Stage IIb High Risk Hodgkin Lymphoma Treated in the H10 and AHL2011 Trials: Similar Efficacy of Both Strategies and Prognostic Impact of Baseline Tmtv and PET2 Response

• Published in: Blood 2019-11, Vol.134 (Supplement_1), p.128-128
• Main Authors: Rossi, Cédric, André, Marc, Joubert, Clémentine, Fortpied, Catherine, Brice, Pauline, Deau-Fisher, Bénédicte, Ghesquieres, Herve, Fornecker, Luc Mathieu, Gac, Anne-Claire, Lazarovici, Julien, Stamatoullas, Aspasia, Raemakers, John, Federico, Massimo, Maerevoet, Marie, Bailly, Sarah, Kanoun, Salim, Meignan, Michel, Cottereau, Anne Ségolène, Casasnovas, Rene-Olivier
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2019-125976

Introduction High risk stage IIB Hodgkin lymphoma (HL) with mediastinum-to-thorax ratio of ≥0.33 or extranodal localization are defined as a poor prognosis subset according to German Hodgkin study group (Sieber et al., Ann. of Oncol. 2000). These patients were treated consecutively in our group as limited stage in the EORTC/LYSA/FIL H10 study (André et al, JCO 2017) or advanced stage in the AHL2011 LYSA trial (Casasnovas et al., Lancet Oncol 2019). However, the relative efficacy of each of these strategies to control disease is unknown in this uncommon subset of patients. In the present retrospective study, we compared the outcome of patients with high risk stage IIB included in the H10 and AHL2011 studies, and analyzed prognostic factors. Methods We included patients with Ann-Arbor disease stage IIB with mediastinum-to-thorax (M/T) ratio of ≥0.33 or extranodal localization enrolled in the H10 or AHL2011 trials, aged between 16 and 60 years for AHL2011 and 18-60 years for H10 with newly diagnosed Hodgkin lymphoma excluding nodular lymphocyte predominant subtype, who had baseline PET and PET2 images available in the LYSA database. In H10 trial, after 2 cycles of ABVD patients received in the standard arm 2 additional cycles of ABVD plus INRT 30 Gy, in the experimental arm 2 to 4 additional cycles of ABVD;- in PET2 negative patients 4 additional cycles of ABVD (or after the trial amendment 2 additional cycles of ABVD plus INRT 30 Gy); - in PET2 positive patients 2 cycles of escalated BEACOPP plus INRT 30Gy. PET2 were reported according to IHP criteria. In AHL2011 study, after 2 upfront escalated BEACOPP patients received either 4 additional escalated BEACOPP in the standard arm and PET2 positive patients of the PET-driven arm, or 4 cycles of ABVD in PET2 negative patients of the PET-driven arm. PET2 were reported using Deauville score (DS 1-2-3 vs 4-5), DS4 being defined positive if SUVmax of the residual lesion >140% of SUVmax of the liver background. Baseline clinical and biological characteristics of patients enrolled in both studies were compared. Total metabolic tumor volume (TMTV) at baseline was calculated with the Beth Israel Fiji software based on a 41% SUVmax cutoff of each lesion. In this study, all PET2 response was reanalysed using Deauville score And PET positivity was defined according to the criteria used in the AHL2011 trial. Results 148 patients were eligible for the study, including 83 and 65 patients enrolled in the AHL2011 and H10 trials