Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdeikrt. 98. 4032, Debrecen, Hungary.
Hell J Nucl Med. 2022 May-Aug;25(2):125-131. doi: 10.1967/s002449912471. Epub 2022 Aug 3.
Although the majority of patients with Hodgkin lymphoma (HL) has recently become long-term survivors, 20%-30% of HL patients have primary refractory disease or relapse. It is essential to identify patients at risk of treatment failure during first-line therapy. To objective of the present study was to investigate the combined prognostic role of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) imaging and thymus and activation-regulated chemokine (TARC) levels in Hodgkin lymphoma.
Between 01/01/2013 and 01/03/2019 77 HL patients were enrolled in this study where serum TARC levels were measured by an immunoassay and F-FDG PET/CT scans were performed at baseline, after the second cycle of ABVD treatment (interim) and at the end of first-line therapy.
Twenty-six patients (34%) had early-stage HL, while 51 patients presented with advanced-stage disease. Fifteen patients had primary refractory HL, while 1 patient relapsed after first-line therapy. Optimal TARC cut-off value for progression-free survival (PFS) was 700pg/mL based on receiver operating characteristic (ROC) curve analysis. With Cox regression analysis, F-FDG PET/CT with Deauville scores of 3, 4, or 5 and TARC levels above 700pg/mL predicted treatment failure at interim assessment. Inclusion of HL patients with a Deauville score of 3 to the high-risk population resulted in a 7-fold increase in the estimated risk of relapse compared to patients with Deauville score 4-5 with TARC levels above 700pg/mL. Patients with interim F-FDG PET/CT Deauville scores 3-5 had a significant survival benefit if their TARC levels were 700pg/mL. Positive predictive value (PPV) of interim F-FDG PET/CT scans with a Deauville score 3-5 was 47.8%, while combined PPV of a similar F-FDGPET/CT assessment and elevated TARC levels was 88.8%.
Interim F-FDG PET/CT and TARC analyzed together accurately identify HL patients who do not respond sufficiently to treatment and who need an early change of therapy.
尽管大多数霍奇金淋巴瘤（HL）患者已成为长期幸存者，但仍有 20%-30%的 HL 患者存在原发性难治或复发。因此，在一线治疗期间识别治疗失败风险患者至关重要。本研究旨在探讨氟-18-氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-FDG PET/CT）成像与胸腺激活调节趋化因子（TARC）水平联合在霍奇金淋巴瘤中的预后作用。
2013 年 1 月 1 日至 2019 年 1 月 3 日期间，共纳入 77 例 HL 患者，采用免疫分析法检测血清 TARC 水平，并在基线、ABVD 治疗第二周期后（中期）和一线治疗结束时进行 F-FDG PET/CT 扫描。
26 例（34%）患者为早期 HL，51 例为晚期 HL。15 例患者为原发性难治性 HL，1 例患者在一线治疗后复发。基于受试者工作特征（ROC）曲线分析，TARC 用于预测无进展生存期（PFS）的最佳截断值为 700pg/mL。Cox 回归分析显示，中期评估时 F-FDG PET/CT 评分≥3、4 或 5 分且 TARC 水平高于 700pg/mL 与治疗失败相关。将 F-FDG PET/CT 评分 3 分的 HL 患者纳入高危人群可使 TARC 水平高于 700pg/mL 且 F-FDG PET/CT 评分 4-5 分的患者复发风险增加 7 倍。如果中期 F-FDG PET/CT 评分 3-5 分的患者 TARC 水平为 700pg/mL，则其生存获益显著。F-FDG PET/CT 评分 3-5 分的中期 PET/CT 扫描的阳性预测值（PPV）为 47.8%，而类似的 F-FDG PET/CT 评估和 TARC 水平升高的联合 PPV 为 88.8%。
中期 F-FDG PET/CT 和 TARC 联合分析可准确识别对治疗反应不足且需要早期改变治疗方案的 HL 患者。
