Impact of imaging modality on clinical outcome in Hodgkin lymphoma in a resource constraint setting.
Hodgkin
PET
cost benefit
lymphomas
Journal
British journal of haematology
ISSN: 1365-2141
Titre abrégé: Br J Haematol
Pays: England
ID NLM: 0372544
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
01
07
2019
accepted:
09
09
2019
pubmed:
8
12
2019
medline:
18
11
2020
entrez:
8
12
2019
Statut:
ppublish
Résumé
Treatment of Hodgkin lymphoma (HL) has evolved with risk-stratified therapy based on PET-CT scan at multiple timepoints. In a resource constraint setting even a single PET-CT scan ($400) is inaccessible to many patients, who are re-assessed with only clinical examination, abdominal ultrasonogram and/or x-ray (C/U/X) ($10). To compare clinical outcomes in patients with HL who have had suboptimal imaging after completion of chemotherapy for HL, with those who had a CT or PET-CT, 283 patients were treated for HL from 2011 to 2015, and 268 patients completed six cycles of ABVD therapy with response assessment modality by CT/PET in 185 patients and by C/U/X in 83. There was no difference in the number of patients with advanced (64·1% vs. 61·1%; P = 0·650) or bulk disease (8·1% vs. 7·2%). A significantly higher number of patients in the CT/PET group received IFRT (25·4% vs. 7·7%; P = 0·0005). The three-year overall survival and progression-free survival of all treated patients (n = 283) was 83·5 ± 2·3% and 76·7 ± 2·6% respectively [median follow-up 36 months (range 2-93)]. At three years, the overall relapse-free survival (RFS) was 80·1 ± 2·5%, with RFS of 77 ± 3·2% vs. 85 ± 4·0% in the CT/PET group and C/U/X groups respectively (P = 0·349). There was no difference in RFS between the two groups either in early-stage disease (88·1 ± 4·6% vs. 91·8 ± 5·6%; P = 0·671) or late-stage disease (73·9 ± 4·8% vs. 81·3 ± 6·0%; P = 0·747). The only significant factor adversely affecting RFS was advanced disease (P = 0·004). Factors not affecting RFS were age (P = 0·763), sex (P = 0·925), bulk disease (P = 0·889) and imaging modality (P = 0·352). There was no difference in relapse rates between patients who had suboptimal imaging compared to those who had a PET/CT. It is possible to use these basic imaging modalities when resources are a constraint, with acceptable outcomes.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
930-934Informations de copyright
© 2019 British Society for Haematology and John Wiley & Sons Ltd.
Références
Adams, H.J.A. & Kwee, T.C. (2016) Proportion of false-positive lesions at interim and end-of-treatment FDG-PET in lymphoma as determined by histology: Systematic review and meta-analysis. European Journal of Radiology, 85, 1963-1970.
Babashov, V., Begen, M.A., Mangel, J. & Zaric, G.S. (2017) Economic evaluation of brentuximab vedotin for persistent Hodgkin lymphoma. Current Oncology, 24, e6-e14.
Bonadonna, G., Zucali, R., Monfardini, S., De Lena, M. & Uslenghi, C. (1975) Combination chemotherapy of Hodgkin's disease with adriamycin, bleomycin, vinblastine, and imidazole carboxamide versus MOPP. Cancer, 36, 252-259.
Chand, R. (2017) National Institution for Transforming India NITIAayog. Available at:https://niti.gov.in/ (accessed on 1 July 2019).
Cheson, B.D., Fisher, R.I., Barrington, S.F., Cavalli, F., Schwartz, L.H., Zucca, E. & Lister, T.A.; Alliance, Australasian Leukaemia and Lymphoma Group; Eastern Cooperative Oncology Group; European Mantle Cell Lymphoma Consortium; Italian Lymphoma Foundation; European Organisation for Research; Treatment of Cancer/Dutch Hemato-Oncology Group; Grupo Español de Médula Ósea; German High-Grade Lymphoma Study Group; German Hodgkin's Study Group; Japanese Lymphorra Study Group; Lymphoma Study Association; NCIC Clinical Trials Group; Nordic Lymphoma Study Group; Southwest Oncology Group; United Kingdom National Cancer Research Institute. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. Journal of Clinical Oncology 2014, 32, 3059-3068.
Dittmann, H., Sokler, M., Kollmannsberger, C., Dohmen, B.M., Baumann, C., Kopp, A., Bares, R., Claussen, C.D., Kanz, L. & Bokemeyer, C. (2001) Comparison of 18FDG-PET with CT scans in the evaluation of patients with residual and recurrent Hodgkin's lymphoma. Oncology Reports, 8, 1393-1399.
Engstrom, A. (2014) The cost-effectiveness of brentuximab vedotin in Hodgkin lymphoma in Sweden. Value in Health, 17, A639.
Hui, L., von Keudell, G., Wang, R., Zeidan, A.M., Gore, S.D., Ma, X., Davidoff, A.J. & