Re-classifying 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 Hodgkin lymphoma.

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


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 2003–2013. Disease was delineated on pre-chemotherapy PET-CT scans by two methods: 1) manual contouring, and 2) sub-thresholding of these contours to give the tumor volume with SUV≥2.5. MTV and TLG were extracted from the threshold volumes (MTVt, TLGt), as well as from the manually contoured soft-tissue volumes (MTVst, TLGst). At a median follow-up time of 4.96 years for the 267 patients evaluated, 27 patients were diagnosed with relapsed or refractory disease and 12 patients died. Both MTVt and TLGt were highly correlated with freedom from progression (FFP) and were dichotomized with 80th percentile cut-off values of 268 and 1703, respectively. Consideration of MTV and TLG enabled re-stratification of early-unfavorable HL patients as having low-risk 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.