Skip to main content
SpringerLink
Log in

Aktueller Stellenwert der Positronenemissionstomographie beim Hodgkin-Lymphom

Current importance of positron emission tomography in Hodgkin’s lymphoma

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Die Positronenemissionstomographie mit 18F-Fluordeoxyglucose (FDG-PET/CT) während und nach Abschluss der Chemotherapie wird zunehmend eingesetzt, um die Behandlungsintensität zu optimieren.

Ziel

Dieses Therapiekonzept wurde von der German Hodgkin Study Group (GHSG) in der HD15-Studie geprüft, die Multizenterstudien der GHSG HD16–HD18 befinden sich derzeit noch in der Rekrutierungsphase.

Material und Methoden

Die HD15-Studie untersuchte den Verzicht auf eine Strahlentherapie bei PET-negativem Restgewebe für fortgeschrittene Stadien (PR ≥ 2,5 cm). Eine vergleichbare Fragestellung untersucht HD16 für frühe Stadien und HD17 für intermediäre Fragestellungen. In HD18 wird bei PET-negativen Patienten in der Early-Interim-PET/CT die Anzahl der Chemotherapiezyklen reduziert.

Ergebnisse

Die Therapiestratifizierung (± Strahlentherapie) mittels FDG-PET/CT nach Abschluss von 6 Zyklen BEACOPPeskaliert bei fortgeschrittenen Stadien des Hodgkin-Lymphoms ist nach der Datenauswertung aus der HD15-Studie der GHSG gesichert. Der Verzicht auf eine Strahlentherapie nach einer weniger intensiven Chemotherapie in frühen und intermediären Stadien des Hodgkin-Lymphoms – stratifiziert nach dem Ergebnis der PET/CT – ist noch kein Standard außerhalb klinischer Studien.

Diskussion

Die Interpretation der Daten erfordert eine Nachbeobachtungsphase. So bleibt in der H10-Studie der EORTC für frühe und intermediäre Stadien abzuwarten, ob eine etwas höhere Anzahl an Rezidiven im kurzfristigen Verlauf durch eine geringere Rate an Langzeitkomplikationen (Sekundärneoplasien, kardiopulmonal) im Langzeitverlauf kompensiert wird und ob im Falle eines Rezidivs eine wirksame Zweitlinientherapie verfügbar ist.

Abstract

Background

18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is increasingly being used during and after chemotherapy to modulate the intensity of therapy.

Aim

This concept was evaluated by the German Hodgkin Study Group (GHSG) in the HD15 trial and recruitment in the multicenter trials of the GHSG HD16–HD18 trials is ongoing.

Material and methods

In the HD15 trial patients with advanced stages and PET negative residual tissue (PR ≥ 2.5 cm) were treated without radiation therapy. A comparable study question is being examined by the HD16 trial for early stages and by the HD17 trial for intermediate stages. In the HD18 trial the number of chemotherapy cycles is reduced for PET negative patients in the early interim PET/CT.

Results

Therapy stratification (with or without radiation therapy) based on PET/CT after 6 cycles of the BEACOPPescalated regimen for advanced stages of Hodgkin’s lymphoma is the standard of care after the final analysis of the HD15 data was published. After a less intensive chemotherapy in the early and intermediated stages of Hodgkin’s lymphoma radiation therapy is the standard of care outside clinical trials.

Discussion

The interpretation of data requires a longer observation period in the follow-up care. For final conclusions from the H10 trial of the European Organisation for Research and Treatment of Cancer (EORTC) for early and intermediate stages, it remains to be seen whether the slightly higher number of early relapses will be compensated by a lower rate of adverse events in the long-term follow-up (e.g., secondary neoplasms and cardiopulmonary toxicity) and whether the second line therapy is effective in cases of relapse.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. André MPE, Reman O, Federico M et al (2012) Interim analysis of the randomized EORTC/Lysa/Fil Intergroup H10 trial on early PET-scan driven treatment adaptation in stage I/II Hodgkin lymphoma. Blood 120:549 (ASH Annual Meeting Abstracts)

