigated agriculture in arid regions, with climate change further amplifying the unpredictability of water resources for agricultural purposes. Despite the critical nature of this issue, there is a lack of research identifying effective adaptation strategies and establishing water-suitable thresholds for agricultural development. This study modified a conventional approach for estimating irrigation water use (IWU) in the Heihe agricultural area of Northwest China, integrating the distributed hydrological components of the Soil and Water Assessment Tool (SWAT) model. It modeled IWU and surface water availability across three representative concentration pathways (RCPs) and conducted an extensive analysis of agricultural water scarcity for the period 2021–2050. The study established threshold levels for water-suitable agricultural development based on predicted local water resource conditions. Findings suggested a trend towards warmer and wetter conditions in the Heihe agricultural area over the next three decades. The anticipated average IWU, predicted by five general circulation models (GCMs), was expected to reach 26.785 × 108 m3 (RCP2.6), 26.827 × 108 m3 (RCP4.5), and 26.865 × 108 m3 (RCP8.5). These projections indicated an increase of 0.815 × 108 m3, 0.857 × 108 m3, and 0.895 × 108 m3, respectively, in comparison to the historical period spanning from 1985 to 2014. Streamflow was anticipated to diminish by 0.28 × 108 m3 (RCP2.6), 0.46 × 108 m3 (RCP4.5), and 0.23 × 108 m3 (RCP8.5). The predicted agricultural water scarcity index (WSI) was 1.764 (RCP2.6), 1.789 (RCP4.5), and 1.763 (RCP8.5), indicating a worsening of agricultural water use shortages due to climate change. The study identified controlling the scale of cultivation as the most effective adaptation strategy, recommending that water-suitable agricultural reclamation in the Heihe agricultural area be confined to 25 × 104 ha. This research offers a comprehensive assessment of future water security in an arid inland basin, providing valuable insights into the sustainable development of global irrigated agriculture and adaptation strategies in response to climate change.

Application of Shannon Entropy in Assessing Changes in Precipitation Conditions and Temperature Based on Long-Term Sequences Using the Bootstrap Method

This study delves into the application of Shannon entropy to analyze the long-term variability in climate data, specifically focusing on precipitation and temperature. By employing data from 1901 to 2010 across 377 catchments worldwide, we investigated the dynamics of climate variables using the generalized extreme value (GEV) distribution and Shannon entropy measures. The methodology hinged on the robust bootstrap technique to accommodate the inherent uncertainties in climatic data, enhancing the reliability of our entropy estimates. Our analysis revealed significant trends in entropy values, suggesting variations in the unpredictability and complexity of climate behavior over the past century. These trends were critically assessed using non-parametric tests to discern the underlying patterns and potential shifts in climate extremes. The results underscore the profound implications of entropy trends in understanding climate variability and aiding the prediction of future climatic conditions. This research not only confirms the utility of Shannon entropy in climatological studies but also highlights its potential in enhancing our understanding of complex and chaotic climate systems. The study’s findings are vital for developing adaptive strategies in response to the evolving nature of climate extremes, thus contributing to more informed decision-making in environmental management and policy formulation.

Response-Adapted Ultralow-Dose Radiation Therapy for Orbital Indolent B-Cell Lymphoma

Radiation therapy to doses of 24 to 36 Gy is currently used to treat indolent B-cell lymphoma of the ocular adnexa; however, ocular adverse effects are common. To determine if a response-adapted radiation therapy strategy will result in excellent disease outcomes while reducing orbital morbidity. This single-institution, phase 2 prospective nonrandomized controlled trial of a response-adapted strategy involved 50 evaluable patients with stage I to IV indolent B-cell lymphoma of the ocular adnexa enrolled between July 2015 and January 2021. This treatment approach was also retrospectively evaluated with a separate 55-patient cohort treated between March 2013 and October 2021. All data were analyzed between November 2021 and December 2023. Patients were treated with ultralow-dose radiation therapy to 4 Gy in 2 fractions and assessed for response at 3-month intervals. Patients with persistent orbital lymphoma were offered an additional 20 Gy in 10 fractions to complete the response-adapted treatment. The primary end point was 2-year local orbital control within the irradiated field after response-adapted therapy. Secondary end points included overall survival and complete response rate. The 50 prospective patients were a median (range) of 63 (29-88) years old, and 31 (62%) were female. Among the 50 patients, 32 (64%) had mucosa-associated lymphoid tissue lymphoma, 12 (24%) had follicular lymphoma, and 6 (12%) had unclassifiable low-grade B-cell lymphoma. Thirty-one patients (62%) had stage I disease, and 36 (72%) were newly diagnosed. At a median follow-up of 37.4 (95% CI, 33.7-52.5) months, the 2-year local control rate was 89.4% (95% CI, 81.0%-98.7%), and the 2-year overall survival rate was 98.0% (95% CI, 94.1%-100%); 45 patients (90.0%; 95% CI, 78.2%-96.7%) experienced a complete response to response-adapted radiation, including 44 patients with a complete response to ultralow-dose radiation and 1 patient with a complete response after an additional 20 Gy. No local recurrences were observed among patients with a complete response to response-adapted therapy. No grade 3 or higher toxic effects were observed. In a planned subset analysis of 22 patients with newly diagnosed, untreated stage I mucosa-associated lymphoid tissue lymphoma, the 2-year local control rate was 90.7% (95% CI, 79.2%-100%), and the 2-year freedom from distant relapse rate was 95.2% (95% CI, 86.6%-100%). In this nonrandomized controlled trial, response-adapted ultralow-dose therapy for indolent orbital B-cell lymphoma resulted in reduced radiation exposure, negligible toxic effects, and excellent disease outcomes. ClinicalTrials.gov Identifier: NCT02494700.

