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Blood. 2018 Mar 29;131(13):1456-1463. doi: 10.1182/blood-2017-07-795476. Epub 2018 Feb 1.

Prognostic value of baseline metabolic tumor volume in early-stage Hodgkin lymphoma in the standard arm of the H10 trial.

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Department of Nuclear Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Descartes University, Paris, France.
Santa Maria Nuova Hospital-IRCCS Reggio Emilia, Reggio Emilia, Italy.
Department of Clinical Physiology, Nuclear Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Hematology Department, INSERM 1231, University Hospital, Dijon, France.
Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
Lymphoma Academic Research Organization (LYSARC) Lymphoma Study Association Imaging, Hôpital Henri Mondor, Créteil, France.
Department of Nuclear Medicine, Centre de Lutte Contre le Cancer François Baclesse, Caen, France.
Nuclear Medicine Unit, Ospedale Santo Stefano, Prato, Italy.
Hematology, Hopital Saint-Louis, AP-HP, Paris, France.
Hematology, Radboud University Medical Center, Nijmegen, The Netherlands.
Hematology, Hôpital Cochin, Paris, France.
European Organisation for Research and Treatment of Cancer, Brussels, Belgium.
Biostatistical Department, LYSARC, Centre Hospitalier Lyon Sud, Lyon, France.
Nuclear Medicine Division, Centre Hospitalo-Universitaire Université Catholique de Louvain, Namur, Yvoir, Belgium.
Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Oncology, University of Turin, Turin, Italy.
Hematology Department, Centre Hospitalo-Universitaire Université Catholique de Louvain, Namur, Yvoir, Belgium.
Lymphoma Study Association Imaging, Hôpital Henri Mondor, Créteil, France; and.
Université Paris Est, Créteil, France.


We tested baseline positron emission tomography (PET)/computed tomography (CT) as a measure of total tumor burden to better identify high-risk patients with early-stage Hodgkin lymphoma (HL). Patients with stage I-II HL enrolled in the standard arm (combined modality treatment) of the H10 trial (NCT00433433) with available baseline PET and interim PET (iPET2) after 2 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine were included. Total metabolic tumor volume (TMTV) was measured on baseline PET. iPET2 findings were reported negative (DS1-3) or positive (DS4-5) with the Deauville scale (DS). The prognostic value of TMTV was evaluated and compared with baseline characteristics, staging classifications, and iPET2. A total of 258 patients were eligible: 101 favorable and 157 unfavorable. The median follow-up was 55 months, with 27 progression-free survival (PFS) and 12 overall survival (OS) events. TMTV was a prognosticator of PFS (P < .0001) and OS (P = .0001), with 86% and 84% specificity, respectively. Five-year PFS and OS were 71% and 83% in the high-TMTV (>147 cm3) group (n = 46), respectively, vs 92% and 98% in the low-TMTV group (≤147 cm3). In multivariable analysis including iPET2, TMTV was the only baseline prognosticator compared with the current staging systems proposed by the European Organization for Research and Treatment of Cancer/Groupe d'Etude des Lymphomes de l'Adulte, German Hodgkin Study Group, or National Comprehensive Cancer Network. TMTV and iPET2 were independently prognostic and, combined, identified 4 risk groups: low (TMTV≤147+DS1-3; 5-year PFS, 95%), low-intermediate (TMTV>147+DS1-3; 5-year PFS, 81.6%), high-intermediate (TMTV≤147+DS4-5; 5-year PFS, 50%), and high (TMTV>147+DS4-5; 5-year PFS, 25%). TMTV improves baseline risk stratification of patients with early-stage HL compared with current staging systems and the predictive value of early PET response as well.

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