Premium
Focal skeletal FDG uptake indicates poor prognosis in cHL regardless of extent and first‐line chemotherapy
Author(s) -
Pedersen Mette A.,
Gormsen Lars C.,
Kamper Peter,
Wassberg Cecilia,
Andersen Maja D.,
d'Amore Alexander L.,
Barrington Sally F.,
Johnson Peter,
HamiltonDutoit Stephen,
Amini RoseMarie,
Enblad Gunilla,
Molin Daniel,
d'Amore Francesco
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.15933
Subject(s) - medicine , dacarbazine , vincristine , chemotherapy , procarbazine , chemotherapy regimen , positron emission tomography , etoposide , regimen , abvd , radiology , cyclophosphamide
Summary 18 F‐fluoro‐2‐deoxy‐D‐glucose positron emission tomography/computed tomography ( FDG ‐ PET / CT ) is used for staging classical Hodgkin lymphoma ( cHL ) with high sensitivity for skeletal involvement. However, it is unclear whether a single bone lesion carries the same adverse prognosis as multifocal lesions and if this is affected by type of chemotherapy [ ABVD (adriamycin, bleomycin, vincristine, dacarbazine) versus BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone)]. We reviewed the clinico‐pathological and outcome data from 209 patients with newly diagnosed cHL staged by FDG ‐ PET / CT . Patterns of skeletal/bone marrow uptake ( BMU ) were divided into ‘low’ and ‘high’ diffuse BMU (i.e. without focal lesions), and unifocal or multifocal lesions. Additional separate survival analysis was performed, taking type of chemotherapy into account. Forty patients (19·2%) had skeletal lesions (20 unifocal, 20 multifocal). The 3‐year progression‐free‐survival ( PFS ) was 80% for patients with ‘low BMU ’, 87% for ‘high BMU ’, 69% for ‘unifocal’ and 51% for ‘multifocal’ lesions; median follow‐up was 38 months. The presence of bone lesions, both uni‐ and multifocal, was associated with significantly inferior PFS (log rank P = 0·0001), independent of chemotherapy type. Thus, increased diffuse BMU should not be considered as a risk factor in cHL , whereas unifocal or multifocal bone lesions should be regarded as important predictors of adverse outcome, irrespective of the chemotherapy regimen used.