Long-term follow-up of bulky classic Hodgkin lymphoma managed with ABVD and PET-guided RT demonstrates excellent outcomes in PET-negative cases.

in British journal of haematology by J L Kim, D Villa, R P Tonseth, A S Gerrie, D Wilson, F Benard, C P Venner, B Skinnider, P Farinha, G W Slack, A C Lo, D W Scott, L H Sehn, K J Savage

TLDR

  • The study found that omitting radiation therapy in patients with bulky cHL who had a negative end-of-treatment PET scan resulted in excellent long-term outcomes
  • Key findings include a 5- and 10-year PFS rate of 94.0% and 90.4%, respectively, in EOT PET-negative cases, and 64.6% in PET-positive cases

Abstract

The outcome of 221 patients with bulky (≥10 cm) classic Hodgkin lymphoma (cHL) treated with doxorubicin, bleomycin, vinblastine, dacarbazine and consolidative radiotherapy (RT) only in those with a positive end-of-treatment (EOT) positron emission tomography (PET) scan was evaluated. With a median follow-up of 9.6 years, 5- and 10-year progression-free survival (PFS) in EOT PET-negative cases were 94.0% and 90.4%, respectively, and in PET-positive cases, 5/10-year PFS was 64.6% (p < 0.001), with 15% overall receiving RT. Five-year PFS for Deauville (D) score DX/D1-3 was 93.6%, compared with D4 66.7% (p < 0.001) and D5 33.3% (p < 0.001). Omission of RT in EOT PET-negative cases is associated with excellent long-term outcomes in bulky cHL.

Overview

  • The study evaluated the outcome of 221 patients with bulky (≥10 cm) classic Hodgkin lymphoma (cHL) treated with doxorubicin, bleomycin, vinblastine, dacarbazine and consolidative radiotherapy (RT) only in those with a positive end-of-treatment (EOT) positron emission tomography (PET) scan
  • The study aimed to investigate the relationship between end-of-treatment PET scans and the need for consolidative radiotherapy in patients with bulky cHL
  • The primary objective was to assess the 5- and 10-year progression-free survival (PFS) in EOT PET-negative and PET-positive cases

Comparative Analysis & Findings

  • The 5- and 10-year PFS in EOT PET-negative cases were 94.0% and 90.4%, respectively, and in PET-positive cases, 5/10-year PFS was 64.6% (p < 0.001)
  • The omission of RT in EOT PET-negative cases was associated with excellent long-term outcomes in bulky cHL
  • The Deauville (D) score DX/D1-3 was associated with a 5-year PFS of 93.6%, compared with D4 66.7% (p < 0.001) and D5 33.3% (p < 0.001)

Implications and Future Directions

  • The study suggests that omission of RT in EOT PET-negative cases can be considered in patients with bulky cHL, resulting in excellent long-term outcomes
  • Further studies are needed to confirm the results and explore the potential role of PET scans in determining the need for consolidative radiotherapy in patients with bulky cHL
  • The study highlights the importance of individualizing treatment decisions based on the presence and severity of residual disease after chemotherapy
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