PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study

Sally F. Barrington; Amy A. Kirkwood; Antonella Franceschetto; Michael J. Fulham; Thomas H. Roberts; Helén Almquist; Eva Brun; Karin Hjorthaug; Zaid N. Viney; Lucy C. Pike; Massimo Federico; Stefano Luminari; John Radford; Judith Trotman; Alexander Fossa; Leanne Berkahn; Daniel Molin; Francesco D'Amore; Donald A. Sinclair; Paul Smith; Michael O'Doherty; Lindsey Stevens; Peter W. Johnson

doi:10.1182/blood-2015-11-679407

PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study

Sally F. Barrington, Amy A. Kirkwood, Antonella Franceschetto, Michael J. Fulham, Thomas H. Roberts, Helén Almquist, Eva Brun, Karin Hjorthaug, Zaid N. Viney, Lucy C. Pike, Massimo Federico, Stefano Luminari, John Radford, Judith Trotman, Alexander Fossa, Leanne Berkahn, Daniel Molin, Francesco D'Amore, Donald A. Sinclair, Paul SmithMichael O'Doherty, Lindsey Stevens, Peter W. Johnson

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Abstract

International guidelines recommend that positron emission tomography-computed tomography (PET-CT) should replace CT in Hodgkin lymphoma (HL). The aims of this study were to compare PET-CT with CT for staging and measure agreement between expert and local readers, using a 5-point scale (Deauville criteria), to adapt treatment in a clinical trial: Response-Adapted Therapy in Advanced Hodgkin Lymphoma (RATHL). Patients were staged using clinical assessment, CT, and bone marrow biopsy (RATHL stage). PET-CT was performed at baseline (PET0) and after 2 chemotherapy cycles (PET2) in a response-adapted design. PET-CT was reported centrally by experts at 5 national core laboratories. Local readers optionally scored PET2 scans. The RATHL and PET-CT stages were compared. Agreement among experts and between expert and local readers was measured. RATHL and PET0 stage were concordant in 938 (80%) patients. PET-CT upstaged 159 (14%) and downstaged 74 (6%) patients. Upstaging by extranodal disease in bone marrow (92), lung (11), or multiple sites (12) on PET-CT accounted for most discrepancies. Follow-up of discrepant findings confirmed the PET characterization of lesions in the vast majority. Five patients were upstaged by marrow biopsy and 7 by contrast-enhanced CT in the bowel and/or liver or spleen. PET2 agreement among experts (140 scans) with a κ (95% confidence interval) of 0.84 (0.76-0.91) was very good and between experts and local readers (300 scans) at 0.77 (0.68-0.86) was good. These results confirm PET-CT as the modern standard for staging HL and that response assessment using Deauville criteria is robust, enabling translation of RATHL results into clinical practice.

Original language	English
Pages (from-to)	1531-1538
Journal	Blood
Volume	127
Issue number	12
Early online date	8 Jan 2016
DOIs	https://doi.org/10.1182/blood-2015-11-679407
Publication status	Published - 24 Mar 2016

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Barrington, S. F., Kirkwood, A. A., Franceschetto, A., Fulham, M. J., Roberts, T. H., Almquist, H., Brun, E., Hjorthaug, K., Viney, Z. N., Pike, L. C., Federico, M., Luminari, S., Radford, J., Trotman, J., Fossa, A., Berkahn, L., Molin, D., D'Amore, F., Sinclair, D. A., ... Johnson, P. W. (2016). PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study. Blood, 127(12), 1531-1538. https://doi.org/10.1182/blood-2015-11-679407

@article{7fddfa54f16f4ef6a0639e08359e4d78,

title = "PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study",

abstract = "International guidelines recommend that positron emission tomography-computed tomography (PET-CT) should replace CT in Hodgkin lymphoma (HL). The aims of this study were to compare PET-CT with CT for staging and measure agreement between expert and local readers, using a 5-point scale (Deauville criteria), to adapt treatment in a clinical trial: Response-Adapted Therapy in Advanced Hodgkin Lymphoma (RATHL). Patients were staged using clinical assessment, CT, and bone marrow biopsy (RATHL stage). PET-CT was performed at baseline (PET0) and after 2 chemotherapy cycles (PET2) in a response-adapted design. PET-CT was reported centrally by experts at 5 national core laboratories. Local readers optionally scored PET2 scans. The RATHL and PET-CT stages were compared. Agreement among experts and between expert and local readers was measured. RATHL and PET0 stage were concordant in 938 (80%) patients. PET-CT upstaged 159 (14%) and downstaged 74 (6%) patients. Upstaging by extranodal disease in bone marrow (92), lung (11), or multiple sites (12) on PET-CT accounted for most discrepancies. Follow-up of discrepant findings confirmed the PET characterization of lesions in the vast majority. Five patients were upstaged by marrow biopsy and 7 by contrast-enhanced CT in the bowel and/or liver or spleen. PET2 agreement among experts (140 scans) with a κ (95% confidence interval) of 0.84 (0.76-0.91) was very good and between experts and local readers (300 scans) at 0.77 (0.68-0.86) was good. These results confirm PET-CT as the modern standard for staging HL and that response assessment using Deauville criteria is robust, enabling translation of RATHL results into clinical practice.",