Research on Cognition and Adaptation to Climate Risks among Inland Northwest Chinese Residents

Global climate change poses a significant threat to the sustainable development of human society, highlighting the critical importance of developing effective adaptation strategies in response to climate-related disasters. Public awareness and adaptive behaviors towards climate risks serve as crucial indicators of community concerns regarding climate change, laying the foundation for effective adaptation strategy design. For this study, we selected inland northwest Chinese residents, represented by Xi’an City, as the research subjects, to investigate their climate risk cognition and adaptation levels. Based on randomly sampled survey data, descriptive statistical analysis and multiple logistic regression models were used to study the public’s climate change awareness, climate risk sensitivity, and climate risk adaptability, as well as evaluation of climate risk adaptation measures in the public sector, and we also analyzed the impact mechanisms of factors such as gender, age, income, and education level on the related indicators. The study found that with the increasing urban heat island effect, residents of Xi’an are more likely to reach a higher level of belief in climate change regarding long-lasting weather events. However, there is still no collective consensus on the reasons for climate change. Residents are overly optimistic about the future impact of climate disasters, and there is high uncertainty in their ability to adapt to climate change risks. Additionally, specific demands were obtained from different groups of urban residents regarding measures in the public sector for climate risk adaptation.

The role of response adapted therapy in the era of novel agents

The optimal treatment of classic Hodgkin Lymphoma (cHL) requires an individualized approach, with therapy guided by pretreatment clinical risk stratification and interim response assessment with positron emission tomography (PET). The overall goal is to achieve high cure rates while minimizing acute toxicity and late therapy-related effects. Interim PET-adapted strategies (iPET) were initially developed with traditional chemotherapy, reducing intensity after interim complete response and escalating treatment for patients with iPET+ disease. Recently, novel agents including brentuximab vedotin and the checkpoint inhibitor immunotherapies (CPIs) pembrolizumab and nivolumab have been adopted into the front-line treatment of cHL, and PET-adapted approaches may be relevant for these drugs as well. In this review we discuss response-adapted strategies utilizing novel agents, consider challenges including indeterminate radiographic findings with CPIs, and address emerging techniques for response assessment including new PET-based imaging metrics and the role of circulating tumor DNA.

The emerging challenge of FLiRT variants: KP.1.1 and KP.2 in the global pandemic landscape.

The SARS-CoV-2 virus has undergone substantial evolution, leading to emergence of new FLiRT variants characterized by specific spike mutations-F to L at position 456 and R to T at position 346-enhancing their transmissibility and immune evasion capabilities. Particularly, KP.2 shows a significant increase in cases in the USA, indicating a potential shift in the pandemic landscape due to its greater ability to evade vaccine-induced immunity and its higher effective reproduction number compared to JN.1. This evolving scenario underscores the need for continuous monitoring and adaptive response strategies to address the challenges posed by these new variants. This abstract examines the emergence of FLiRT variants KP.2 and KP1.1, descendants of the Omicron JN.1 variant, as they draw global attention amidst the ongoing coronavirus disease-2019 pandemic.

