Sarah A Milgrom1, Jihyun Kim2,3, Alin Chirindel4, Jongho Kim4, Qinglin Pei5, Lu Chen5, Allen Buxton6, Sandy Kessel7, Jeffrey Leal4, Kathleen M McCarten7, Bradford S Hoppe8, Suzanne L Wolden9, Cindy L Schwartz10, Debra L Friedman11,12, Kara M Kelly13, Steve Y Cho2,14. 1. Department of Radiation Oncology, University of Colorado, Aurora, Colorado, USA. 2. Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA. 3. Division of Nuclear Medicine, Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 4. Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA. 5. Children's Oncology Group, Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida, USA. 6. Children's Oncology Group, Statistics and Data Center, Monrovia, California, USA. 7. Imaging and Radiation Oncology Core Group, Lincoln, Rhode Island, USA. 8. Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA. 9. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA. 10. Division of Pediatric Hematology, Oncology, and BMT, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. 11. Division of Pediatric Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 12. Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA. 13. Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, and University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA. 14. University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA.
Abstract
BACKGROUND: Positron emission tomography (PET)-based measures of baseline total-body tumor burden may improve risk stratification in intermediate-risk Hodgkin lymphoma (HL). MATERIALS AND METHODS: Evaluable patients were identified from a cohort treated homogeneously with the same combined modality regimen on the Children's Oncology Group AHOD0031 study. Eligible patients had high-quality baseline PET scans. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were each measured based on 15 thresholds for every patient. Univariate and multivariable Cox regression and Kaplan-Meier survival analyses assessed for an association of MTV and TLG with event-free survival (EFS). RESULTS: From the AHOD0031 cohort (n = 1712), 86 patients were identified who (i) were treated with four cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone, cyclophosphamide (ABVE-PC) chemotherapy followed by involved field radiotherapy, and (ii) had a baseline PET scan that was amenable to quantitative analysis. Based on univariate Cox regression analysis, six PET-derived parameters were significantly associated with EFS. For each of these, Kaplan-Meier analyses and the log-rank test were used to compare patients with highest tumor burden (i.e., highest 15%) to the remainder of the cohort. EFS was significantly associated with all six PET parameters (all p < .029). In a multivariable model controlling for important covariates including disease bulk and response to chemotherapy, MTV2BP was significantly associated with EFS (p = .012). CONCLUSION: Multiple baseline PET-derived volumetric parameters were associated with EFS. MTV2BP was highly associated with EFS when controlling for disease bulk and response to chemotherapy. Incorporation of baseline MTV into risk-based treatment algorithms may improve outcomes in intermediate-risk HL.
BACKGROUND: Positron emission tomography (PET)-based measures of baseline total-body tumor burden may improve risk stratification in intermediate-risk Hodgkin lymphoma (HL). MATERIALS AND METHODS: Evaluable patients were identified from a cohort treated homogeneously with the same combined modality regimen on the Children's Oncology Group AHOD0031 study. Eligible patients had high-quality baseline PET scans. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were each measured based on 15 thresholds for every patient. Univariate and multivariable Cox regression and Kaplan-Meier survival analyses assessed for an association of MTV and TLG with event-free survival (EFS). RESULTS: From the AHOD0031 cohort (n = 1712), 86 patients were identified who (i) were treated with four cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone, cyclophosphamide (ABVE-PC) chemotherapy followed by involved field radiotherapy, and (ii) had a baseline PET scan that was amenable to quantitative analysis. Based on univariate Cox regression analysis, six PET-derived parameters were significantly associated with EFS. For each of these, Kaplan-Meier analyses and the log-rank test were used to compare patients with highest tumor burden (i.e., highest 15%) to the remainder of the cohort. EFS was significantly associated with all six PET parameters (all p < .029). In a multivariable model controlling for important covariates including disease bulk and response to chemotherapy, MTV2BP was significantly associated with EFS (p = .012). CONCLUSION: Multiple baseline PET-derived volumetric parameters were associated with EFS. MTV2BP was highly associated with EFS when controlling for disease bulk and response to chemotherapy. Incorporation of baseline MTV into risk-based treatment algorithms may improve outcomes in intermediate-risk HL.
Authors: Kara M Kelly; Richard Sposto; Raymond Hutchinson; Vickie Massey; Kathleen McCarten; Sherrie Perkins; Mark Lones; Doojduen Villaluna; Michael Weiner Journal: Blood Date: 2010-11-15 Impact factor: 22.113
Authors: T A Lister; D Crowther; S B Sutcliffe; E Glatstein; G P Canellos; R C Young; S A Rosenberg; C A Coltman; M Tubiana Journal: J Clin Oncol Date: 1989-11 Impact factor: 44.544
Authors: Debra L Friedman; Lu Chen; Suzanne Wolden; Allen Buxton; Kathleen McCarten; Thomas J FitzGerald; Sandra Kessel; Pedro A De Alarcon; Allen R Chen; Nathan Kobrinsky; Peter Ehrlich; Robert E Hutchison; Louis S Constine; Cindy L Schwartz Journal: J Clin Oncol Date: 2014-10-13 Impact factor: 44.544
Authors: Jamie E Flerlage; Kara M Kelly; Auke Beishuizen; Steve Cho; Pedro A De Alarcon; Ute Dieckmann; Richard A Drachtman; Bradford S Hoppe; Scott C Howard; Sue C Kaste; Regine Kluge; Lars Kurch; Judith Landman-Parker; Jocelyn Lewis; Michael P Link; Kathleen McCarten; Angela Punnett; Dietrich Stoevesandt; Stephan D Voss; William Hamish Wallace; Christine Mauz-Körholz; Monika L Metzger Journal: Pediatr Blood Cancer Date: 2017-01-18 Impact factor: 3.167
Authors: Anna S Holmqvist; Yanjun Chen; Jennifer Berano Teh; Canlan Sun; Jillian M Birch; Cor van den Bos; Lisa R Diller; Kimberley Dilley; Jill Ginsberg; Laura T Martin; Rajaram Nagarajan; Paul C Nathan; Joseph P Neglia; Monica Terenziani; David Tishler; Anna T Meadows; Leslie L Robison; Odile Oberlin; Smita Bhatia Journal: Cancer Date: 2018-12-17 Impact factor: 6.860
Authors: Burton E Appel; Lu Chen; Allen Buxton; Suzanne L Wolden; David C Hodgson; James B Nachman Journal: Pediatr Blood Cancer Date: 2012-07-27 Impact factor: 3.167
Authors: Nick Figura; Stella Flampouri; Nancy P Mendenhall; Christopher G Morris; Barry McCook; Savas Ozdemir; William Slayton; Eric Sandler; Bradford S Hoppe Journal: Adv Radiat Oncol Date: 2017-01-18