Autologous hematopoietic cell transplantation (AHCT) is curative for 60% of patients with relapsed or refractory Hodgkin lymphoma (R/R HL). A more precise assessment of the depth of remission before AHCT may help to identify patients likely to benefit from AHCT. We aimed to determine whether positron emission tomography (PET)-based quantitative parameters of total metabolic tumor volume (TMTV), total lesion glycolysis (TLG), and maximal standardized uptake volume (SUV max ) measured before AHCT predict progression-free survival (PFS) after transplant. Pretransplant PET/computed tomography images of 96 consecutive patients with R/R HL were analyzed. Median TMTV, TLG, and SUV max were 7.97 cm 3 (range, 1.3 to 102.1), 23.7 (range, 4.0 to 813.1), and 5.23 (range, 2.7 to 23.2). Two-year PFS in patients with high TMTV (TMTVhigh; more than median; n = 17) was only 12% (95% CI, 1% to 38%) compared with 53% (95% CI, 28% to 73%; P =.05) in patients with TMTVlow (lower or equal to median; n = 17) and 63% (95% CI, 50% to 74%) in 61 patients with no metabolically active tumor (TMTV0; P >.01). In concordance, high TLG (>19) and SUV max (>4.9) predicted inferior 2-year PFS. In multivariate analysis patients with TMTVhigh had a 3.5-fold higher risk of treatment failure compared with TMTV0/TMTVlow (HR, 3.49; 95% CI, 1.75 to 6.93; P <.01). Deauville (D)-scores of 4 to 5 before AHCT predicted worse PFS compared with D-scores of 1 to 3 (HR, 3.7; 95% CI, 1.92 to 7.28; P <.01). Yet, TMTV and D-scores were disconcordant in 12 subjects; 9 patients in the D4 group with TMTVlow had 2-year PFS of 44% (95% CI, 14% to 72%), which was 2-fold higher than predicted by D4 score. In conclusion, in patients with R/R HL and PET-positive residual disease, TMTVhigh can identify very poor AHCT responders. Patients with TMTVlow, TLG, and SUV max before AHCT have similar outcomes to those without metabolically active disease.
Bibliographical noteFunding Information:
Financial disclosure: Vít Procházka gratefully acknowledges the support of the J. W. Fulbright Commission ( http://www.fulbright.cz ) and University of Minnesota Proshek Scholar Fund . This study was kindly supported by IGA-LF-2017-007 and RVO 61989592 grants. Research reported in this publication was supported by National Institutes of Health grant P30 CA77598 using the Biostatistics and Bioinformatics Core and the Translational Therapy Laboratory shared resources of the Masonic Cancer Center, University of Minnesota and by the National Center for Advancing Translational Sciences of the National Institutes of Health award number UL1TR000114 . This work was also supported by American Society of Hematology Scholar Award (to VB) . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
- Autologous transplantation
- Hodgkin lymphoma
- Metabolic tumor volume
- Positron emission tomography