PET-CT ADAPTED THERAPY AFTER 3 CYCLES OF ABVD TO ALL STAGES OF HODGKIN LYMPHOMA. GATLA TRIAL HL-05.
(Abstract release date: 05/19/16)
EHA Library. Pavlovsky A. 06/10/16; 135141; S108
Dr. Astrid Pavlovsky
Contributions
Contributions
Abstract
Abstract: S108
Type: Oral Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 12:15 - 12:30
Location: Hall A2
Background
Positron emission tomography using fluoro-2-deoxy-d-glucose (PET-CT) is an important tool for treatment response assessment in Hodgkin Lymphoma (HL) treated with ABVD.
Aims
Adapt therapy to all stage of Hodgkin Lymphoma to the result of PET-CT after 3 ABVD (PET-CT+3). Reduce therapy in pts. who achieve early CR with negative PET-CT. Intensify treatment, in pts. with positive PET-CT after 3 ABVD. Achieve CR, event free survival (EFS) and overall survival (OS), as good as in our historical control (LH -96), when we used 3-6 ABVD adapted to stage plus involved field radio therapy (IFRT) in all pts
Methods
Four hundred and one newly diagnosed pts. with HL Stages I-IV have been included (LH-05). All pts. received 3 ABVD and were evaluated with a PET-CT (PET-CT +3). Pts. with a negative PET-CT+3 were considered in CR and received no further therapy. Pts in partial response (PR) completed 6 ABVD and IFRT on PET-CT positive areas. Pts with less than PR received salvaje chemotherapy. Three hundred and seventy seven pts have been evaluated. With a median age of 35 yrs.and 38% age older than 59 years. Two hundred and twenty eight 860%9 presented with localized stage (I-IIA) and 144 (40%) presented with advanced stage (IIB-III-IV).
Results
Of all pts. 260 (69%) achieved CR with negative PET-CT + 3, 117 (31%) were PET-CT+3 positive, 101 pts. were in PR with chemo-sensitive disease and completed a total of 6 ABVD + IFRT in PET-CT positive areas. Eighty-two (81%) achieved CR. With a median follow up of 68 months the EFS and OS at 3 years is 80% and 96% respectively. Pts with negative PET-CT +3 had an EFS of 90% both for localized and advances stage, compared to 58% for pts. with positive PET-CT+3 and loc. stage and 5%for with a positive PET-TC+3 and adv. stage. We perform a multivariate analysis for EFS which included age, stage, IPS, bulky disease, extranodal areas and the result of the PET+3. This last parameter together with age were the only ones with statistical significance (p=0.001 and 0.046 respectively), finding stage at diagnosis not significant. When comparing the results LH-05 with our previous clinical trial (LH-96) there is no difference in EFS and OS at 36 months (83% vs. 85% and 97 vs. 96%) but in LH-05 only 30% received more than 3 cycles of ABVD and IFRT compared to 61% and 100% in LH-96. This reduces the exposure to chemo and radiotherapy.
Conclusion
With PET-CT adapted therapy for all stages of HL after 3 ABVD, 260 pts. received only 3 cycles of ABVD as initial therapy with an EFS and OS of 91% and 98% at 36 months. In the Cox regression model, PET-CT at completion of treatment was the most significant factor associated to EFS. Treatment with 3 cycles of ABVD can be adequate for pts. with negative PET-CT+3 regardless their stage at diagnosis
Session topic: First-line treatment of Hodgkin Lymphoma
Keyword(s): Hodgkin's lymphoma, PET, Therapy
Type: Oral Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 12:15 - 12:30
Location: Hall A2
Background
Positron emission tomography using fluoro-2-deoxy-d-glucose (PET-CT) is an important tool for treatment response assessment in Hodgkin Lymphoma (HL) treated with ABVD.