Response-adapted ultra-low-dose 4 Gy radiation as definitive therapy of gastric MALT lymphoma: a single-centre, pilot trial

Given the favourable prognosis of patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma, treatment-related toxicity should be minimised. We aimed to evaluate the efficacy of 4 Gy radiotherapy given in a response-adapted approach. We conducted a single-centre, single-arm, prospective trial at MD Anderson Cancer Center (Houston, TX, USA) of response-adapted ultra-low-dose radiotherapy. Eligible patients were 18 years or older and had newly diagnosed or relapsed Helicobacter pylori-negative gastric MALT lymphoma, with stage I-IV disease. Given the expected low toxicity profile of treatment, performance status was not an exclusion criterion. Patients received external beam photon-based radiotherapy for a total dose of 4 Gy in two fractions. Patients with a complete response to 4 Gy via endoscopy and imaging at 3-4 months were observed; patients with a partial response were re-evaluated in 6-9 months. Residual disease at 9-13 months or stable or progressive disease at any time required additional treatment with 20 Gy. The primary endpoint was gastric complete response at 1 year (second evaluation timepoint) after 4 Gy treatment. All analyses were performed as intention to treat. This trial is registered at ClinicalTrials.gov (NCT03680586) and is complete and closed to enrolment. Between March 27, 2019, and Oct 12, 2021, we enrolled 24 eligible patients. The median age of participants was 67 years (IQR 58-74; range 40-85); 15 (63%) were female and nine (37%) male; 18 (75%) were White, four (17%) Asian, and two (8%) Hispanic; 20 (83%) had stage I disease, one (4%) stage II, and three (13%) stage IV. Median follow-up time was 36 months (IQR 26-42). 20 patients (83%) had a complete response to 4 Gy (16 at 3-4 months, four at 9-13 months); two patients received 20 Gy for symptomatic stable disease at 3-4 months and two for residual disease at 9-13 months; all had a complete response. The 3-year local control rate was 96% (95% CI 88-100), with one local relapse at 14 months after 4 Gy radiotherapy salvaged successfully with 20 Gy. One patient with stage IV disease had a distant relapse. The most common adverse events were grade 1 nausea (nine [38%] of 24 patients who received 4 Gy and two [50%] of four patients who received 20 Gy) and grade 1 abdominal pain (five [21%] of 24 and zero of four, respectively). No grade 3 or worse adverse events were noted, including no treatment-related deaths. Most patients had a complete response after 4 Gy radiotherapy; all who required an additional 20 Gy had a complete response within 12 months. This response-adapted strategy could be used to select patients who would benefit from additional radiotherapy and spare others potential associated toxicity. National Cancer Institute.

Beyond hazard-induced migration: Dissecting everyday mobilities in response to air pollution and extreme cold events at multiple spatial and temporal scales

Human mobility can be considered an effective adaptation strategy in response to environmental risks, given that adverse environmental conditions are often temporary and in-situ adaptation may not always be feasible or desirable. Despite its importance, the concept of short-term mobility as a behavioral response to environmental hazards has been understudied in geographies of health and place and behavioral economics. For a comprehensive understanding of how everyday mobilities are used as a risk adaptation strategy, this study avails of a multiscalar approach's ability to examine the influences of air pollution and extreme cold events on origin-destination movements. The modifiable areal unit problem (MAUP) and modifiable temporal unit problem (MTUP) are analyzed. The results suggest that the scale effects of the MAUP and MTUP are evident from the variations in regression coefficients of the differences in air quality and extreme cold events between origin and destination units. It is also found that the prefecture-level units that include both urbanized city proper and rural countryside, are not an ideal spatial analysis scale. Furthermore, this study reveals that the nexus of air quality differences and short-term movements is significantly impacted by changes in temporal scales. Our results offer fresh evidence on the decision-making process underlying mobility as an adaptation strategy to air pollution and cold events.

Research on the Impact of Digital Currency on the Money Multiplier: Insights from the Money Multiplier Formula

This study examines the impact of digital currencies on the money multiplier. Through a comprehensive analysis of various factors, including cash leakage rate, deposit reserve ratio, time deposit ratio, and the proportion of digital currencies in circulation, the study reveals important insights into the relationship between digital currencies and the money multiplier. The findings indicate that the adoption of digital currencies reduces cash leakage rate by providing an alternative to traditional cash, thereby expanding the money multiplier. Digital currencies also influence deposit reserve requirements, either decreasing or increasing the need for reserves, depending on regulatory responses. Furthermore, digital currencies affect the proportion of time deposits, as they lower transaction costs and make long-term deposits more attractive, contributing to the expansion of the money multiplier. Importantly, the study uncovers a positive relationship between the proportion of digital currencies and the magnitude of the money multiplier. As digital currencies gain prominence and their share in the currency system increases, their impact on the money multiplier becomes more pronounced.The study highlights the implications for policymakers, central banks, and financial institutions, emphasizing the need for adaptive strategies in response to the changing landscape of digital currencies. Further research is encouraged to deepen our understanding of the broader implications of digital currencies on the economy and financial system.

