Positron emission tomography has a high negative predictive value for progression or early relapse for patients with residual disease after first-line chemotherapy in advanced-stage Hodgkin lymphoma
Positron emission tomography has a high negative predictive value for progression or early relapse for patients with residual disease after first-line chemotherapy in advanced-stage Hodgkin lymphoma
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DOI：
10.1182/blood-2008-06-155820
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发表时间：
2008-11-15
期刊：
影响因子：
20.3
通讯作者：
Engert, Andreas
中科院分区：
文献类型：
--
作者：
Kobe, Carsten;Dietlein, Markus;Engert, Andreas
在德国霍奇金研究组的HD 15试验中，评价了使用[（18）F]-氟脱氧葡萄糖的正电子发射断层扫描（PET）在晚期霍奇金淋巴瘤（HL）中的阴性预测值（NPV）。共有817例患者入组并随机分配接受基于BEACOPP的化疗。在完成化疗后，通过PET对311例患者的直径大于或等于2.5 cm的残留病变进行了评估。PET的NPV定义为PET（-）患者在PET审查小组后12个月内无进展、复发或放疗的比例。PET（-）患者的无进展生存率为96%（95%置信区间[CI]，94%-99%），PET（-）患者为86%（95% CI，78%-95%，P = 0.011）。本分析中PET的NPV为94%（95% CI，91%-97%）。因此，与完全缓解患者相比，PET（-）残留病变患者可以省略巩固放疗，而不会增加疾病进展或早期复发的风险。必须等待这一发现对5年总生存率的影响。在此之前，PET引导的HL患者反应适应性治疗似乎是一种有前途的方法，应在临床试验中进一步评估。本试验在http://isrctn.org研究中注册为#ISRCTN32443041。（血。2008; 112：3989- 3994）
In the HD15 trial of the German Hodgkin Study Group, the negative predictive value (NPV) of positron emission tomography (PET) using [(18)F]-fluorodeoxyglucose in advanced-stage Hodgkin lymphoma (HL) was evaluated. A total of 817 patients were enrolled and randomly assigned to receive BEACOPP-based chemotherapy. After completion of chemotherapy, residual disease measuring more than or equal to 2.5 cm in diameter was assessed by PET in 311 patients. The NPV of PET was defined as the proportion of PET(-) patients without progression, relapse, or irradiation within 12 months after PET review panel. The progression-free survival was 96% for PET(-) patients (95% confidence interval [CI], 94%-99%) and 86% for PET(-) patients (95% CI, 78%-95%, P = .011). The NPV for PET in this analysis was 94% (95% CI, 91%-97%). Thus, consolidation radiotherapy can be omitted in PET(-) patients with residual disease without increasing the risk for progression or early relapse compared with patients in complete remission. The impact of this finding on the overall survival at 5 years must be awaited. Until then, response adapted therapy guided by PET for HL patients seems to be a promising approach that should be further evaluated in clinical trials. This trial is registered at http://isrctn.org study as #ISRCTN32443041. (Blood. 2008; 112: 3989- 3994)