Aims
Adapt therapy to all stage of Hodgkin Lymphoma to the result of PET-CT after 3 ABVD (PET-CT+3). Reduce therapy in pts. who achieve early CR with negative PET-CT. Intensify treatment, in pts. with positive PET-CT after 3 ABVD. Achieve CR, event free survival (EFS) and overall survival (OS), as good as in our historical control (LH -96), when we used 3-6 ABVD adapted to stage plus involved field radio therapy (IFRT) in all pts
Methods
Four hundred and one newly diagnosed pts. with HL Stages I-IV have been included (LH-05). All pts. received 3 ABVD and were evaluated with a PET-CT (PET-CT +3). Pts. with a negative PET-CT+3 were considered in CR and received no further therapy. Pts in partial response (PR) completed 6 ABVD and IFRT on PET-CT positive areas. Pts with less than PR received salvaje chemotherapy. Three hundred and seventy seven pts have been evaluated. With a median age of 35 yrs.and 38% age older than 59 years. Two hundred and twenty eight 860%9 presented with localized stage (I-IIA) and 144 (40%) presented with advanced stage (IIB-III-IV).
Results
Of all pts. 260 (69%) achieved CR with negative PET-CT + 3, 117 (31%) were PET-CT+3 positive, 101 pts. were in PR with chemo-sensitive disease and completed a total of 6 ABVD + IFRT in PET-CT positive areas. Eighty-two (81%) achieved CR. With a median follow up of 68 months the EFS and OS at 3 years is 80% and 96% respectively. Pts with negative PET-CT +3 had an EFS of 90% both for localized and advances stage, compared to 58% for pts. with positive PET-CT+3 and loc. stage and 5%for with a positive PET-TC+3 and adv. stage. We perform a multivariate analysis for EFS which included age, stage, IPS, bulky disease, extranodal areas and the result of the PET+3. This last parameter together with age were the only ones with statistical significance (p=0.001 and 0.046 respectively), finding stage at diagnosis not significant. When comparing the results LH-05 with our previous clinical trial (LH-96) there is no difference in EFS and OS at 36 months (83% vs. 85% and 97 vs. 96%) but in LH-05 only 30% received more than 3 cycles of ABVD and IFRT compared to 61% and 100% in LH-96. This reduces the exposure to chemo and radiotherapy.
Conclusion
With PET-CT adapted therapy for all stages of HL after 3 ABVD, 260 pts. received only 3 cycles of ABVD as initial therapy with an EFS and OS of 91% and 98% at 36 months. In the Cox regression model, PET-CT at completion of treatment was the most significant factor associated to EFS. Treatment with 3 cycles of ABVD can be adequate for pts. with negative PET-CT+3 regardless their stage at diagnosis
Session topic: First-line treatment of Hodgkin Lymphoma
Keyword(s): Hodgkin's lymphoma, PET, Therapy
Abstract: S108
Type: Oral Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 12:15 - 12:30
Location: Hall A2
Background
Positron emission tomography using fluoro-2-deoxy-d-glucose (PET-CT) is an important tool for treatment response assessment in Hodgkin Lymphoma (HL) treated with ABVD.
Aims
Adapt therapy to all stage of Hodgkin Lymphoma to the result of PET-CT after 3 ABVD (PET-CT+3). Reduce therapy in pts. who achieve early CR with negative PET-CT. Intensify treatment, in pts. with positive PET-CT after 3 ABVD. Achieve CR, event free survival (EFS) and overall survival (OS), as good as in our historical control (LH -96), when we used 3-6 ABVD adapted to stage plus involved field radio therapy (IFRT) in all pts
Methods
Four hundred and one newly diagnosed pts. with HL Stages I-IV have been included (LH-05). All pts. received 3 ABVD and were evaluated with a PET-CT (PET-CT +3). Pts. with a negative PET-CT+3 were considered in CR and received no further therapy. Pts in partial response (PR) completed 6 ABVD and IFRT on PET-CT positive areas. Pts with less than PR received salvaje chemotherapy. Three hundred and seventy seven pts have been evaluated. With a median age of 35 yrs.and 38% age older than 59 years. Two hundred and twenty eight 860%9 presented with localized stage (I-IIA) and 144 (40%) presented with advanced stage (IIB-III-IV).