    Google Scholar 

  2. Clinicaltrials.gov [Internet]. Fluorodeoxyglucose F 18 PET scan-guided therapy or standard therapy in treating patients with previously untreated stage I or II Hodgkin’s lymphoma (EORTC/GELA/FIL). http://clinicaltrials.gov/ct2/show/NCT00433433

  3. Clinicaltrials.gov [Internet]. Response-based therapy assessed by PET-scan in treating patients with bulky stage I and stage II classical Hodgkin lymphoma. http://clinicaltrials.gov/ct2/show/NCT01118026

  4. Clinicaltrials.gov [Internet]. Chemotherapy based on PET scan in treating patients with stage I or stage II Hodgkin lymphoma (ECOG). http://clinicaltrials.gov/ct2/show/NCT01390584

  5. Clinicaltrials.gov [Internet]. Chemotherapy based on positron emission tomography scan in treating patients with stage I or stage II Hodgkin lymphoma (CALGB 50604). http://clinicaltrials.gov/ct2/show/NCT01132807

  6. Clinicaltrials.gov [Internet]. PET scan in planning treatment in patients undergoing combination chemotherapy for stage IA or stage IIA Hodgkin lymphoma. http://clinicaltrials.gov/ct2/show/NCT00943423

  7. Clinicaltrials.gov [Internet]. Positron emission tomography (PET)-adapted chemotherapy in advanced Hodgkin lymphoma (HD0607). http://clinicaltrials.gov/ct2/show/NCT00795613

  8. Clinicaltrials.gov [Internet]. Fluorodeoxyglucose F-18-PET/CT imaging and combination chemotherapy with or without additional chemotherapy and G-CSF in treating patients with stage III or stage IV Hodgkin lymphoma (SWOG-CALG-B). http://clinicaltrials.gov/ct2/show/NCT00822120

  9. Clinicaltrials.gov [Internet]. Study of a treatment driven by early PET response to a treatment not monitored by early PET in patients with a stage 3–4 or 2B HL (AHL 2011). http://clinicaltrials.gov/ct2/show/NCT01358747

  10. Clinicaltrials.gov [Internet]. Fluorodeoxyglucose F-18-PET/CT imaging in assessing response to chemotherapy in patients with newly diagnosed stage II, stage III, or stage IV Hodgkin lymphoma (RATHL). http://clinicaltrials.gov/ct2/show/NCT00678327

  11. Clinicaltrials.gov [Internet]. HD18 for advanced stages in Hodgkin’s lymphoma. http://clinicaltrials.gov/ct2/show/NCT00515554

  12. Clinicaltrials.gov [Internet]. High-dose chemotherapy and stem cell transplantation in patients PET-2 positive after 2 courses of ABVD (HD0801) and comparison of RT versus no RT in PET-2 negative patients (HD0802). http://clinicaltrials.gov/ct2/show/NCT00784537

  13. Clinicaltrials.gov [Internet]. Tailored therapy for Hodgkin lymphoma using early interim therapy PET for therapy decision. http://clinicaltrials.gov/ct2/show/NCT00392314

  14. Dann EJ, Bar-Shalom R, Tamir A et al (2007) Risk-adapted BEACOPP regimen can reduce the cumulative dose of chemotherapy for standard and high-risk Hodgkin lymphoma with no impairment of outcome. Blood 109:905–909

    Article  CAS  PubMed  Google Scholar 

  15. Dann EJ, Bar-Shalom R, Tamir A et al (2010) A functional dynamic scoring model to elucidate the significance of post-induction interim fluorine-18-fluorodeoxyglucose positron emission tomography findings in patients with Hodgkin’s lymphoma. Haematologica 95:1198–1206

    Article  PubMed Central  PubMed  Google Scholar 

  16. Diehl V, Franklin J, Pfreundschuh M et al (2003) Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin’s disease. N Engl J Med 348:2386–2395

