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Autografting

Pre-transplant FDG-PET-based survival model in relapsed and refractory Hodgkin’s lymphoma: outcome after high-dose chemotherapy and auto-SCT

Bone Marrow Transplantation volume 48, pages 1530–1536 (2013)Cite this article

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Abstract

Hodgkin’s lymphoma (HL) patients with positive 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) post salvage chemotherapy or before high-dose chemotherapy and auto-SCT (HDC ASCT) have inferior outcomes. We reviewed 21 prognostic factors before salvage chemotherapy (at relapse/progression) and integrated post salvage FDG-PET results to develop a prognostic model for post HDC ASCT outcome. We used Fine and Gray method for competing risk analysis and regression model for risks assessment and outcome. One hundred and forty-one patients had post salvage FDG-PET before HDC ASCT (median age 25.5 years); male/female 55%:45%, relapsed/refractory 43%:57%, median follow-up 33 months. Multivariate analysis identified HL International Prognostic Score ⩾3 (P=0.001; hazard ratio (HR): 3.7 (1.6–8.3)) and post salvage positive FDG-PET (P=0.011; HR: 3.4 (1.3–8.9)) with higher hazard of disease-specific death (model P=0.0001). Cumulative incidence of disease-specific death with 0, 1, 2 risk factors was 7%:29%:52%, respectively (P=0.00003). For disease-specific event (persistent, progressive or relapsed disease), mediastinal involvement (P=0.024; HR: 2.7 (1.14–6.5)), B symptoms (P=0.027; HR: 2.1 (1.09–4.2)) and positive post salvage FDG-PET (P=0.001; HR: 3.3 (1.7–6.7)) were significant (model P=<0.00001). Cumulative incidence of disease-specific event with 0, 1, 2, 3 risk factors was 8%:31%:50%:75%, respectively (P=0.0000006). Patients with higher scores have higher risk of treatment failure. They are potential candidates for newer therapies along with HDC ASCT.

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Acknowledgements

We appreciate Ms Ruqaya Belkhedim, Mr Fayez Abu Zeid and Ms Fadia Mansour from BMT clinic, Mr Edgardo Colcol and Riad Youniss from Oncology Research Unit for their valuable contribution. This study was approved by the Institutional Research Advisory Counsel.

Abstract/Presentation

1. S Akhtar, A Al-Sugair, Y Al Kadhi, A Al-Zahrani, M Abdelsalam, S Bazarbashi, D Ajarim, I Maghfoor. Prospective evaluation of 18F-fluorodeoxyglucose (FDG) positron emission tomography as a predictor of residual disease and subsequent relapse in patients with diffuse large-cell lymphoma and Hodgkin’s lymphoma undergoing HDC and ASCT. Transplantation 2008; 4: supplement 1, S213, Abstract O 262. 34th Annual Meeting of the European Group for Blood and Marrow Transplantation, 30 March–2 April 2008, Florence, Italy.

2. Akhtar S, Al-Sugair A, Abuzaid M, Al Kadhi Y, Dingle M, Abdelsalam M, Soudy H, Darwish A, Altijani A, Nabil M, Maghfoor I. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) prior to high dose chemotherapy and autologous stem cell transplant predicts outcome after ASCT in patients with diffuse large cell lymphoma and Hodgkin’s lymphoma. Results of 110 patients. European Group for Blood and Marrow Transplantation 36th Annual Congress (EBMT) 2010, Vienna, Austria, 21–24 March 2010. Bone Marrow Transplantation 2010; (45)S2;S247, Abstract P819.

3. S Akhtar, A Al-Sugair, M Abuzaid, Y Al Kadhi, M Dingle, M Abdelsalam, H Soudy, A Darwish, A El tigani, M Nabil, I Maghfoor. A new pre-transplant predictive model for event free survival incorporating functional imaging using FDG-PET in lymphoma patients undergoing HDC & ASCT. European Hematology Association 15th Congress, 10–13 June 2010. Barcelona, Spain. Hematologica 2010;95:s2;208–209, Abstract 0510.

4. M Abouzeid, A Al-Sugair, Y Al Kadhi, M Dingle, M Abdelsalam, H Soudy, A Darwish, A Altijani, I Maghfoor, S Akhtar. Predictive value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) prior to high dose chemotherapy and autologous stem cell transplant in patients with Hodgkin’s lymphoma: Results of 93 patients. Society of Nuclear Medicine, 57th Annual Meeting, 5–9 June, 2010. Salt Lake City, Utah, USA. J Nucl Med 2010;51:349.

5. Akhtar S, Al-Sugair AS, Abouzied M, Alkadhi Y, Dingle M, Abdelsalam M, Soudy H, Darwish A, Eltigani A, Elhassan TA, Nabil-Ahmed M, Maghfoor I. Pre-transplant FDG-PET scan response and other prognostic factors based survival model in patients with relapsed and refractory Hodgkin’s lymphoma is useful to predict outcome after high dose chemotherapy and autologous stem cell transplant. Oral presentation. EBMT 2013, London.

Author contributions

SA was the principal investigator, who designed the research, collected data, analyzed and interpreted data and wrote the manuscript. AAl-S and M Abu collected data, read PET scans and critically reviewed/provided input for manuscript; YA collected data, read CT scans and critically reviewed the manuscript; TAME performed statistical analysis and wrote statistical portion of the manuscript. M Abd, MD, HS, MN-A, AD, AE, collected data and critically reviewed/provided input for manuscript, IM designed the research, collected data, interpreted data, helped in manuscript writing.

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Authors and Affiliations

  1. Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia

    S Akhtar, M Dingle, M Abdelsalam, H Soudy, A Darwish, A Eltigani, T A M Elhassan, M Nabil-Ahmed & I Maghfoor

  2. Department of Medical Imaging Services, Section of Nuclear Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia

    A S Al-Sugair & M Abouzied

  3. Department of Medical Imaging Services, Section of Abdominal Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia

    Y AlKadhi

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Akhtar, S., Al-Sugair, A., Abouzied, M. et al. Pre-transplant FDG-PET-based survival model in relapsed and refractory Hodgkin’s lymphoma: outcome after high-dose chemotherapy and auto-SCT. Bone Marrow Transplant 48, 1530–1536 (2013). https://doi.org/10.1038/bmt.2013.88

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