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Purpose: Response-adapted treatment using early interim functional imaging with PET after two cycles of chemotherapy (PET-2) for advanced-stage Hodgkin's lymphoma (AS-HL) is the standard of care in several countries. However, the distribution of residual metabolic disease in PET-2 and the prognostic relevance of multiple involved regions have not been reported to date. Methods: We retrospectively analyzed data from all PET-2-positive patients included in HD18. Residual tissue was visually compared with reference regions according to the Deauville score (DS). PET-2 positivity was defined as residual tissue with uptake above the liver (DS4). PFS was defined as the time from staging until progression, relapse, or death from any cause, or to the day when information was last received on the patient's disease status and analyzed using Kaplan-Meier and Cox regressions. Comparisons were made between patients with 1–2 and >2 positive regions in PET-2 as well as patients without PET-2-positive regions randomized into comparator arms of HD18. Results: Between 2008 and 2014, 1964 patients with newly diagnosed AS-HL were recruited in HD18 and randomized following their PET-2 scan. Of these, 480 patients had a positive PET-2 and were eligible for this analysis. Upper and lower mediastinum in almost half of all patients: 230 (47.9%) and 195 (40.6%), respectively. 372 (77.5%) of patients have 1–2 positive regions in PET-2. 5y-PFS for patients with 1–2 regions was 91.7% (CI95: 88.7–94.6) vs. 81.8% (CI95: 74.2–90.1) for those with >2 regions with a corresponding hazard ratio (HR) of 2.2 (CI95: 1.2–4.0). Compared with patients without PET-2-positive disease receiving 6–8 cycles of chemotherapy, patients with 1–2 had a higher risk for a PFS event (HR 1.35; CI95 0.81–2.28), but it was not statistically significant (p=0.25). Patients with >2 PET-2-positive lesions had a significantly higher risk (HR 2.95; CI95: 1.62–5.37; p<0.001). Conclusion: PET-2-positive residuals of AS-HL are mostly located in the mediastinum, and a majority of patients have few affected regions. The risk of progression was twofold higher in patients with more than two positive regions in PET-2. [ABSTRACT FROM AUTHOR]

Objectives: The prognostic relevance of metabolic tumor volume (MTV) having recently been demonstrated in patients with early‐stage favorable and advanced‐stage Hodgkin lymphoma. The current study aimed to assess the potential prognostic value of 18F‐fluorodeoxyglucose (FDG) positron emission tomography (PET) in early‐stage unfavorable Hodgkin lymphoma patients treated within the German Hodgkin Study Group HD17 trial. Methods: 18F‐FDG PET/CT images were available for MTV analysis in 154 cases. We used three different threshold methods (SUV2.5, SUV4.0, and SUV41%) to calculate MTV. Receiver‐operating‐characteristic analysis was performed to describe the value of these parameters in predicting an adequate therapy response. Therapy response was evaluated as PET negativity after 2 cycles of eBEACOPP followed by 2 cycles of ABVD. Results: All three threshold methods analyzed for MTV showed a positive correlation with the PET response after chemotherapy. Areas under the curve (AUC) were 0.70 (95% CI 0.53–0.87) and 0.65 (0.50–0.80) using the fixed thresholds of SUV4.0 and SUV2.5, respectively, for MTV‐ calculation. The calculation of MTV using a relative threshold of SUV41% showed an AUC of 0.63 (0.47–0.79). Conclusions: MTV does have predictive value after chemotherapy in early‐stage unfavorable Hodgkin lymphoma, particularly when the fixed threshold of SUV4.0 is used for MTV calculation. Trial registration: ClinicalTrials.gov NCT01356680. [ABSTRACT FROM AUTHOR]

Value of bone marrow biopsy in Hodgkin lymphoma patients staged by FDG PET: results from the German Hodgkin Study Group trials HD16, HD17, and HD18. Keywords: bone marrow involvement; Hodgkin lymphoma; intensive chemotherapy; positron emission tomography; prognosis EN bone marrow involvement Hodgkin lymphoma intensive chemotherapy positron emission tomography prognosis e5 e8 4 03/30/22 20220401 NES 220401 Newly diagnosed advanced-stage Hodgkin lymphoma (HL) has become a curable malignancy in the vast majority of patients.1,2 With response-adapted treatment comprising four or six cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) in escalated dose (eBEACOPP), outstanding cure rates are achieved through a comparatively short and safe treatment approach.3,4 Around 5 to 15% of HL patients present with bone marrow (BM) involvement, as assessed by conventional biopsy.5-7 According to the Ann Arbor classification, BM involvement reflects a high tumour burden and therefore defines stage IV disease.8 Positron emission tomography (PET) using SP 18 sp F-fluoro-2-deoxy-d-glucose (FDG) has demonstrated superior sensitivity compared to BM biopsy.9-11 In paediatric advanced HL, only individuals showing three or more BM lesions were assumed to be at higher risk for progression or relapse.12 Yet, there are insufficient data available to establish whether this also holds true for adult patients receiving intensive first-line treatment. PET imaging was shown to identify BM lesions at a higher sensitivity than biopsy of the iliac bone and has become part of diagnostic work-up in most countries.15 Current study protocols no longer recommend BM biopsy in PET-negative individuals. [Extracted from the article]