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PET ‐adapted therapy after three cycles of ABVD for all stages of Hodgkin lymphoma: results of the GATLA LH ‐05 trial
Author(s) -
Pavlovsky Astrid,
Fernandez Isolda,
Kurgansky Nicolas,
Prates Virginia,
Zoppegno Lucia,
Negri Pedro,
Milone Gustavo,
Cerutti Ider,
Zabaljauregui Soledad,
Mariano Romina,
Grecco Horacio F.,
Basquiera Ana L.,
Saba Silvia,
Rudoy Silvia,
Sackmann Federico,
Castano Vanesa,
Remaggi Guillermina,
Cabrejo Maria,
Roveri Eriberto,
Casale Maria F.,
Cabane Vanina,
Taus Rossana,
Venturini Claudia,
Sakamoto Francisco,
Varela Ana I.,
Riddick Maximiliano,
Pavlovsky Santiago
Publication year - 2019
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.15838
Subject(s) - abvd , dacarbazine , medicine , vinblastine , hodgkin's lymphoma , positron emission tomography , hazard ratio , nuclear medicine , stage (stratigraphy) , bleomycin , progression free survival , lymphoma , oncology , chemotherapy , confidence interval , vincristine , paleontology , biology , cyclophosphamide
Summary The role of Ann Arbor staging in determining treatment intensity after achieving a negative positron emission tomography ( PET ) has not been established in classical Hodgkin lymphoma ( cHL ). Patients with stage I– IV cHL , received three cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and an interim PET scan ( PET 3). PET 3‐negative patients received no further therapy. PET 3‐positive patients received three additional cycles of ABVD plus involved‐field radiation therapy or salvage chemotherapy, if refractory to ABVD , and were re‐evaluated by PET scan ( PET 6). Study endpoints were 3‐year progression‐free survival ( PFS ) and overall survival ( OS ) rates. Two hundred and thirty‐nine patients with early‐stage and 138 with advanced‐stage were evaluable. Overall, 260 patients (70%) were PET 3‐negative and had higher 3‐year PFS (90% vs. 65%; P < 0·0001) and OS (98% vs. 92%; P = 0·007) rates than PET 3‐positive patients. All PET 3‐negative patients, regardless of disease stage at diagnosis, achieved similarly good PFS (90–91%; P = 0·76) and OS (97–99%). The only independent prognostic factor for PFS was PET 3‐negativity (Hazard ratio 3·8; 95% confidence interval 2·4–6·3; P < 0·0001). This study suggests that cHL patients who achieve a negative PET 3 following ABVD have an excellent outcome, regardless of stage at diagnosis. An appropriately powered, phase III trial will be necessary to confirm these findings.