Reclassifying patients with early-stage Hodgkin lymphoma based on functional radiographic markers at presentation

Mani Akhtari, Sarah A. Milgrom, Chelsea C. Pinnix, Jay P. Reddy, Wenli Dong, Grace L. Smith, Osama Mawlawi, Zeinab Abou Yehia, Jillian Gunther, Eleanor M. Osborne, Therese Y. Andraos, Christine F. Wogan, Eric Rohren, Naveen Garg, Hubert Chuang, Joseph D. Khoury, Yasuhiro Oki, Michelle Fanale and Bouthaina S. Dabaja

Key Points

  • Radiographic parameters obtained from the initial PET-CT correlate strongly with survival outcomes in early-stage HL.

  • Early-stage unfavorable HL patients can be subdivided into low- and high-risk categories based on these radiographic parameters.

Publisher's Note: There is a Blood Commentary on this article in this issue.


The presence of bulky disease in Hodgkin lymphoma (HL), traditionally defined with a 1-dimensional measurement, can change a patient’s risk grouping and thus the treatment approach. We hypothesized that 3-dimensional measurements of disease burden obtained from baseline 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scans, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), would more accurately risk-stratify patients. To test this hypothesis, we reviewed pretreatment PET-CT scans of patients with stage I-II HL treated at our institution between 2003 and 2013. Disease was delineated on prechemotherapy PET-CT scans by 2 methods: (1) manual contouring and (2) subthresholding of these contours to give the tumor volume with standardized uptake value ≥2.5. MTV and TLG were extracted from the threshold volumes (MTVt, TLGt) and from the manually contoured soft-tissue volumes. At a median follow-up of 4.96 years for the 267 patients evaluated, 27 patients were diagnosed with relapsed or refractory disease and 12 died. Both MTVt and TLGt were highly correlated with freedom from progression and were dichotomized with 80th percentile cutoff values of 268 and 1703, respectively. Consideration of MTV and TLG enabled restratification of early unfavorable HL patients as having low- and high-risk disease. We conclude that MTV and TLG provide a potential measure of tumor burden to aid in risk stratification of early unfavorable HL patients.

  • Submitted April 3, 2017.
  • Accepted October 3, 2017.
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