Interim PET for Hodgkin’s – pro

A PET after two cycles of chemotherapy has prognostic significance in Hodgkin’s disease. If negative, prognosis is good and if positive, a change in therapy can be considered. Prognostic accuracy studies of interim FDG-PET for advanced-stage HL have consistently reported excellent specificity and moderately good sensitivity. A recent articel expolred whetehr bleomycin can be dropepd if PET is negative after 2 cycles. It concluded: 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.

There remains controversy because of the risk of false positives and other issues. A 2011 German review articel concluded: “….several trials are ongoing both for localised and advanced disease to evaluate the FDG-PET potential for early treatment monitoring and tailoring. Until the results of these prospective randomized trials become available, treatment changes according to the interim PET results should remain inappropriate and limited to well-conducted clinical trials.” However, NCCN has incorporated a recommendation for PET after two cycles.

M. André et al, Interim FDG-PET Scan in Hodgkin’s Lymphoma: Hopes and Caveats
Advances in HematologyVolume 2011 (2011), Article ID 430679, 6 pagesdoi:10.1155/2011/430679Review Article

Ng A, Constine LS, Advani R, et al. ACR Appropriateness Criteria: follow-up of Hodgkin’s lymphoma. Curr Probl Cancer 2010;34:211–227.

Jost L. Hodgkin’s disease: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 2007;18(Suppl 2):ii53–ii54.

Stefano Luminari, M.D., Michael O’Doherty, M.D., et al.
Adapted Treatment Guided by Interim PET-CT Scan in Advanced Hodgkin’s Lymphoma. N Engl J Med 2016; 374:2419-2429

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