Cuccaro Annarosa, Annunziata Salvatore, Cupelli Elisa, Martini Maurizio, Calcagni Maria L, Rufini Vittoria, Giachelia Manuela, Bartolomei Francesca, Galli Eugenio, D'Alò Francesco, Voso Maria T, Leone Giuseppe, Giordano Alessandro, Larocca Luigi M, Hohaus Stefan
Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy.
Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy.
Cancer Med. 2016 Mar;5(3):398-406. doi: 10.1002/cam4.585. Epub 2016 Jan 13.
Early response evaluation with [(18) F]fluordeoxyglucose (FDG) positron emission tomography after 2 cycles of chemotherapy (interim PET) has been indicated as the strongest predictor for outcome in classical Hodgkin lymphoma (HL). We studied the prognostic role of the number of tumor-infiltrating CD68+ cells and of the plasma levels of TARC (thymus and activation-regulated chemokine) in the context of interim PET in 102 patients with classical HL treated with Adriamycin, Bleomycin, Vinblastine, Dacarbazine (ABVD). After 2 ABVD cycles, interim PET according to Deauville criteria was negative (score 0-3) in 85 patients and positive (score 4-5) in 15 patients (2 patients technically not evaluable). TARC levels were elevated in 89% of patients at diagnosis, and decreased after 2 cycles in 82% of patients. Persistently elevated TARC levels in 18% of patients were significantly associated with a positive PET result (P = 0.007). Strong predictors for progression-free survival (PFS) were a negative interim PET (85% vs. 28%, P < 0.0001) and CD68+ cell counts <5% (89% vs. 67%, P = 0.006), while TARC levels at diagnosis and at interim evaluation had no prognostic role. In multivariate analysis, interim PET, CD68+ cell counts and presence of B-symptoms were independently associated with PFS. We conclude that although TARC levels are a biomarker for early response evaluation, they cannot substitute for interim PET as outcome predictor in HL. The evaluation of CD68 counts and B-symptoms at diagnosis may help to identify low-risk patients regardless positive interim PET.
在接受2个周期化疗后使用[（18）F]氟脱氧葡萄糖（FDG）正电子发射断层扫描进行早期反应评估（中期PET）已被证明是经典型霍奇金淋巴瘤（HL）预后的最强预测指标。我们研究了102例接受阿霉素、博来霉素、长春花碱、达卡巴嗪（ABVD）治疗的经典型HL患者在中期PET情况下肿瘤浸润CD68 +细胞数量及胸腺和活化调节趋化因子（TARC）血浆水平的预后作用。经过2个ABVD周期后，根据Deauville标准，85例患者的中期PET为阴性（评分0 - 3），15例患者为阳性（评分4 - 5）（2例患者技术上无法评估）。89%的患者在诊断时TARC水平升高，82%的患者在2个周期后下降。18%的患者TARC水平持续升高与PET阳性结果显著相关（P = 0.007）。无进展生存期（PFS）的强预测指标为中期PET阴性（85%对28%，P < 0.0001）和CD68 +细胞计数<5%（89%对67%，P = 0.006），而诊断时和中期评估时的TARC水平无预后作用。在多变量分析中，中期PET、CD68 +细胞计数和B症状的存在与PFS独立相关。我们得出结论，尽管TARC水平是早期反应评估的生物标志物，但它们不能替代中期PET作为HL的预后预测指标。诊断时评估CD68计数和B症状可能有助于识别低风险患者，无论中期PET结果如何。
