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Annals of Oncology Advance Access published online on June 6, 2005
Annals of Oncology, doi:10.1093/annonc/mdi200
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© 2005 European Society for Medical Oncology
Received March 21, 2005
Accepted March 24, 2005

Original article

Prognostic value of interim FDG-PET after two or three cycles of chemotherapy in Hodgkin lymphoma

M. Hutchings 1, N. G. Mikhaeel 1*, P. A. Fields 2, T. Nunan 3, and A. R. Timothy 1

1 Department of Clinical Oncology, London, UK,
2 Department of Haematology, London, UK,
3 The Clinical PET Centre, Guy's and St. Thomas’ Hospital, London, UK

* To whom correspondence should be addressed.
N. G. Mikhaeel, E-mail: george.mikhaeel{at}gstt.nhs.uk


  Abstract

Background: Long-term survival from Hodgkin lymphoma (HL) is 80-90%, but the treatment has serious late adverse effects. Modern risk-adapted treatment requires accurate assessment of the patient's prognosis. This investigation assessed the value of positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-d-glucose (FDG-PET) after two or three cycles of chemotherapy for prediction of progression-free survival (PFS) and overall survival (OS).

Patients and methods: A total of 85 patients with HL underwent FDG-PET after two or three cycles of chemotherapy. Median follow-up was 3.3 years. FDG-PET results were related to PFS and OS using Kaplan-Meier analysis. Regression analyses were employed to test for independence of established pretreatment prognostic factors.

Results: After two or three cycles of chemotherapy, 63 patients had negative FDG-PET scans, nine patients had minimal residual uptake (MRU) and 13 patients had positive scans. Three PET-negative patients and one patient from the MRU group relapsed. In the PET-positive group, nine patients progressed and two died. Survival analyses showed highly significant associations between early interim FDG-PET and PFS (P <0.0001) and OS (P <0.03). All advanced-stage patients with positive interim FDG-PET relapsed within 2 years.

Conclusion: Early interim FDG-PET is an accurate and independent predictor of PFS and OS in HL. A positive interim FDG-PET is highly predictive of relapse in advanced-stage disease.

Keywords: fluorodeoxyglucose F18; Hodgkin lymphoma; positron emission tomography; prognosis.
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