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Adapted Treatment Guided by Interim PET-CT Scan in Advanced Hodgkin’s Lymphoma

Open access
Johnson, Peter, Federico, Massimo, Kirkwood, Amy, Fosså, Alexander, Berkahn, Leanne, Carella, Angelo, d’Amore, Francesco, Enblad, Gunilla, Franceschetto, Antonella, Fulham, Michael, Luminari, Stefano, O’Doherty, Michael, Patrick, Pip, Roberts, Thomas, Sidra, Gamal, Stevens, Lindsey, Smith, Paul, Trotman, Judith, Viney, Zaid, Radford, John, Barrington, Sally·2016·New England Journal of Medicine
DOI 10.1056/nejmoa1510093
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Abstract

BACKGROUND: We tested interim positron-emission tomography-computed tomography (PET-CT) as a measure of early response to chemotherapy in order to guide treatment for patients with advanced Hodgkin's lymphoma. METHODS: Patients with newly diagnosed advanced classic Hodgkin's lymphoma underwent a baseline PET-CT scan, received two cycles of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy, and then underwent an interim PET-CT scan. Images were centrally reviewed with the use of a 5-point scale for PET findings. Patients with negative PET findings after two cycles were randomly assigned to continue ABVD (ABVD group) or omit bleomycin (AVD group) in cycles 3 through 6. Those with positive PET findings after two cycles received BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone). Radiotherapy was not recommended for patients with negative findings on interim scans. The primary outcome was the difference in the 3-year progression-free survival rate between randomized groups, a noninferiority comparison to exclude a difference of 5 or more percentage points. RESULTS: A total of 1214 patients were registered; 937 of the 1119 patients (83.7%) who underwent an interim PET-CT scan according to protocol had negative findings. With a median follow-up of 41 months, the 3-year progression-free survival rate and overall survival rate in the ABVD group were 85.7% (95% confidence interval [CI], 82.1 to 88.6) and 97.2% (95% CI, 95.1 to 98.4), respectively; the corresponding rates in the AVD group were 84.4% (95% CI, 80.7 to 87.5) and 97.6% (95% CI, 95.6 to 98.7). The absolute difference in the 3-year progression-free survival rate (ABVD minus AVD) was 1.6 percentage points (95% CI, -3.2 to 5.3). Respiratory adverse events were more severe in the ABVD group than in the AVD group. BEACOPP was given to the 172 patients with positive findings on the interim scan, and 74.4% had negative findings on a third PET-CT scan; the 3-year progression-free survival rate was 67.5% and the overall survival rate 87.8%. A total of 62 patients died during the trial (24 from Hodgkin's lymphoma), for a 3-year progression-free survival rate of 82.6% and an overall survival rate of 95.8%. CONCLUSIONS: Although the results fall just short of the specified noninferiority margin, the omission of bleomycin from the ABVD regimen after negative findings on interim PET resulted in a lower incidence of pulmonary toxic effects than with continued ABVD but not significantly lower efficacy. (Funded by Cancer Research UK and Others; ClinicalTrials.gov number, NCT00678327.).

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Metadata

Authors
Johnson, P., Federico, M., Kirkwood, A., Fosså, A., Berkahn, L., Carella, A., d’Amore, F., Enblad, G., Franceschetto, A., Fulham, M., Luminari, S., O’Doherty, M., Patrick, P., Roberts, T., Sidra, G., Stevens, L., Smith, P., Trotman, J., Viney, Z., Radford, J., & Barrington, S.
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2016-06-23
Volume
374
Issue
25
Pages
2419-2429
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa1510093
OpenAlex
W2469052042
Cited by
818
References
18
FWCI
69.83
Type
journal article
Language
en
Open access
bronze

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CoChat. (2026). Citation check: Adapted Treatment Guided by Interim PET-CT Scan in Advanced Hodgkin’s Lymphoma. https://app.cochat.ai/papers/10.1056/nejmoa1510093
The paper
Johnson, P., Federico, M., Kirkwood, A., Fosså, A., Berkahn, L., Carella, A., d’Amore, F., Enblad, G., Franceschetto, A., Fulham, M., Luminari, S., O’Doherty, M., Patrick, P., Roberts, T., Sidra, G., Stevens, L., Smith, P., Trotman, J., Viney, Z., . . . Barrington, S. (2016). Adapted Treatment Guided by Interim PET-CT Scan in Advanced Hodgkin’s Lymphoma. New England Journal of Medicine. https://doi.org/10.1056/nejmoa1510093

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Bibliographic data: Semantic Scholar, OpenAlex, Crossref.

Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.