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Prognostic value of baseline and interim [18F]FDG PET metabolic parameters in pediatric Hodgkin’s lymphoma

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Background

Hodgkin lymphoma (HL) in pediatric populations has a high survival rate but poses risks for long-term morbidities. Although [18F]fluoro‑2‑deoxy‑2‑d‑glucose positron emission tomography ([18F]FDG PET) scans offer potential for improved risk stratification, the definitive prognostic value of quantitative [18F]FDG PET parameters remains unclear for pediatric HL.

Methods

A single-center, retrospective study included pediatric patients diagnosed with HL between 2016 and 2023 treated according to EuroNet-PHL-C1 and DAL/GPOH-HD protocols. Patients underwent baseline and interim PET/CT scans after two chemotherapy cycles. Event-free survival (EFS) was the primary endpoint, Deauville score was the secondary endpoint. Quantitative [18F]FDG PET parameters included SUVmax, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) that were evaluated using two segmentation methods (SUV 2.5, 41% SUVmax). Survival outcomes were assessed using Cox regression analysis.

Results

A total of 115 patients (50 males, median age 14.2 years) were studied, with a median follow-up period of 35 months. During this period, 16 cases (13.9%) of relapse or progression were noted. Baseline and interim MTV 2.5, MTV 41%, TLG 2.5, and TLG 41%, along with interim SUVmax, were significantly associated with worse EFS and correlated with post-treatment Deauville scores. In multivariable analysis, interim MTV 2.5 > 0 ml (adj. hazard ratio, HR: 3.89, p = 0.009) and interim TLG 41% ≥ 30 g (adj. HR: 7.98, p = 0.006) were independent risk factors for EFS.

Conclusion

Baseline and interim [18F]FDG PET parameters can serve as significant prognostic indicators for EFS and treatment response in pediatric HL. These quantitative measures could enhance individualized, risk-adapted treatment strategies for children and adolescents with HL.

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Data availability

The authors declare that all data supporting the findings of this study are available within the article.

Abbreviations

[18F]FDG:

[18F]fluoro‑2‑deoxy‑2‑d‑glucose

AUC:

Area Under Curve

CI:

Confidence Interval

CR:

Complete Remission

CRu:

Complete Remission Unconfirmed

CT:

Computed Tomography

DS:

Deauville Score

EFS:

Event-Free Survival

ESR:

Erythrocyte Sedimentation Rate

HL:

Hodgkin Lymphoma

HR:

Hazard Ratio

IQR:

Interquartile Range

MTV:

Metabolic Tumor Volume

NAC:

Neoadjuvant Chemotherapy

NOS:

Not Otherwise Specified

OS:

Overall Survival

PET:

Positron Emission Tomography

PR:

Partial Remission

PRO:

Progression

RT:

Radiotherapy

ROC:

Receiver Operating Characteristic

SD:

Stable Disease

SUVmax:

Maximum Standardized Uptake Value

SUVmean:

Mean Standardized Uptake Value

SUVpeak:

Peak Standardized Uptake Value

TLG:

Total Lesion Glycolysis

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia

    Mikhail Ya. Yadgarov, M. M. Dunaykin, G. I. Shestopalov, C. Kailash, E. D. Kireeva, N. V. Myakova & Yu. N. Likar

  2. Department of PET and Radionuclide Diagnostics, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samory Mashela Str. 1, 117997, Moscow, Russia

    Mikhail Ya. Yadgarov

  3. Russian Children’s Clinical Hospital, N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia

    G. I. Shestopalov

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  1. Mikhail Ya. Yadgarov
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  4. C. Kailash
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Contributions

M.Y., N.M. and Y.L. contributed to the design and implementation of the research, M.Y., M.D., G.S. collected the data, M.D., C.K., Y.L. analyzed images, M.Y., Y.L. preformed the analysis of the results, M.Y., M.D., E.K., N.M., Y.L. wrote of the manuscript. All authors discussed the results and commented on the manuscript.

Corresponding author

Correspondence to Mikhail Ya. Yadgarov.

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Ethics approval and consent to participate

This is a retrospective cohort study. The NMRCPHOI Independent Ethics Committee has confirmed that no ethical approval is required. All parents or persons having custody signed an informed consent for therapy, diagnostic procedures and processing of patients' personal data.

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Not applicable.

Competing interests

The authors have no relevant financial or non-financial interests to disclose.

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Yadgarov, M.Y., Dunaykin, M.M., Shestopalov, G.I. et al. Prognostic value of baseline and interim [18F]FDG PET metabolic parameters in pediatric Hodgkin’s lymphoma. Eur J Nucl Med Mol Imaging (2024). https://doi.org/10.1007/s00259-024-06643-8

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