author = "Barrington, {Sally F.} and Kirkwood, {Amy A.} and Antonella Franceschetto and Fulham, {Michael J.} and Roberts, {Thomas H.} and Hel{\'e}n Almquist and Eva Brun and Karin Hjorthaug and Viney, {Zaid N.} and Pike, {Lucy C.} and Massimo Federico and Stefano Luminari and John Radford and Judith Trotman and Alexander Fossa and Leanne Berkahn and Daniel Molin and Francesco D'Amore and Sinclair, {Donald A.} and Paul Smith and Michael O'Doherty and Lindsey Stevens and Johnson, {Peter W.}",

year = "2016",

month = mar,

day = "24",

doi = "10.1182/blood-2015-11-679407",

language = "English",

volume = "127",

pages = "1531--1538",

journal = "Blood",

issn = "0006-4971",

publisher = "American Society of Hematology",

number = "12",

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Barrington, SF, Kirkwood, AA, Franceschetto, A, Fulham, MJ, Roberts, TH, Almquist, H, Brun, E, Hjorthaug, K, Viney, ZN, Pike, LC, Federico, M, Luminari, S, Radford, J, Trotman, J, Fossa, A, Berkahn, L, Molin, D, D'Amore, F, Sinclair, DA, Smith, P, O'Doherty, M, Stevens, L & Johnson, PW 2016, 'PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study', Blood, vol. 127, no. 12, pp. 1531-1538. https://doi.org/10.1182/blood-2015-11-679407

TY - JOUR

T1 - PET-CT for staging and early response

T2 - results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study

AU - Barrington, Sally F.

AU - Kirkwood, Amy A.

AU - Franceschetto, Antonella

AU - Fulham, Michael J.

AU - Roberts, Thomas H.

AU - Almquist, Helén

AU - Brun, Eva

AU - Hjorthaug, Karin

AU - Viney, Zaid N.

AU - Pike, Lucy C.

AU - Federico, Massimo

AU - Luminari, Stefano

AU - Radford, John

AU - Trotman, Judith

AU - Fossa, Alexander

AU - Berkahn, Leanne

AU - Molin, Daniel

AU - D'Amore, Francesco

AU - Sinclair, Donald A.

AU - Smith, Paul

AU - O'Doherty, Michael

AU - Stevens, Lindsey

AU - Johnson, Peter W.

PY - 2016/3/24

Y1 - 2016/3/24

N2 - International guidelines recommend that positron emission tomography-computed tomography (PET-CT) should replace CT in Hodgkin lymphoma (HL). The aims of this study were to compare PET-CT with CT for staging and measure agreement between expert and local readers, using a 5-point scale (Deauville criteria), to adapt treatment in a clinical trial: Response-Adapted Therapy in Advanced Hodgkin Lymphoma (RATHL). Patients were staged using clinical assessment, CT, and bone marrow biopsy (RATHL stage). PET-CT was performed at baseline (PET0) and after 2 chemotherapy cycles (PET2) in a response-adapted design. PET-CT was reported centrally by experts at 5 national core laboratories. Local readers optionally scored PET2 scans. The RATHL and PET-CT stages were compared. Agreement among experts and between expert and local readers was measured. RATHL and PET0 stage were concordant in 938 (80%) patients. PET-CT upstaged 159 (14%) and downstaged 74 (6%) patients. Upstaging by extranodal disease in bone marrow (92), lung (11), or multiple sites (12) on PET-CT accounted for most discrepancies. Follow-up of discrepant findings confirmed the PET characterization of lesions in the vast majority. Five patients were upstaged by marrow biopsy and 7 by contrast-enhanced CT in the bowel and/or liver or spleen. PET2 agreement among experts (140 scans) with a κ (95% confidence interval) of 0.84 (0.76-0.91) was very good and between experts and local readers (300 scans) at 0.77 (0.68-0.86) was good. These results confirm PET-CT as the modern standard for staging HL and that response assessment using Deauville criteria is robust, enabling translation of RATHL results into clinical practice.

AB - International guidelines recommend that positron emission tomography-computed tomography (PET-CT) should replace CT in Hodgkin lymphoma (HL). The aims of this study were to compare PET-CT with CT for staging and measure agreement between expert and local readers, using a 5-point scale (Deauville criteria), to adapt treatment in a clinical trial: Response-Adapted Therapy in Advanced Hodgkin Lymphoma (RATHL). Patients were staged using clinical assessment, CT, and bone marrow biopsy (RATHL stage). PET-CT was performed at baseline (PET0) and after 2 chemotherapy cycles (PET2) in a response-adapted design. PET-CT was reported centrally by experts at 5 national core laboratories. Local readers optionally scored PET2 scans. The RATHL and PET-CT stages were compared. Agreement among experts and between expert and local readers was measured. RATHL and PET0 stage were concordant in 938 (80%) patients. PET-CT upstaged 159 (14%) and downstaged 74 (6%) patients. Upstaging by extranodal disease in bone marrow (92), lung (11), or multiple sites (12) on PET-CT accounted for most discrepancies. Follow-up of discrepant findings confirmed the PET characterization of lesions in the vast majority. Five patients were upstaged by marrow biopsy and 7 by contrast-enhanced CT in the bowel and/or liver or spleen. PET2 agreement among experts (140 scans) with a κ (95% confidence interval) of 0.84 (0.76-0.91) was very good and between experts and local readers (300 scans) at 0.77 (0.68-0.86) was good. These results confirm PET-CT as the modern standard for staging HL and that response assessment using Deauville criteria is robust, enabling translation of RATHL results into clinical practice.

U2 - 10.1182/blood-2015-11-679407

DO - 10.1182/blood-2015-11-679407

M3 - Article

SN - 0006-4971

VL - 127

SP - 1531

EP - 1538

JO - Blood

JF - Blood

IS - 12

ER -

PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study

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