PDF(Pubmed)
Abstract：
The Children\'s Oncology Group AHOD0831 study used a positron emission tomography (PET) response-adapted approach in high-risk Hodgkin lymphoma, whereby slow early responders (SERs) received more intensive therapy than rapid early responders (RERs). We explored if baseline PET-based characteristics would improve risk stratification. Of 166 patients enrolled in the COG AHOD0831 study, 94 (57%) had baseline PET scans evaluable for quantitative analysis. For these patients, total body metabolic tumour volume (MTV), total lesion glycolysis (TLG), maximum standardized uptake value (SUVmax ) and peak SUV (SUVpeak ) were obtained. MTV/TLG thresholds were an SUV of 2.5 (MTV2.5 /TLG2.5 ) and 40% of the tumour SUVmax (MTV40% /TLG40% ). TLG2.5 was associated with event-free survival (EFS) in the complete cohort (p = 0.04) and in RERs (p = 0.01), but not in SERs (p = 0.8). The Youden index cut-off for TLG2.5 was 1841. Four-year EFS was 92% for RER/TLG2.5 up to 1841, 60% for RER/TLG2.5 greater than 1841, 74% for SER/TLG2.5 up to 1841 and 79% for SER/TLG2.5 greater than 1841. Second EFS for RER/TLG2.5 up to 1841 was 100%. Thus, RERs with a low baseline TLG2.5 experienced excellent EFS with less intensive therapy, whereas RERs with a high baseline TLG2.5 experienced poor EFS. These findings suggest that patients with a high upfront tumour burden may benefit from intensified therapy, even if they achieve a RER.
摘要：
儿童肿瘤学小组AHOD0831研究在高危霍奇金淋巴瘤中使用了正电子发射断层扫描（PET）反应适应方法，因此，缓慢的早期反应者（SER）比快速的早期反应者（RER）接受更多的强化治疗。我们探讨了基于基线PET的特征是否会改善风险分层。在COGAHOD0831研究的166名患者中，94（57％）的基线PET扫描可用于定量分析。对于这些患者来说,全身代谢性肿瘤体积（MTV），总病变糖酵解（TLG），获得最大标准化摄取值(SUVmax)和峰值SUV(SUVpeak)。MTV/TLG阈值是SUV为2.5(MTV2.5/TLG2.5)和肿瘤SUVmax的40%(MTV40%/TLG40%)。在完整队列（p=0.04）和RER（p=0.01）中，TLG2.5与无事件生存率（EFS）相关，但在SER中没有(p=0.8)。TLG2.5的Youden指数截止值为1841。四年EFS对于RER/TLG2.5至1841年为92％，对于RER/TLG2.5大于1841年为60％，对于SER/TLG2.5至1841年为74％，对于SER/TLG2.5大于1841年为79％。到1841年的RER/TLG2.5的第二次EFS为100％。因此，具有低基线TLG2.5的RERs经历了良好的EFS与较少的强化治疗，而基线TLG2.5高的RERs经历了较差的EFS。这些发现表明，前期肿瘤负担较高的患者可能会从强化治疗中受益。即使他们实现了RER。
