Background Interim PET after two ABVD cycles (iPET2) predicts treatment outcome in classical Hodgkin's lymphoma. To test whether an earlier assessment of chemosensitivity would improve the prediction accuracy, we launched a prospective, multicenter observational study aimed at assessing the predictive value of iPET after one ABVD (iPET1) and the kinetics of response assessed by sequential PET scanning. Patients and methods Consecutive patients with newly diagnosed classical Hodgkin's lymphoma underwent interim PET scan after one ABVD course (iPET1). PETs were interpreted according to the Deauville score (DS) as negative (-) (DS 1-3) and positive (+) (DS 4, 5). Patients with iPET1 DS 3-5 underwent iPET2. Results About 106 early (I-IIA) and 204 advanced (IIB-IV) patients were enrolled between January 2008 and October 2014. iPET1 was (-) in 87/106 (82%) or (+) in 19/106 (18%) of early, and (-) in 133/204 (65%) or (+) in 71/204 (35%) of advanced stage patients, respectively. Twenty-four patients were excluded from response analysis due to treatment escalation. After a median follow-up of 38.2 (3.2-90.2) months, 9/102 (9%) early and 43/184 (23%) advanced patients experienced a progression-free survival event. At 36 months, negative and positive predictive value for iPET1 were 94% and 41% (early) and 84% and 43% (advanced), respectively. The kinetics of PET response was assessed in 198 patients with both iPETs. All 116 patients with iPET1(-) remained iPET2(-) (fast responders), 41/82 with IPET1(+) became iPET2(-) (slow responders), and the remaining 41 stayed iPET2(+) (non-responders); progression-free survival at 36 months for fast, slow and non-responders was 0.88, 0.79 and 0.34, respectively. Conclusion The optimal tool to predict ABVD outcome in HL remains iPET2 because it distinguishes responders, whatever their time to response, from non-responders. However, iPET1 identified fast responders with the best outcome and might guide early treatment de-escalation in both early and advanced-stage HL.

中文翻译：

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霍奇金淋巴瘤患者第一个化疗周期后中期 PET 的预测作用和对 ABVD 反应的序贯评估 - 波兰淋巴瘤研究组 (PLRG) 观察性研究。

背景 两个 ABVD 周期后的中期 PET (iPET2) 可预测经典霍奇金淋巴瘤的治疗结果。为了测试对化学敏感性的早期评估是否会提高预测准确性，我们开展了一项前瞻性、多中心观察研究，旨在评估一次 ABVD (iPET1) 后 iPET 的预测价值以及通过连续 PET 扫描评估的反应动力学。患者和方法 新诊断的经典霍奇金淋巴瘤的连续患者在一个 ABVD 疗程 (iPET1) 后接受了中期 PET 扫描。根据多维尔评分 (DS) 将 PET 解释为阴性 (-) (DS 1-3) 和阳性 (+) (DS 4, 5)。iPET1 DS 3-5 的患者接受了 iPET2。结果 2008 年 1 月至 2014 年 10 月期间，约有 106 名早期（I-IIA）和 204 名晚期（IIB-IV）患者入组。iPET1 在 87/106 (82%) 中为 (-) 或在 19/106 (18%) 中为 (+)，在 133/204 (65%) 中为 (-) 或在 71/204 (35 %) 的晚期患者。由于治疗升级，24 名患者被排除在反应分析之外。在中位随访 38.2 (3.2-90.2) 个月后，9/102 (9%) 的早期患者和 43/184 (23%) 的晚期患者经历了无进展生存事件。在 36 个月时，iPET1 的阴性和阳性预测值分别为 94% 和 41%（早期）和 84% 和 43%（晚期）。对 198 名具有两种 iPET 的患者的 PET 反应动力学进行了评估。所有 116 名 iPET1(-) 患者均保持 iPET2(-)（快速反应者），41/82 名 iPET1(+) 患者变为 iPET2(-)（慢反应者），其余 41 名患者保持 iPET2(+)（无反应者） ; 快速、慢速和无反应者在 36 个月时的无进展生存期分别为 0.88、0。分别为 79 和 0.34。结论 预测 HL 中 ABVD 结果的最佳工具仍然是 iPET2，因为它可以区分反应者和无反应者，无论他们的反应时间如何。然而，iPET1 确定了具有最佳结果的快速反应者，并可能指导早期和晚期 HL 的早期治疗降级。