Treatment escalation or reduction based on PET scan for patients with early stage or advanced Hodgkin lymphoma

The authors looked at the effect of adjusting treatment plans for patients with Hodgkin lymphoma based on positron emission tomography (PET) scans part way through treatment. The authors concluded that escalating or reducing treatment based on a PET scan is beneficial for patients.

Hodgkin lymphoma (HL) is generally considered a curable disease. Because of this, new research is looking into reducing treatment intensity. Before increasing or decreasing treatment intensity, doctors must know which patients would benefit from a change in treatment regimen.

Positron emission tomography (PET) scans have been successfully used to identify patients for treatment escalation or reduction. A positive PET scan means there is residual disease and treatment may be escalated. A negative PET scan means there is no detectable disease and treatment may be reduced. More research is needed to determine if intensity escalation and reduction works both for patients with early stage and patients with advanced HL.

This study looked at the outcomes for patients whose treatment was escalated or reduced based on a positive or negative PET scan. 355 patients were recruited for this study. 170 patients had early stage HL. 185 patients had advanced HL. The average length of follow-up was 55 months.

Early-stage and advanced patients with a positive PET scan received escalated doses of chemotherapy and radiation to the involved site. Early stage patients with a negative PET scan received reduced intensity treatment. Advanced patients with a negative PET scan continued normal treatment.

The 5-year overall survival (time from treatment to death from any cause) for early stage patients with a negative PET scan was 100%. The 5-year overall survival for early stage patients with a positive PET scan was 95%.

The 5-year overall survival for advanced patients with a negative PET scan was 97.8%. The 5-year overall survival for advanced patients with a positive PET scan was 91.4%. 

The study concluded that patients with advanced stage HL and a positive PET scan benefit the most from therapy escalation Patients with either early stage or advanced HL with a negative PET scan may be treated with reduced intensity treatment.