Results
Of all pts. 260 (69%) achieved CR with negative PET-CT + 3, 117 (31%) were PET-CT+3 positive, 101 pts. were in PR with chemo-sensitive disease and completed a total of 6 ABVD + IFRT in PET-CT positive areas. Eighty-two (81%) achieved CR. With a median follow up of 68 months the EFS and OS at 3 years is 80% and 96% respectively. Pts with negative PET-CT +3 had an EFS of 90% both for localized and advances stage, compared to 58% for pts. with positive PET-CT+3 and loc. stage and 5%for with a positive PET-TC+3 and adv. stage. We perform a multivariate analysis for EFS which included age, stage, IPS, bulky disease, extranodal areas and the result of the PET+3. This last parameter together with age were the only ones with statistical significance (p=0.001 and 0.046 respectively), finding stage at diagnosis not significant. When comparing the results LH-05 with our previous clinical trial (LH-96) there is no difference in EFS and OS at 36 months (83% vs. 85% and 97 vs. 96%) but in LH-05 only 30% received more than 3 cycles of ABVD and IFRT compared to 61% and 100% in LH-96. This reduces the exposure to chemo and radiotherapy.
Conclusion
With PET-CT adapted therapy for all stages of HL after 3 ABVD, 260 pts. received only 3 cycles of ABVD as initial therapy with an EFS and OS of 91% and 98% at 36 months. In the Cox regression model, PET-CT at completion of treatment was the most significant factor associated to EFS. Treatment with 3 cycles of ABVD can be adequate for pts. with negative PET-CT+3 regardless their stage at diagnosis
Session topic: First-line treatment of Hodgkin Lymphoma
Keyword(s): Hodgkin's lymphoma, PET, Therapy
Type: Oral Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 12:15 - 12:30
Location: Hall A2
Background
Positron emission tomography using fluoro-2-deoxy-d-glucose (PET-CT) is an important tool for treatment response assessment in Hodgkin Lymphoma (HL) treated with ABVD.
Aims
Adapt therapy to all stage of Hodgkin Lymphoma to the result of PET-CT after 3 ABVD (PET-CT+3). Reduce therapy in pts. who achieve early CR with negative PET-CT. Intensify treatment, in pts. with positive PET-CT after 3 ABVD. Achieve CR, event free survival (EFS) and overall survival (OS), as good as in our historical control (LH -96), when we used 3-6 ABVD adapted to stage plus involved field radio therapy (IFRT) in all pts
Methods
Four hundred and one newly diagnosed pts. with HL Stages I-IV have been included (LH-05). All pts. received 3 ABVD and were evaluated with a PET-CT (PET-CT +3). Pts. with a negative PET-CT+3 were considered in CR and received no further therapy. Pts in partial response (PR) completed 6 ABVD and IFRT on PET-CT positive areas. Pts with less than PR received salvaje chemotherapy. Three hundred and seventy seven pts have been evaluated. With a median age of 35 yrs.and 38% age older than 59 years. Two hundred and twenty eight 860%9 presented with localized stage (I-IIA) and 144 (40%) presented with advanced stage (IIB-III-IV).
Results
Of all pts. 260 (69%) achieved CR with negative PET-CT + 3, 117 (31%) were PET-CT+3 positive, 101 pts. were in PR with chemo-sensitive disease and completed a total of 6 ABVD + IFRT in PET-CT positive areas. Eighty-two (81%) achieved CR. With a median follow up of 68 months the EFS and OS at 3 years is 80% and 96% respectively. Pts with negative PET-CT +3 had an EFS of 90% both for localized and advances stage, compared to 58% for pts. with positive PET-CT+3 and loc. stage and 5%for with a positive PET-TC+3 and adv. stage. We perform a multivariate analysis for EFS which included age, stage, IPS, bulky disease, extranodal areas and the result of the PET+3. This last parameter together with age were the only ones with statistical significance (p=0.001 and 0.046 respectively), finding stage at diagnosis not significant. When comparing the results LH-05 with our previous clinical trial (LH-96) there is no difference in EFS and OS at 36 months (83% vs. 85% and 97 vs. 96%) but in LH-05 only 30% received more than 3 cycles of ABVD and IFRT compared to 61% and 100% in LH-96. This reduces the exposure to chemo and radiotherapy.
Conclusion
With PET-CT adapted therapy for all stages of HL after 3 ABVD, 260 pts. received only 3 cycles of ABVD as initial therapy with an EFS and OS of 91% and 98% at 36 months. In the Cox regression model, PET-CT at completion of treatment was the most significant factor associated to EFS. Treatment with 3 cycles of ABVD can be adequate for pts. with negative PET-CT+3 regardless their stage at diagnosis
Session topic: First-line treatment of Hodgkin Lymphoma
Keyword(s): Hodgkin's lymphoma, PET, Therapy
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