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Impact of baseline and interim quantitative PET parameters on outcomes of classical Hodgkin Lymphoma

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Abstract

Currently, analysis of interim PET (iPET) according to the Deauville score (DS) is the most important predictive factor in Hodgkin lymphoma (HL); however, there is room for improvement in its prognostic power. This study aimed to evaluate the prognostic value of quantitative PET analysis (maximum standard uptake value [SUVmax], total metabolic tumor volume [TMTV] and total lesion glicolysis [TLG]) at baseline (PET0) and iPET in a retrospective cohort of newly diagnosed classical HL. For positive iPET (+ iPET), the reduction of quantitative parameters in relation to PET0 (ΔSUVmax, ΔTMTV and ΔTLG) was calculated. Between 2011 and 2017, 234 patients treated with ABVD were analyzed. Median age was 30 years-old, 59% had advanced stage disease, 57% a bulky mass and 25% a + iPET (DS 4–5). At baseline, high TLG was associated with an increased cumulative incidence of failure (CIF) (p = 0.032) while neither SUVmax, TMTV or TLG were associated with overall survival (OS) or progression-free survival (PFS). In multivariate analysis, only iPET was associated with CIF (p < 0.001). Among ΔSUVmax, ΔTMTV and ΔTLG, only a ΔSUVmax ≥ 68.8 was significant for PFS (HR: 0.31, CI95%: 0.11–0.86, p = 0.024). A subset of patients with improved PFS amongst + iPET was identified by the quantitative (ΔSUVmax ≥ 68.8%) analysis. In this real-world Brazilian cohort, with prevalent high-risk patients, quantitative analysis of PET0 did not demonstrate to be prognostic, while a dynamic approach incorporating the ΔSUVmax to + iPET succeeded in refining a subset with better prognosis. These findings warrant validation in larger series and indicate that not all patients with + iPET might need treatment intensification.

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Data available on request from the corresponding author.

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Authors and Affiliations

  1. Instituto Do Cancer Do Estado de Sao Paulo (ICESP), Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo-SP, Brazil

    Fernanda Maria Santos, Marcos Santos Lima, Wellington Fernandes Silva-Junior, Rodrigo Dolphini Velasques, Marcelo Junqueira Atanazio, Ana Carolina Arrais Maia, Valeria Buccheri & Vanderson Rocha

  2. Nuclear Medicine Medical Investigation Laboratory LIM43, Hospital das Clinicas, FMUSP (HCFMUSP), Sao Paulo-SP, Brazil

    Jose Flavio Gomes Marin, Marcos Santos Lima & Carlos A. Buchpiguel

  3. Division of Hematology and Cell Therapy, HCFMUSP, Sao Paulo-SP, Brazil

    Wellington Fernandes Silva-Junior, Lucas Bassolli O. Alves, Frederico R. Moreira, Rodrigo Dolphini Velasques, Marcelo Junqueira Atanazio, Ana Carolina Arrais Maia, Valeria Buccheri & Vanderson Rocha

  4. Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Internal Medicine, Division of Hematology, HCFMUSP, Sao Paulo-SP, Brazil

    Valeria Buccheri & Vanderson Rocha

  5. Department of Hematology, Churchill Hospital, NHS BT, Oxford University, Oxford, UK

    Vanderson Rocha

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  1. Fernanda Maria Santos
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Contributions

FMS, VB, CAB, VR designed the research study; LBOS created the database, FMS collected the clinical data; JFGM, MSL performed the PET-CT analysis; FRM, LBOS, WSFJ contributed to statistical analysis; FMS, WSFJ, ACAM, MJA, RDV contributed to interpretation of the results; FMS drafted the manuscript; VB, CAB, VR provided critical review.

Corresponding author

Correspondence to Fernanda Maria Santos.

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Ethical appproval

The study was approved by the ethics committee of the Faculdade de Medicina of the Universidade de Sao Paulo in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards (number: 79442717.0.0000.0065—CAAE- Plataforma Brasil).

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Valeria Buccheri and Vanderson Rocha share the last position of authorship.

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Santos, F.M., Marin, J.F.G., Lima, M.S. et al. Impact of baseline and interim quantitative PET parameters on outcomes of classical Hodgkin Lymphoma. Ann Hematol 103, 175–183 (2024). https://doi.org/10.1007/s00277-023-05461-6

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