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Conference/Presentation Title: | 18f-FDG PET-CT assessment of responses to salvage therapy and autologous stem cell transplant (ASCT) in relapsed/refractory classical hodgkin lymphoma (cHL). | Authors: | Collins G.;Tatarczuch M.;Hildyard C.;Subesinghe M.;Eyre T.A. | Monash Health Department(s): | Haematology | Institution: | (Tatarczuch) Department of Haematology, Monash Health, Clayton, Australia (Tatarczuch) Churchill Hospital, Haematology Department, Oxford University Hospital, Oxford, United Kingdom (Hildyard, Eyre) Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom (Subesinghe) Radiology, Oxford University Hospital, Oxford, United Kingdom (Collins) Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford, United Kingdom | Presentation/Conference Date: | 29-Jan-2018 | Copyright year: | 2017 | Publisher: | American Society of Hematology | Publication information: | Blood. Conference: 59th Annual Meeting of the American Society of Hematology, ASH 2017. Atlanta, GA United States. 130 (Supplement 1) (no pagination), 2017. Date of Publication: December 2017. | Abstract: | Background: Approximately 25% of patients with cHL have relapsed or refractory (r/r) disease. Although salvage chemo-radiotherapy followed by autologous stem cell transplant (ASCT) offers the best chance of freedom from treatment failure (FFTF) (~50%), a portion patients have a poor prognosis despite this approach. Traditional prognostic scores are less well validated than in de novo disease, and hence F-FDG PET-CT, the gold-standard imaging modality in cHL, has an increasing role as a powerful prognostic indicator in this context. Our aims were a) to compare response rates to salvage therapy using F-FDG PET-CT (reported according to Lugano 2014 criteria) with trialreported outcomes; and b) to assess the prognostic value of F-FDG PET-CT in this context. Method(s): Retrospective data were collected on r/r cHL patients treated across 3 UK hospital sites (2011-2017). PET-CT scans were retrospectively reviewed according to Lugano 2014 response criteria i.e. complete metabolic response (CMR), partial metabolic response (PMR), no metabolic response (NMR) and progressive metabolic disease (PMD). Prognostic scores were calculated as described by Jostings et al. 2000. Result(s): 34 patients were identified: 21 with refractory cHL (<90 days) and 13 with relapsed disease. Median age was 43 years (range 14-77). Median time to relapse was 94 weeks (193-687). 100% patients had a prognostic score of <2, with 90% <1 (score unable to be calculated: n=2). 88% patients achieved an overall response (ORR) after 1 line salvage therapy, with 33% achieving CMR and 55% PMR ( F-FDG PET not performed: n=1). Patients were treated with 1-4 lines of salvage therapy (median= 1), with 33% receiving brentuximab vedotin. Of the 82% patients that proceeded to ASCT, 46% were in CMR, 50% were in PMR and 4% had mixed disease response. 47% of patients achieved CMR post-ASCT, with FFTF in 37% (Post-ASCT FFDG PET unavailable: n=3). As shown in the table below, there was a 55% rate of FFTF in patients with CMR post 1 line salvage therapy, compared with a 23% rate of FFTF in patients with PMR post 1 line salvage. 38% of patients with an overall CMR pre-ASCT had FFTF, compared with 43% with overall PMR. Conclusion(s): There is a wide discrepancy in FFTF, comparable with previous trial data, between patients achieving CMR and those achieving a PMR on F-FDG PET-CT post 1 line salvage chemotherapy. However, patients who received multiple lines of salvage therapy achieved similar rates of FF2F, irrespective of their metabolic response on their pre-ASCT F-FDG PET-CT. This suggests that F-FDG PET-CT may have limited prognostic value in this setting (Table presented). | Conference Start Date: | 2017-12-09 | Conference End Date: | 2017-12-12 | ISSN: | 1528-0020 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/38972 | Type: | Conference Abstract | Subjects: | clinical article controlled clinical trial controlled study drug therapy female human human cell male metabolic disorder outcome assessment *positron emission tomography-computed tomography recurrent disease relapse retrospective study *salvage therapy *stem cell treatment failure brentuximab vedotin conference abstract cancer chemotherapy adult cancer prognosis *cancer recurrence *classical Hodgkin lymphoma metabolic disorder outcome assessment *positron emission tomography-computed tomography recurrent disease relapse retrospective study *salvage therapy *stem cell treatment failure controlled study drug therapy clinical article *classical Hodgkin lymphoma *cancer recurrence cancer prognosis cancer chemotherapy adult controlled clinical trial female human human cell male |
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