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Positron Emission Tomography-Based Assessment of Metabolic Tumor Volume Predicts Survival after Autologous Hematopoietic Cell Transplantation for Hodgkin Lymphoma

Vít Procházka, Rakhee S Gawande, Zuzan Cayci, Jerry W Froelich, Qing Cao, Chris Wilke, Kathryn Dusenbery, Daniel J Weisdorf, Veronika Bachanova
Biology of Blood and Marrow Transplantation 2017 September 20
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 prior to AHCT may help to identify patients likely to benefit from AHCT. We aimed to determine whether PET-based quantitative parameters of total metabolic tumor volume (TMTV), total lesion glycolysis (TLG), and maximal standardized uptake volume (SUVmax) measured prior to AHCT predict progression-free survival (PFS) after transplant. Pre-transplant PET/CT images of 96 consecutive patients with R/R HL were analyzed. Median TMTV, TLG, and SUVmax were 7.97 cm3 (range 1.3-102.1cm3), 23.7 (4.0-813.1), and 5.23 (2.7-23.2). Two-year PFS in patients with high metabolic tumor volume TMTVhigh (>median; n=17) was only 12% (95% CI 1-38%) compared to 53% (95% CI 28-73%; P=0.05) in patients with TMTVlow (≤median; n=17) and 63% (95% CI; 50-74%) in 61 patients with no metabolically active tumor (TMTV0; P>0.01). In concordance, high TLG (>19) and SUVmax (>4.9) predicted inferior 2-year PFS. In multivariate analysis, patients with TMTVhigh had 3.5-fold higher risk of treatment failure compared to TMTV0/TMTVlow (hazard ratio 3.49 (1.75-6.93; p<0.01). Deauville (D) scores of 4-5 prior to AHCT predicted worse PFS compared to D-scores of 1-3 (HR 3.7, 95% CI, 1.92-7.28; p<0.01). Yet, TMTV and D-scores were disconcordant in 12 subjects; nine patients in the D4 group with TMTVlow had 2-year PFS of 44% (95% CI 14- 72%), which was 2-fold higher than predicted by D4 score. In conclusion, in patients with R/R HL and PET positive residual disease, high TMTV can identify very poor AHCT responders. Patients with low TMTV, TLG, and SUVmax prior to AHCT have similar outcomes to those without metabolically active disease.


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