• Radiology · Jun 2020

    Multicenter Study Comparative Study

    Performance of CT Compared with 18F-FDG PET in Predicting the Efficacy of Nivolumab in Relapsed or Refractory Hodgkin Lymphoma.

    • Fatima-Zohra Mokrane, Aiping Chen, Lawrence H Schwartz, Franck Morschhauser, Apasia Stamatoullas, Jean-Marc Schiano de Colella, Laetitia Vercellino, Olivier Casasnovas, Adrien Chauchet, Alain Delmer, Emmanuelle Nicolas-Virelizier, Hervé Ghesquières, Marie-Pierre Moles-Moreau, Anna Schmitt, Rémy Duléry, Krimo Bouabdallah, Cecile Borel, Mohamed Touati, Bénédicte Deau-Fischer, Frédéric Peyrade, Romain-David Seban, Guillaume Manson, Roch Houot, and Laurent Dercle.
    • From the Dept of Radiology, New York Presbyterian Hosp, Columbia Univ Medical Ctr, New York, NY (F.Z.M., L.D., A.C., L.H.S.); Dept of Radiology, Rangueil Univ Hosp, Toulouse, France (F.Z.M.); Dept of Radiology, First Affiliated Hosp of Nanjing Medical Univ, Nanjing, China (A.C.); Univ Lille, CHU Lille, EA 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France (F.M.); Dept of Hematology, Centre Henri Becquerel, Rouen, France (A.S.); Dept of Hematology, Paoli-Calmette Inst, Marseille, France (J.M.S.d.C.); Dept of Nuclear Medicine, Saint-Louis Hosp, AP-HP, Paris, France (L.V.); Dept of Hematology, Univ Hosp of Dijon, Dijon, France (O.C.); Dept of Hematology, Univ Hosp of Besançon, Besançon, France (A.C.); Dept of Hematology, Univ Hosp of Reims, Reims, France (A.D.); Dept of Hematology, Leon Berard Ctr, Lyon, France (E.N.V.); Dept of Hematology, Univ Hosp of Lyon, Lyon, France (H.G.); Dept of Hematology, Univ Hosp of Angers, Angers, France (M.P.M.M.); Dept of Hematology, Bergonie Inst, Bordeaux, France (A.S.); Dept of Hematology, Saint-Antoine Hosp, AP-HP, Paris, France (R.D.); Dept of Hematology, Univ Hosp of Bordeaux, Bordeaux, France (K.B.); Dept of Hematology, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France (C.B.); Dept of Hematology, Univ Hosp of Limoges, Limoges, France (M.T.); Dept of Hematology, Cochin Hosp, AP-HP, Paris, France (B.D.F.); Centre Antoine Lacassagne, Nice, France (F.P.); Dept of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); Dept of Hematology, Univ Hosp of Rennes, Rennes, France (G.M., R.H.); INSERM, U1236, Rennes, France (G.M., R.H.); and UMR1015, Institut Gustave Roussy, Université Paris Saclay, Villejuif 94800, France (L.D.).
    • Radiology. 2020 Jun 1; 295 (3): 651-661.

    AbstractBackground CT and fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT performances following immune therapy are not well known in patients with relapsed or refractory Hodgkin lymphoma (RRHL). Purpose To compare CT and PET/CT for prognostic value of early response evaluation following nivolumab therapy. Materials and Methods This retrospective study included patients from 34 institutions who underwent early imaging response evaluation from July 2013 to April 2017. Three experienced readers classified imaging response by using Cheson et al and 2016 Lymphoma Response to Immunomodulatory Therapy Criteria as follows: complete (metabolic) response, partial (metabolic) response, stable disease or no metabolic response, or progressive (metabolic) disease. Primary CT and PET assessments were performed at a median of 2.0 months (interquartile range, 1.7-3.7 months) after nivolumab initiation. Kaplan-Meier analysis was used to determine the relationship of primary CT and PET assessment response categories to overall survival (OS). Agreements between primary and secondary imaging assessments were assessed by using κ analysis. Results A total of 45 patients (median age, 37 years; range, 18-77 years; 25 men) underwent a primary assessment using CT and PET/CT; 36 patients also underwent a subsequent assessment. Eleven patients (24%) died after a median follow-up of 21.2 months. CT and PET response categories were associated with OS (P = .03 for primary CT assessment; P = .02 for primary PET assessment). There was no pseudoprogression at primary CT and PET assessments. At the primary assessment, response categories by using CT were reclassified by using PET in 44% (20 of 45) of patients. Among these, 55% (11 of 20) were reclassified to complete metabolic response (complete metabolic response rate: 29% [13 of 45 patients] vs complete response rate: 4% [two of 45 patients]), with a 2-year OS probability of 100%. At the secondary assessment, complete response rate using CT increased to 17% (six of 36 patients), hence a better agreement with PET (κ = 0.78; P < .001). Conclusion Early CT and PET/CT at a median of 2 months after initiation of nivolumab predicted overall survival in relapsed or refractory Hodgkin lymphoma. Early PET detected additional patients with complete metabolic response. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Scott and Wang in this issue.

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