Adaptive silviculture for climate change in the Great Lakes- St. Lawrence Forest Region of Canada: Background and design of a long-term experiment

We present the implementation of the Adaptive Silviculture for Climate Change (ASCC) initiative at the Petawawa Research Forest (PRF) in Ontario, Canada. The study addresses the urgent need for adaptive forest management strategies in response to climate change by examining silvicultural treatments aimed at mitigating its impacts on forest ecosystems. It addresses the complex interplay between climate change projections, regional climate characteristics, and forest management practices for pine dominated forests in the Great Lakes-St. Lawrence Forest region of Canada, underscoring the importance of adaptive approaches in sustaining forest ecosystems. We outline the design and objectives of five distinct treatments—control, business-as-usual, resistance, resilience, and transition—implemented over 4 replicate blocks on a 212-ha area at the PRF. We provide detailed descriptions of each treatment’s management objectives, desired future conditions, and silvicultural strategies. We conclude by summarizing planned research efforts, including seedling survival assessments, phenological monitoring, and measuring treatment impact on fuel loads. By addressing the challenges and opportunities of climate change as part of an international research network, this research will contribute to a deeper understanding of forest ecosystem responses to climate change and inform adaptive management strategies for sustainable forest management.

Comparative chloroplast genomes: insights into the identification and phylogeny of rapid radiation genus Rhodiola.

Rhodiola L. is a genus exhibiting rapid radiation and represents a typical case for studying plastid gene adaptation in species that spread from high altitudes to low altitudes. In this study, 23 samples of 18 Rhodiola species were collected from the Qinghai-Tibetan Plateau and five scattered alpine areas, and the plastid genomes (plastomes) of these species were sequenced, annotated, and compared between high-altitude and widely distributed groups. The plastomes of Rhodiola were found to be highly conserved in terms of gene size, content, and order but highly variable in several lineage-specific features, such as codon usage bias, IR boundary shifting, and distinct repeat sequence structures binding to SSRs. Codon usage in the genes of photosystem II exhibited an obvious preference, reflecting significant environmental adaptation pressures. In this study, three repeat regions compounded with trinucleotide and mononucleotide repeats were found for the first time in R. forrestii, R. himalensis, and R. yunnanensis. High-variability regions such as ndhF, ycf1, trnH-psbA, and rpoC1-rpoB were screened, laying the foundation for the precise identification of these species. The phylogenetic analysis revealed the occurrence of cyto-nuclear discordance, likely originating from the frequent interspecific hybridization events observed within Rhodiola species during rapid radiation. Dioecious and hermaphrodite species can be broadly categorized into two subclades, probably they have different environmental adaptation strategies in response to climate change. In addition, the phylogenetic tree supported the monophyly of R. forrestii and R. yunnanensis, which compose R. Sect. Pseudorhodiola. In conclusion, plastome data enrich the genetic information available for the Rhodiola genus and may provide insight into species migration events during climate change.

Real-life study on the use of response adapted therapy in patients with Hodgkin Lymphoma: Results from a multicenter experience.

Few data are known regarding the use of interim positron emission tomography (iPET) after the first two cycles (iPET2) of chemotherapy in treatment-naïve classical Hodgkin lymphoma (cHL) in routine clinical practice, and about the real-life adoption of intensification strategies for iPET positive patients. We conducted a multicenter retrospective study on cHL to investigate the use of iPET in the real-life setting, its prognostic role and outcomes of patients early shifted to intensification. Six hundreds and forty-one patients were enrolled (62% had advanced stage). iPET2 was positive in 89 patients (14%) including 8.7% and 17% early and advanced stage patients, respectively (p=0.003). Among iPET 2 positive cases treatment was immediately modified in 19 cases; in 14 cases treatment was modified after an additional positive iPET4. Overall 56 iPET2 positive patients never received intensified therapies. Most frequently used intensified therapy was autologous stem cell transplantation followed by BEACOPP. After a median follow-up of 72months, the 5-year progression-free survival (PFS) was 82% with iPET2 positive patients showing a worse PFS compared with iPET2 negative cases: 31% versus 85%. Focusing on advanced stage patients with a positive iPET2, the 5-year PFS was 59% for patients shifted to intensified therapy at any time point versus 61% for patients who never received intensified therapy. Our study confirmed the higher curability of naïve cHL patients in a real-world setting, and the prognostic role of iPET2 in this setting. A poor adherence to response-adapted strategy which however did not translate into a difference in patient outcomes.