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Blood, 15 November 2008, Vol. 112, No. 10, pp. 3989-3994.
Prepublished online as a Blood First Edition Paper on August 29, 2008; DOI 10.1182/blood-2008-06-155820.
 Previous Article | Next Article 
Submitted June 3, 2008
Accepted August 9, 2008
Positron emission tomography has a high negative predictive value for progression or early relapse for patients with residual disease after first line chemotherapy in advanced-stage Hodgkin lymphoma
Carsten Kobe, Markus Dietlein, Jeremy Franklin, Jana Markova, Andreas Lohri, Holger Amthauer, Susanne Klutmann, Wolfram H Knapp, Josee M Zijlstra, Andreas Bockisch, Matthias Weckesser, Reinhard Lorenz, Mathias Schreckenberger, Roland Bares, Hans T Eich, Rolf-Peter Mueller, Michael Fuchs, Peter Borchmann, Axel Gossmann, Harald Schicha, Volker Diehl, and Andreas Engert*
Department of Nuclear Medicine, University of Cologne, Cologne, Germany
German Hodgkin Study Group, University of Cologne, Cologne, Germany
Department of Clinical Hematology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
Schweizer Arbeitsgruppe fur Klinische Krebsforschung, (SAKK), Bern, Switzerland
Klinik fur Strahlenheilkunde, Charite - Universitatsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
Department of Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Department of Nuclear Medicine, Hanover University Medical School, Hanover, Germany
Department of Hematology, VU University Medical Centre, Amsterdam, Netherlands
Department of Nuclear Medicine, University of Duisburg-Essen, Essen, Germany
Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
Department of Nuclear Medicine, University of Wuerzburg, Wuerburg, Germany
Department of Nuclear Medicine, Gutenberg University Hospital, Mainz, Germany
Department of Nuclear Medicine, University of Tuebingen, Tuebingen, Germany
Department of Radiation Oncology, University of Cologne, Cologne, Germany
Department I of Internal Medicine, University of Cologne, Cologne, Germany
Department of Radiology, University of Cologne, Cologne, Germany
* Corresponding author; email: a.engert{at}uni-koeln.de.
In the HD15 trial of the German Hodgkin Study Group the negative predictive value (NPV) of positron emission tomography (PET) using [18F]-fluorodeoxyglucose (FDG) in advanced-stage Hodgkin lymphoma (HL) was evaluated. 817 patients with newly diagnosed, histology-proven HL were enrolled and randomly assigned to receive BEACOPP-based chemotherapy (6 cycles, 8 cycles, BEACOPP-14). After completion of chemotherapy, residual disease measuring  2.5 cm in diameter was assessed by PET. The NPV of PET was defined as the proportion of PET- patients without progression, relapse or irradiation within 12 months after PET-review panel. 311 patients had residual disease 2.5 cm after chemotherapy. The progression-free survival was 96% for PET- patients (95% CI: 94-99%) and 86% for PET+ patients (95% CI: 78-95%, p=0.011). The NPV for PET in this analysis was 94% (95% CI: 91-97%). Thus, consolidation radiotherapy can be omitted in PET- patients with residual disease without increasing the risk for progression or early relapse as compared to patients in complete remission. The impact of this finding on the overall survival at 5 years must be awaited. Until then, response adapted therapy guided by PET for HL patients seems to be a promising approach that should be further evaluated in clinical trials. This trial is registered at http://isrctn.org study ID:ISRCTN32443041.
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