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Prognostic significance of baseline metabolic tumor volume in relapsed and refractory Hodgkin lymphoma

Alison J. Moskowitz, Heiko Schöder, Somali Gavane, Katie L. Thoren, Martin Fleisher, Joachim Yahalom, Susan J. McCall, Briana R. Cadzin, Stephanie Y. Fox, John Gerecitano, Ravinder Grewal, Paul A. Hamlin, Steven M. Horwitz, Anita Kumar, Matthew Matasar, Andy Ni, Ariela Noy, M. Lia Palomba, Miguel-Angel Perales, Carol S. Portlock, Craig Sauter, David Straus, Anas Younes, Andrew D. Zelenetz and Craig H. Moskowitz

Key points

  • Baseline metabolic tumor volume and presence of refractory disease predicts outcome for patients with relapsed/refractory Hodgkin lymphoma.

  • Metabolic tumor volume improves the predictive power of pre-transplant PET in relapsed/refractory Hodgkin lymphoma.

Abstract

Identification of prognostic factors for patients with relapsed or refractory (rel/ref) Hodgkin lymphoma (HL) is essential for optimizing therapy with risk-adapted approaches. In our phase II study of PET-adapted salvage therapy with brentuximab vedotin (BV) and augmented ifosfamide, carboplatin, etoposide (augICE) we assessed clinical factors, quantitative PET assessments, and cytokines/chemokine values. Transplant-eligible patients with rel/ref HL received 2 (cohort 1) or 3 (cohort 2) cycles of weekly BV; PET-negative (Deauville ≤ 2) patients proceeded to autologous stem cell transplant (ASCT) while PET-positive patients received augICE before ASCT. Serum cytokine and chemokine levels were measured at baseline and after BV. Metabolic tumor volume (MTV) and total lesion glycolysis were measured at baseline, after BV and after augICE. 65 patients enrolled (45 cohort 1, 20 cohort 2); 49 (75%) achieved CR and 64 proceeded to ASCT. 3-year overall survival and EFS were 95% and 82%. Factors predictive for EFS by multivariate analysis were baseline MTV (bMTV) (p<0.001) and refractory disease (p=0.003). Low bMTV (<109.5cm3) and relapsed disease identified a favorable group (3-yr EFS 100%). For transplanted patients, bMTV and pre-ASCT PET were independently prognostic; 3-year EFS for pre-ASCT PET-positive patients with low bMTV was 86%. In this phase II study of PET-adapted therapy with BV and augICE for rel/ref HL, bMTV and refractory disease were independent prognostic factors for EFS. Furthermore, bMTV improved the predictive power of pre-ASCT PET. Future studies should optimize efficacy and tolerability of salvage therapy by stratifying patients according to risk factors such as bMTV.

  • Submitted June 12, 2017.
  • Accepted August 14, 2017.