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Impact of imaging modality on clinical outcome in Hodgkin lymphoma in a resource constraint setting
Author(s) -
Korula Anu,
Devasia Anup Joseph,
Kulkarni Uday,
Abubacker Fouzia N.,
Lakshmi Kavitha M.,
Abraham Aby,
Srivastava Alok,
George Biju,
Mathews Vikram
Publication year - 2020
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.16289
Subject(s) - medicine , stage (stratigraphy) , lymphoma , radiology , nuclear medicine , abvd , hodgkin lymphoma , positron emission tomography , chemotherapy , gastroenterology , cyclophosphamide , vincristine , biology , paleontology
Summary Treatment of Hodgkin lymphoma (HL) has evolved with risk‐stratified therapy based on PET‐CT scan at multiple timepoints. In a resource constraint setting even a single PET‐CT scan ($400) is inaccessible to many patients, who are re‐assessed with only clinical examination, abdominal ultrasonogram and/or x‐ray (C/U/X) ($10). To compare clinical outcomes in patients with HL who have had suboptimal imaging after completion of chemotherapy for HL, with those who had a CT or PET‐CT, 283 patients were treated for HL from 2011 to 2015, and 268 patients completed six cycles of ABVD therapy with response assessment modality by CT/PET in 185 patients and by C/U/X in 83. There was no difference in the number of patients with advanced (64·1% vs. 61·1%; P = 0·650) or bulk disease (8·1% vs. 7·2%). A significantly higher number of patients in the CT/PET group received IFRT (25·4% vs. 7·7%; P = 0·0005). The three‐year overall survival and progression‐free survival of all treated patients ( n = 283) was 83·5 ± 2·3% and 76·7 ± 2·6% respectively [median follow‐up 36 months (range 2–93)]. At three years, the overall relapse‐free survival (RFS) was 80·1 ± 2·5%, with RFS of 77 ± 3·2% vs. 85 ± 4·0% in the CT/PET group and C/U/X groups respectively ( P = 0·349). There was no difference in RFS between the two groups either in early‐stage disease (88·1 ± 4·6% vs. 91·8 ± 5·6%; P = 0·671) or late‐stage disease (73·9 ± 4·8% vs. 81·3 ± 6·0%; P = 0·747). The only significant factor adversely affecting RFS was advanced disease ( P = 0·004). Factors not affecting RFS were age ( P = 0·763), sex ( P = 0·925), bulk disease ( P = 0·889) and imaging modality ( P = 0·352). There was no difference in relapse rates between patients who had suboptimal imaging compared to those who had a PET/CT. It is possible to use these basic imaging modalities when resources are a constraint, with acceptable outcomes.