Interim FDG-PET/CT May Have Positive Prognostic Value for Hodgkin’s Lymphoma

Fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) can be used to detect Hodgkin’s lymphoma (HL) at initial staging, re-staging, and recurrence, according to the authors of a study published in Nature.

The interim FDG-PET/CT (iPET) was found to have an effective predictive value for HL patients who are treated with standard adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy, and researchers suggest using it earlier, rather than later, in the treatment cycle.

“iPET is now recommended after 2 rather than 4 cycles of ABVD probably due to the fact that treatment modifications, if indicated, should take place as early as possible after the response assessment,” wrote the study authors.

This study was conducted to analyze the predictive value of iPET in HL patients who were treated with ABVD therapy. Interim FDG-PET/CT (iPET) is suggested to have an impact on patient management because it assesses if further treatment options are necessary.

Results from PET scans are now standardized using Deauville criteria, which assesses complete metabolic response (CMR) and non-complete metabolic response (nCMR). It is common practice for health care professionals to use the Deauville criteria to alter treatment; however, this can make it difficult to understand the real predictive value of iPET without intervention.

Over 4 years, the research team evaluated 245 patients with de novo HL and subsequently conducted a retrospective analysis of the treatment. Patients received ABVD (considered to be the most used treatment regime for early and advanced stage HL), then researchers completed PET/CT scans at baseline, 2 cycles or 4 cycles of treatment ([iPET, iPET], iPET4). Additionally, patients were tested at the end of therapy and at follow-up.

HL patients were analyzed for their end-of-therapy (EoT) response, event-free survival (EFS), and overall survival (OS). “The most important finding of our investigation is that iPET performed after 2 or 4 cycles of ABVD strongly correlated with EoT response, EFS, and OS,” the study authors wrote.

Accordingly, iPET was associated with a strong EoT response—in 96.5% of patients with iPET-CMR experienced a complete response at EoT. Less than half of patients with a negative CMR at had complete response at EoT.

Among patients with iPET-CMR, 91% had better EFS and 95% had better OS outcomes at 3 years. However, among iPET-nCMR patients, 41% had EFS and 86% had OS at 3 years. And the data further suggest that the iPET scan could indicate when ABVD treatment can be de-escalated to decrease toxic load.

Findings align with previous studies looking at the value of iPET, as it was “found to be a powerful predictor of outcome being superior to the well-established international prognostic score in advanced HL,” the study authors wrote. “This study investigated the prognostic value of iPET interpreted using the contemporary Deauville criteria in HL patients receiving ABVD treatment unequivocally demonstrating its prognostic value of both EFS and OS and prediction of the treatment response.”

Reference

Al-Ibraheem, Akram, Anwar, Farah, Juweid, Malik, et al. Interim FDG-PET/CT for therapy monitoring and prognostication in Hodgkin’s Lymphoma. Sci Rep 12, 17702 (2022). https://doi.org/10.1038/s41598-022-22032-3