    Article  CAS  PubMed  Google Scholar 

  17. Dietlein M, Kobe C, Kuhnert G et al (2013) Interim PET/CT in HD18 der GHSG beim Hodgkin Lymphom – Lokale plus zentrale Interpretation und Patientensicherheit [Abstract]. Nuklearmedizin 52:A19

    Google Scholar 

  18. Dietlein M, Kuhnert G, Kahraman D et al (2013) Early Interim PET/CT beim Hodgkin Lymphom des Erwachsenen – Von der Risikostratefizierung zur Therapiestratifizierung. Nuklearmediziner 36:79–85

    Article  Google Scholar 

  19. Engert A, Plütschow A, Eich HT et al (2010) Reduced treatment intensity in patients with early-stage Hodgkin’s lymphoma. N Engl J Med 363:640–652

    Article  CAS  PubMed  Google Scholar 

  20. Engert A, Haverkamp H, Kobe C et al (2012) Reduced -intensity chemotherapy and PET-guided radiotherapy in patients with advanced stage Hodgkin’s lymphoma (HD15 trial): a randomised, open-label, phase 3 non-inferiority trial. Lancet 379:1791–1799

    Article  CAS  PubMed  Google Scholar 

  21. Gallamini A, Rigacci L, Merli F et al (2006) The predicive value of positron emission tomography scanning performed after two courses of standard therapy on treatment outcome in advanced stage Hodgkin’s lymphoma. Haematologica 91:475–481

    PubMed  Google Scholar 

  22. Gallamini A, Hutchings M, Rigacci L et al (2007) Early interim 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography is prognostically superior to international prognostic score in advanced-stage Hodgkin’s lymphoma: a report from a joint Italian-Danish study. J Clin Oncol 25:3746–3752

    Article  CAS  PubMed  Google Scholar 

  23. Gallamini A, Kostakoglu L (2012) Interim FDG-PET in Hodgkin lymphoma: a compass for a safe navigation in clinical trials? Blood. doi:10.1182/blood-2012-03-403790 (prepublished online)

  24. Hutchings M, Loft A, Hansen M et al (2006) FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin Lymphoma. Blood 107:52–59

    Article  CAS  PubMed  Google Scholar 

  25. Hutchings M, Mikhaeel NG, Fields PA et al (2005) Prognostic value of interim PET after two or three cycles of chemotherapy in Hodgkin lymphoma. Ann Oncol 16:1160–1168

    Article  CAS  PubMed  Google Scholar 

  26. Juweid ME, Stroobants S, Hoekstra OS et al (2007) Use of positron emission tomography for response assessment of lymphoma: consensus of the imaging subcommittee of international harmonization project in lymphoma. J Clin Oncol 25:571–578

    Article  PubMed  Google Scholar 

  27. Klasa R (2013) BCCA experience: population-based PET guided treatment. Vortrag am 12.10.2013, 9th International Symposium on Hodgkin Lymphoma, Cologne

  28. Kobe C, Dietlein M, Franklin J et al (2008) Positron emission tomography has a high negative predictive value for progression or early relapse for patients with residual disease after first-line chemotherapy in advanced-stage Hodgkin lymphoma. Blood 112:3389–3994

    Article  Google Scholar 

  29. Kobe C, Dietlein M, Mauz-Körholz C et al (2008) FDG-PET in Hodgkin lymphoma. Nuklearmedizin 47:235–238

    CAS  PubMed  Google Scholar 

  30. Kobe C, Kuhnert G, Kahraman D et al (2013) PET/CT zur Therapiekontrolle beim Hodgkin Lymphom des Erwachsenen: Hängt die Indikation zur Strahlentherapie vom Ergebnis der PET/CT ab? Nuklearmediziner 36:86–91

    Article  Google Scholar 

  31. Markova J, Kobe C, Skopalova M et al (2009) FDG-PET for assessment of early treatment response after 4 cycles of chemotherapy in patients with advanced-stage Hodgkin lymphoma has a high negative predictive value. Ann Oncol 20:1270–1274

