Infradiaphragmatic Hodgkin lymphoma: a large series of patients staged with PET-CT
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Cédric Rossi1,2, Morgane Mounier3, Pauline Brice4, Violaine Safar5, Emmanuelle Nicolas-Virelizier6, Philippe Rey6, Aspasia Stamatoullas-Bastard7, Marion Alcantara7, Adrien Chauchet8, Emilie Reboursière9, Lauriane Filliatre10, Aurore Perrot10, Sylvain Garciaz11, Gilles Salles6, Bertrand Coiffier6, Hervé Ghesquières5,6 and René-Olivier Casasnovas1,12
1Hématologie Clinique, CHU Le Bocage, Dijon, France
2INSERM UMR 1037 - Cancer Research Center of Toulouse, Toulouse, France
3Registre des Hémopathies Malignes de Côte d’Or, EA4184, Université de Bourgogne, Dijon, France
4Hématologie Clinique, CHU Paris-GH St-Louis Lariboisière F-Widal - Hôpital Saint-Louis, Paris, France
5Hématologie Clinique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
6Hématologie Clinique, Centre Régional de Lutte Contre le Cancer Léon Bérard, Lyon, France
7Hématologie Clinique, Centre Henri Becquerel, Rouen, France
8Hématologie Clinique, CHU Besançon, Besançon, France
9Hématologie Clinique, CHU Caen, Caen, France
10Hématologie Clinique, CHRU Nancy, Nancy, France
11Hématologie Clinique, Institut Paoli-Calmettes, Marseille, France
12INSERM UMR 1231, Université Bourgogne Franche-Comté, Dijon, France
Cédric Rossi, email: [email protected]
Keywords: Hodgkin lymphoma, infradiaphragmatic, radiotherapy
Received: March 21, 2017 Accepted: June 19, 2017 Published: July 19, 2017
Introduction: Infradiaphragmatic Hodgkin Lymphoma (IDHL) accounts for 3-11% of adult cases of stage I-II Hodgkin Lymphoma and the treatment strategy in IDHL is still heterogeneous. All previous published studies were conducted before the PET-CT era. PET may provide a more accurate evaluation of IDHL stage. The aim of this study was to analyze the clinical and biological characteristics of IDHL patients staged by CT scan or PET-CT in eight French hematology departments and their impact on outcomes in these patients.
Methods: Baseline clinical and biological data and outcomes in patients with a first diagnosis of stage I-II IDHL treated with ABVD +/- radiotherapy were retrospectively collected.
Results: Among the 99 patients included, 65 (66%) were staged with PET-CT. These patients were older (53 years vs 46 years, p=0.043), had lower ESR (27 vs 58mm, p=0.022), higher hemoglobin level (13.6 vs 12.8g/dL, p=0.015), less frequent Ann Arbor stage II (74% vs 91%) and less central adenopathy involvement (60% vs 82%, p=0.024). Treatment was chemotherapy alone in 55% of patients and the remaining patients received chemo-radiotherapy (CRT). Five-year PFS and OS rates in PET-CT-staged patients were 78% (95% CI 64-87) and 88% (95% CI 73-95), respectively, compared with 65% (p=0.225) and 82% (p=0.352) in CT-staged patients. The CRT strategy was associated with fewer relapses (p=0.027).
Conclusion: This study showed that the characteristics of CT-staged IDHL patients were less favorable than those of PET-CT-staged patients and indicated that CRT provided better PFS than did chemotherapy alone.
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