Persistent mediastinal FDG uptake on PET-CT after frontline therapy for Hodgkin lymphoma: biopsy, treat or observe?

Mattia Novo, Grzegorz S. Nowakowski, Thomas M. Habermann, Thomas E. Witzig, Ivana N. Micallef, Patrick B. Johnston, David J. Inwards, Barbara Botto, Kay M. Ristow, Jason R. Young, Umberto Vitolo, Stephen M. Ansell

Research output: Contribution to journalArticle

Abstract

Residual mediastinal FDG-uptake after frontline therapy for classical Hodgkin lymphoma (cHL) may constitute persistent disease or inflammatory changes. We analyzed practice patterns at two institutions to determine how often a mediastinal biopsy influenced patient management and outcome. Forty-two cases were eligible for review, mostly treated with ABVD. Twenty (group1) underwent a mediastinal biopsy and 22 did not (group2). In group1, 10/20 were positive for cHL and proceeded to salvage therapy (ST); 4/10 biopsy-negative patients were observed, and 6/10 received consolidative radiotherapy. Ten of 22 patients from group 2 were observed, 12/22 received ST. Ten of 14 observed patients remained PET-positive and 8/8 biopsies in these patients showed cHL. Deauville score (DS) 5 was associated with a positive biopsy (10/16). No overall survival difference between groups was observed. We conclude that observation and repeat a FDG-PET is reasonable for DS3-4 while for DS5, ST should be considered pending biopsy confirmation when feasible.

Original languageEnglish (US)
JournalLeukemia and Lymphoma
DOIs
StateAccepted/In press - Jan 1 2019

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Hodgkin Disease
Biopsy
Salvage Therapy
Therapeutics
Positron Emission Tomography Computed Tomography
Radiotherapy
Observation
Survival

Keywords

  • ABVD
  • Deauville score
  • FDG-PET
  • Hodgkin lymphoma

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

@article{36b4905221cb40a8b8b7df252a9216eb,
title = "Persistent mediastinal FDG uptake on PET-CT after frontline therapy for Hodgkin lymphoma: biopsy, treat or observe?",
abstract = "Residual mediastinal FDG-uptake after frontline therapy for classical Hodgkin lymphoma (cHL) may constitute persistent disease or inflammatory changes. We analyzed practice patterns at two institutions to determine how often a mediastinal biopsy influenced patient management and outcome. Forty-two cases were eligible for review, mostly treated with ABVD. Twenty (group1) underwent a mediastinal biopsy and 22 did not (group2). In group1, 10/20 were positive for cHL and proceeded to salvage therapy (ST); 4/10 biopsy-negative patients were observed, and 6/10 received consolidative radiotherapy. Ten of 22 patients from group 2 were observed, 12/22 received ST. Ten of 14 observed patients remained PET-positive and 8/8 biopsies in these patients showed cHL. Deauville score (DS) 5 was associated with a positive biopsy (10/16). No overall survival difference between groups was observed. We conclude that observation and repeat a FDG-PET is reasonable for DS3-4 while for DS5, ST should be considered pending biopsy confirmation when feasible.",
keywords = "ABVD, Deauville score, FDG-PET, Hodgkin lymphoma",
author = "Mattia Novo and Nowakowski, {Grzegorz S.} and Habermann, {Thomas M.} and Witzig, {Thomas E.} and Micallef, {Ivana N.} and Johnston, {Patrick B.} and Inwards, {David J.} and Barbara Botto and Ristow, {Kay M.} and Young, {Jason R.} and Umberto Vitolo and Ansell, {Stephen M.}",
year = "2019",
month = "1",
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doi = "10.1080/10428194.2019.1663422",
language = "English (US)",
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T1 - Persistent mediastinal FDG uptake on PET-CT after frontline therapy for Hodgkin lymphoma

T2 - biopsy, treat or observe?

AU - Novo, Mattia

AU - Nowakowski, Grzegorz S.

AU - Habermann, Thomas M.

AU - Witzig, Thomas E.

AU - Micallef, Ivana N.

AU - Johnston, Patrick B.

AU - Inwards, David J.

AU - Botto, Barbara

AU - Ristow, Kay M.

AU - Young, Jason R.

AU - Vitolo, Umberto

AU - Ansell, Stephen M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Residual mediastinal FDG-uptake after frontline therapy for classical Hodgkin lymphoma (cHL) may constitute persistent disease or inflammatory changes. We analyzed practice patterns at two institutions to determine how often a mediastinal biopsy influenced patient management and outcome. Forty-two cases were eligible for review, mostly treated with ABVD. Twenty (group1) underwent a mediastinal biopsy and 22 did not (group2). In group1, 10/20 were positive for cHL and proceeded to salvage therapy (ST); 4/10 biopsy-negative patients were observed, and 6/10 received consolidative radiotherapy. Ten of 22 patients from group 2 were observed, 12/22 received ST. Ten of 14 observed patients remained PET-positive and 8/8 biopsies in these patients showed cHL. Deauville score (DS) 5 was associated with a positive biopsy (10/16). No overall survival difference between groups was observed. We conclude that observation and repeat a FDG-PET is reasonable for DS3-4 while for DS5, ST should be considered pending biopsy confirmation when feasible.

AB - Residual mediastinal FDG-uptake after frontline therapy for classical Hodgkin lymphoma (cHL) may constitute persistent disease or inflammatory changes. We analyzed practice patterns at two institutions to determine how often a mediastinal biopsy influenced patient management and outcome. Forty-two cases were eligible for review, mostly treated with ABVD. Twenty (group1) underwent a mediastinal biopsy and 22 did not (group2). In group1, 10/20 were positive for cHL and proceeded to salvage therapy (ST); 4/10 biopsy-negative patients were observed, and 6/10 received consolidative radiotherapy. Ten of 22 patients from group 2 were observed, 12/22 received ST. Ten of 14 observed patients remained PET-positive and 8/8 biopsies in these patients showed cHL. Deauville score (DS) 5 was associated with a positive biopsy (10/16). No overall survival difference between groups was observed. We conclude that observation and repeat a FDG-PET is reasonable for DS3-4 while for DS5, ST should be considered pending biopsy confirmation when feasible.

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