Impact of imaging modality on clinical outcome in Hodgkin lymphoma in a resource constraint setting. (7th December 2019)

• Record Type: Journal Article
• Authors: Korula, Anu; Devasia, Anup Joseph; Kulkarni, Uday; Abubacker, Fouzia N.; Lakshmi, Kavitha M.; Abraham, Aby; Srivastava, Alok; George, Biju; Mathews, Vikram
• Is Part Of: British journal of haematology. Volume 188:Number 6(2020)
• Page Start: 930
• Page End: 934
• Publication Date: 2019-12-07
• Subjects: lymphomas -- cost benefit -- Hodgkin -- PET; Hematology -- Periodicals; Blood -- Diseases -- Periodicals; 616.15
• DOI: 10.1111/bjh.16289
• Languages: English
• ISSNs: 0007-1048

Abstract

Summary: Treatment of Hodgkin lymphoma (HL) has evolved with risk‐stratified therapy based on PET‐CT scan at multiple timepoints. In a resource constraint setting even a single PET‐CT scan ($400) is inaccessible to many patients, who are re‐assessed with only clinical examination, abdominal ultrasonogram and/or x‐ray (C/U/X) ($10). To compare clinical outcomes in patients with HL who have had suboptimal imaging after completion of chemotherapy for HL, with those who had a CT or PET‐CT, 283 patients were treated for HL from 2011 to 2015, and 268 patients completed six cycles of ABVD therapy with response assessment modality by CT/PET in 185 patients and by C/U/X in 83. There was no difference in the number of patients with advanced (64·1% vs. 61·1%; P = 0·650) or bulk disease (8·1% vs. 7·2%). A significantly higher number of patients in the CT/PET group received IFRT (25·4% vs. 7·7%; P = 0·0005). The three‐year overall survival and progression‐free survival of all treated patients ( n = 283) was 83·5 ± 2·3% and 76·7 ± 2·6% respectively [median follow‐up 36 months (range 2–93)]. At three years, the overall relapse‐free survival (RFS) was 80·1 ± 2·5%, with RFS of 77 ± 3·2% vs. 85 ± 4·0% in the CT/PET group and C/U/X groups respectively ( P = 0·349). There was no difference in RFS between the two groups either in early‐stage disease (88·1 ± 4·6% vs. 91·8 ± 5·6%; P = 0·671) or late‐stage disease (73·9 ± 4·8% vs. 81·3 ± 6·0%; P = 0·747). The only significant factor adversely affecting RFS was advanced disease ( P = 0·004). Factors not affecting RFS were age ( P = 0·763), sex ( P = 0·925), bulk disease ( P = 0·889) and imaging modality ( P = 0·352). There was no difference in relapse rates between patients who had suboptimal imaging compared to those who had a PET/CT. It is possible to use these basic imaging modalities when resources are a constraint, with acceptable outcomes.