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GITIL

Early chemotherapy intensification with BEACOPP in high-risk, interim-PET positive, advanced-stage Hodgkin lymphoma, improves the overall treatment outcome of ABVD.

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GITIL

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  1. Early chemotherapy intensification with BEACOPP in high-risk, interim-PET positive, advanced-stage Hodgkin lymphoma, improves the overall treatment outcome of ABVD. Gallamini A, Patti C, Viviani S., Rossi A, Fiore F, Di Raimondo F, Cantonetti M, Stelitano C, Feldman T, Gavarotti P, Sorasio R, Mulè A, Leone M, Rambaldi A, Biggi A, Barrington S., Fallanca F., Ficola U, Chauvie S, Gianni AM, for the Gruppo Italiano Terapie Innovative nei Linfomi (GITIL). GITIL

  2. Gallamini, JCO 25:3746-52, 2007 ? Ziakas PD: Eur J Nucl Med Mol Imaging 2008; 35:1573–1575

  3. Treatment plan IIB-IVB or IIA with more than 3 nodal sites, ESR > 50, bulky lesion High-risk HL PET-0 ABVD x2 PET-2 PET-2 +ve HL PET-2 -ve HL escalated BEACOPP x4 ABVD x4 standard BEACOPP x4 Consolidation RxT Consolidation RxT End-therapy PET

  4. Early chemotherapy intensification with BEACOPP in PET-2 positive, ABVD-treated HL pts.

  5. Inclusion criteria • advanced stage HL(Ann Arbor stages IIB-IVB) or stage IIA with adverse prognostic factors (three or more nodal regions affected, bulky mediastinal lesion, erythrocyte sedimentation rate higher than 50 mm.); • treatment starting with ABVDchemotherapy per two courses followed by interim PET scan; • patients with a negative PET-2allowed to continueABVDtherapy for a total of six cycles, followed by consolidation radiotherapy on the nodal sites with bulky disease recorded at baseline; • patients with a positive PET-2treated with escalatedBEACOPPfor 4 courses, followed by baseline BEACOPP for 4 courses; • both PET scans performed in the same PET centre; • minimumfollow-up of one year; • PET-0 and PET-2images available for central PET reviewing; • retrospective written informed consent to participate in the trial.

  6. Patient characteristics N= 162

  7. 5-point scale for interim-PET interpretation • No uptake • Uptake ≤ mediastinum • Uptake > mediastinum but ≤ liver • Moderately increased uptake compared to liver • Markedly increased uptake compared to liver or new areas of FDG uptake Negative scan Positive scan Meignan M: Leukemia & Lymphoma, 2009; 50: 1257–1260

  8. PET scan review: reviewers concordance . Discordance between 2 reviewers was observed in 3 case. Discrepancies has been resolved by the third reviewer. Cohen’s Kappa = 0.94

  9. PET-2 scan review local center vs. review panel Discordance between local Center and reviewers was observed in 8 cases. Cohen’s Kappa = 0.84. The clinical history of the patients is reported.

  10. Multivariate analysis for prognostic factors associated with FFS

  11. Trial results (162 pts.) 162 pts. ABVD x 2 4 pts. CT-PET ABVD x 4 (Medical decision) - + CT-PET BEACOPP-esc. x 4 23 pts. ABVD x 4 135 pts. BEACOPP-bas. x 4 CCR Rel-Pro Rxt. IF Rxt. IF 2 pts. 2 pts. CT-PET CT-PET CCR Rel-Pro CCR Rel-Pro 15 pts. 8 pts. 123 pts. 12 pts.

  12. FFS according to PET-2 results reported by the local PET centers. Subgroup of 141 patients with stage IIB-IVB disease Cohort of 158 patients correctly treated All patients PET-2 negative PET-2 positive

  13. FFS curves of the 152 patients correctly treated according to PET review All patients PET-2 negative PET-2 positive

  14. Conclusions • In advanced-stage, ABVD-treated HL patients in which chemotherapy was intensified with BEACOPP only in PET-2 +-ve patients, the overall treatment outcome of the entire cohort of patients was comparable to that of BEACOPP given from the onset in all patients • An undue toxicity from more aggressive chemotherapy was spared in four fifths of the patients; • The efficacy of this therapeutic strategy, currently being tested in a prospective way in several multi-centre clinical trials, has been retrospectively demonstrated; • A very good concordance rate, using the 5-point semi-quantitative scale, was found among reviewers.

  15. Acknowledgements P. Gavarotti,Hematology Chair, University of Turin - Torino S. Viviani, V. Bonfante,Medical Oncology, Istituto Tumori, Milano C. Stelitano,Hematology Dept., Poloiclinico A. Melacrino, Reggio Calabria R. Sorasio, F. Fiore,Hematology Dept., S. Croce e Carle Hospital , Cuneo A. Rossi,Hematology Dept., Ospedali Riuniti di Bergamo - Bergamo L. Trentin, R. Zambello; Experimental medicine, Hematology and Immunology Dept., Padoa University, Padova M. Cantonetti.Hematology Chair University Tor Vergata - Roma K. Patti, S. Mrito :Hematology Dept. , Ospedale “ A. Cervello”, Palermo, Palermo G. Di Raimondo,Hematology Dept. and BMT Unit, University of Catania, Catania T. Feldman ,Hackensack Medical Center, Hackensack University , N.Y. - USA S. BarringtonPET Imaging Centre, St Thomas’ Kings College Division of Imaging, London, UK. U. Ficola.PET Imaging Department. Ospedale La Maddalena. Palermo - A. Biggi, Chauvie S. . PET Imaging Department. S. Croce e Carle Hospital Cuneo. D. Panush . Hackensack Medical Center, Hackensack University , N.Y. - USA

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