Clinical outcomes of interim positron emission tomography-computed tomography scan-guided response-adaptive therapy in advanced Hodgkin's lymphoma: a tertiary cancer centre experience from South India

Vasanth Rooban Narasimman; Ramkumar Bakthavachalam; Raja Gopal; Pandidurai M.; Atul J.; Manish Kumar Sharma; Shaoni Parai; Sridevi Gnanasekaran

doi:10.18203/2320-6012.ijrms20243767

Authors

Vasanth Rooban Narasimman Department of Medical Oncology, Government Royapettah Hospital, Affiliated to Government Kilpauk Medical College, Chennai, Tamil Nadu, India
Ramkumar Bakthavachalam Department of Medical Oncology, Government Royapettah Hospital, Affiliated to Government Kilpauk Medical College, Chennai, Tamil Nadu, India
Raja Gopal Department of Medical Oncology, Government Royapettah Hospital, Affiliated to Government Kilpauk Medical College, Chennai, Tamil Nadu, India
Pandidurai M. Department of Medical Oncology, Government Royapettah Hospital, Affiliated to Government Kilpauk Medical College, Chennai, Tamil Nadu, India
Atul J. Department of Medical Oncology, Government Royapettah Hospital, Affiliated to Government Kilpauk Medical College, Chennai, Tamil Nadu, India
Manish Kumar Sharma Department of Medical Oncology, Government Royapettah Hospital, Affiliated to Government Kilpauk Medical College, Chennai, Tamil Nadu, India
Shaoni Parai Department of Medical Oncology, Government Royapettah Hospital, Affiliated to Government Kilpauk Medical College, Chennai, Tamil Nadu, India
Sridevi Gnanasekaran Department of Community Medicine, AIIMS, Gorakhpur, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20243767

Keywords:

HL, iPET-CT, Response-adapted therapy, EFS

Abstract

Background: Hodgkin’s lymphoma (HL) is a highly curable malignancy, but some patients fail standard ABVD chemotherapy, requiring intensified treatment. Interim positron emission tomography-computed tomography scan (iPET-CT) using the Deauville scoring system allows response-adapted therapy, enabling de-escalation to AVD in good responders and escalation to dose-escalated BEACOPP (EB) in poor responders. This study evaluates iPET-guided therapy outcomes in HL patients at a tertiary care center in South India.

Methods: A retrospective study of 69 HL patients (aged 12-65 years) treated over 5 years was conducted. After two ABVD cycles, iPET-2 scans guided treatment: PET-negative patients (Deauville 1-3) received four additional AVD cycles, while PET-positive patients (Deauville 4-5) received four EB cycles. The primary endpoint was event-free survival (EFS); secondary endpoints included overall survival (OS), toxicities, and quality of life. Statistical analyses included Kaplan-Meier survival analysis and Cox regression.

Results: The cohort (median age: 38 years, 87% male) had predominantly advanced-stage disease (73.9%) and systemic B symptoms (81.2%). iPET identified 16% as PET-positive. Median OS was 73 months (95% CI: 67.77-78.23), and median EFS was 30 months (95% CI: 28.64-31.36). PET-negative patients showed significantly better 2-year EFS (81%) compared to PET-positive patients (50%; p<0.05). Toxicities were higher in the EB group, with grade 3-4 neutropenia in 85% of cycles.

Conclusions: iPET-CT-guided therapy effectively stratifies HL patients, improving outcomes in PET-positive poor responders while avoiding overtreatment in PET-negative patients. Despite higher toxicities, escalated BEACOPP was feasible and safe, highlighting the potential of response-adapted strategies in resource-limited settings.

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