Follow-up of the GHSG HD16 trial of PET-guided treatment in early-stage favorable Hodgkin lymphoma
Authors
- M. Fuchs
- A.S. Jacob
- H. Kaul
- C. Kobe
- G. Kuhnert
- T. Pabst
- R. Greil
- P.J. Bröckelmann
- M.S. Topp
- M. Just
- B. Hertenstein
- M. Soekler
- M. Vogelhuber
- J.M. Zijlstra
- U.B. Keller
- S.W. Krause
- U. Dührsen
- J. Meissner
- A. Viardot
- H.T. Eich
- C. Baues
- V. Diehl
- A. Rosenwald
- I. Buehnen
- B. von Tresckow
- M. Dietlein
- P. Borchmann
- A. Engert
- D.A. Eichenauer
Journal
- Leukemia
Citation
- Leukemia 38 (1): 160-167
Abstract
The primary analysis of the GHSG HD16 trial indicated a significant loss of tumor control with PET-guided omission of radiotherapy (RT) in patients with early-stage favorable Hodgkin lymphoma (HL). This analysis reports long-term outcomes. Overall, 1150 patients aged 18-75 years with newly diagnosed early-stage favorable HL were randomized between standard combined-modality treatment (CMT) (2x ABVD followed by PET/CT [PET-2] and 20 Gy involved-field RT) and PET-2-guided treatment omitting RT in case of PET-2 negativity (Deauville score [DS] < 3). The study aimed at excluding inferiority of PET-2-guided treatment and assessing the prognostic impact of PET-2 in patients receiving CMT. At a median follow-up of 64 months, PET-2-negative patients had a 5-year progression-free survival (PFS) of 94.2% after CMT (n = 328) and 86.7% after ABVD alone (n = 300; HR = 2.05 [1.20-3.51]; p = 0.0072). 5-year OS was 98.3% and 98.8%, respectively (p = 0.14); 4/12 documented deaths were caused by second primary malignancies and only one by HL. Among patients assigned to CMT, 5-year PFS was better in PET-2-negative (n = 353; 94.0%) than in PET-2-positive patients (n = 340; 90.3%; p = 0.012). The difference was more pronounced when using DS4 as cut-off (DS 1-3: n = 571; 94.0% vs. DS ≥ 4: n = 122; 83.6%; p < 0.0001). Taken together, CMT should be considered standard treatment for early-stage favorable HL irrespective of the PET-2-result.