Identification of prognostic factors for patients with relapsed/refractory Hodgkin lymphoma (HL) is essential for optimizing therapy with risk-adapted approaches. In our phase 2 study of positron emission tomography (PET)–adapted salvage therapy with brentuximab vedotin (BV) and augmented ifosfamide, carboplatin, and etoposide (augICE), we assessed clinical factors, quantitative PET assessments, and cytokine and chemokine values. Transplant-eligible patients with relapsed/refractory HL received 2 (cohort 1) or 3 (cohort 2) cycles of weekly BV; PET-negative patients (Deauville score ≤2) proceeded to autologous stem cell transplantation (ASCT) whereas PET-positive patients received augICE before ASCT. Serum cytokine and chemokine levels were measured at baseline and after BV. Metabolic tumor volume (MTV) and total lesion glycolysis were measured at baseline, after BV, and after augICE. Sixty-five patients enrolled (45, cohort 1; 20, cohort 2); 49 (75%) achieved complete response and 64 proceeded to ASCT. Three-year overall survival and event-free survival (EFS) were 95% and 82%, respectively. Factors predictive for EFS by multivariable analysis were baseline MTV (bMTV) (P < .001) and refractory disease (P = .003). Low bMTV (<109.5 cm³) and relapsed disease identified a favorable group (3-year EFS, 100%). For patients who received a transplant, bMTV and pre-ASCT PET were independently prognostic; 3-year EFS for pre-ASCT PET-positive patients with low bMTV was 86%. In this phase 2 study of PET-adapted therapy with BV and augICE for relapsed/refractory HL, bMTV and refractory disease were independent prognostic factors for EFS. Furthermore, bMTV improved the predictive power of pre-ASCT PET. Future studies should optimize efficacy and tolerability of salvage therapy by stratifying patients according to risk factors such as bMTV.

识别复发/难治性霍奇金淋巴瘤（HL）患者的预后因素对于优化适应风险的方法的治疗至关重要。在我们的第二期正电子发射断层扫描（PET）适应性治疗中，使用brentuximab vedotin（BV）和增强的异环磷酰胺，卡铂和依托泊苷（augICE）进行挽救治疗，我们评估了临床因素，定量PET评估以及细胞因子和趋化因子值。符合移植资格的复发/难治性HL患者每周接受2次（队列1）或3次（队列2）BV治疗；PET阴性患者（Deauville得分≤2）进行自体干细胞移植（ASCT），而PET阳性患者在ASCT之前接受了augICE治疗。在基线和BV后测量血清细胞因子和趋化因子水平。在基线，BV后和augICE后测量代谢性肿瘤体积（MTV）和总病变糖酵解。入组患者65例（第1组45人；第2组20人）；49（75％）人获得了完全的回应，另有64人进行了ASCT。三年总体生存率和无事件生存率（EFS）分别为95％和82％。通过多变量分析预测EFS的因素是基线MTV（bMTV）（P <.001）和难治性疾病（P = .003）。低bMTV（<109.5 cm ³）和复发性疾病确定为有利组（3年EFS，100％）。对于接受移植的患者，bMTV和ASCT前PET是独立的预后。低bMTV的ASCT前PET阳性患者的3年EFS为86％。在这个2期研究中，PET联合BV和augICE治疗复发/难治性HL，bMTV和难治性疾病是EFS的独立预后因素。此外，bMTV改善了ASCT前PET的预测能力。未来的研究应通过根据bMTV等危险因素对患者进行分层，从而优化挽救疗法的疗效和耐受性。