    Article  CAS  PubMed  Google Scholar 

  32. Markova J, Kahraman D, Kobe C et al (2012) Role of [18F]-fluoro-2-deoxy-D-glucose positron emission tomography in early and late therapy assessment of patients with advanced Hodgkin lymphoma treated with bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine and prednisone. Leuk Lymphoma 53:64–70

    Article  CAS  PubMed  Google Scholar 

  33. Meignan M, Gallamini A, Haioun C (2009) Report on the first international workshop on interim-PET scan in lymphoma. Leuk Lymphoma 50:1257–1260

    Article  PubMed  Google Scholar 

  34. Mittal BR, Manohar K, Malhotra P et al (2011) Can fluorodeoxyglucose positron emission tomography/computed tomography avoid negative iliac crest biopsies in evaluation of marrow involvement by lymphoma at time of initial staging? Leuk Lymphoma 52:2111–2116

    Article  CAS  PubMed  Google Scholar 

  35. Naumann R, Beuthien-Baumann B, Reiss A et al (2004) Substantial impact of FDG PET imaging on the therapy decision in patients with early-stage Hodgkin’s lymphoma. Br J Cancer 90:620–625

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Picardi M, De Renzo A, Pane F et al (2007) Randomized comparison of consolidation radiation versus observation in bulky Hodgkin’s lymphoma with post-chemotherapy negative positron emission tomography scans. Leuk Lymphoma 48:1721–1727

    Article  PubMed  Google Scholar 

  37. Radford J, Barrington S, Counsell N et al (2012) Involved field radiotherapy versus no further treatment in patients with clinical stages IA and IIA Hodgkin lymphoma and a ‚negative‘ PET scan after 3 cycles ABVD. Results of the UK NCRI RAPID Trial. Blood 120:547 (ASH Annual Meeting Abstracts)

    Google Scholar 

  38. Rancea M, Engert A, Tresckow B von et al (2013) Interdisziplinäre S-3 Leitlinie zur Diagnostik, Therapie und Nachsorge des Hodgkin Lymphoms bei erwachsenen Patienten. Dtsch Ärztebl 110(11):C177–C183

    Google Scholar 

  39. Richardson SE, Sudak J, Warbey V et al (2012) Routine bone marrow biopsy is not necessary in the staging of patients with classical Hodgkin lymphoma in the 18F-fluoro-2-deoxyglucose positron emission tomography era. Leuk Lymphoma 53:381–385

    Article  CAS  PubMed  Google Scholar 

  40. Tresckow B von, Plütschow A, Fuchs M et al (2012) Dose-intensification in early unfavorable Hodgkin’s lymphoma: final analysis of the German hodgkin study group HD14 trial. J Clin Oncol 30:907–913

    Article  Google Scholar 

  41. Zinzani PL, Tani M, Fanti S et al (2006) Early positron emission tomography (PET) restaging: a predictive final response in Hodgkin’s disease patients. Ann Oncol 17:1296–1300

    Article  CAS  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Dietlein, G. Kuhnert, R. Semrau, B. Nast-Kolb, C. Baues, M. Fuchs, A. Drzezga und C. Kobe geben an, dass kein Interessenkonflikt besteht. Das vorliegende Manuskript enthält keine Studien an Tieren. Alle im Manuskript beschriebenen Untersuchungen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland

    M. Dietlein, G. Kuhnert, A. Drzezga & C. Kobe

  2. Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Köln, Köln, Deutschland

    R. Semrau, B. Nast-Kolb & C. Baues

  3. Klinik I für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland

    M. Fuchs

  4. German Hodgkin Study Group (GHSG), Universitätsklinikum Köln, Köln, Deutschland

    M. Fuchs

Authors
  1. M. Dietlein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Kuhnert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Semrau
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Nast-Kolb
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Baues
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Fuchs
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Drzezga
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C. Kobe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Dietlein.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dietlein, M., Kuhnert, G., Semrau, R. et al. Aktueller Stellenwert der Positronenemissionstomographie beim Hodgkin-Lymphom. Onkologe 20, 429–440 (2014). https://doi.org/10.1007/s00761-013-2634-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00761-013-2634-6

Schlüsselwörter

Keywords

Search

Navigation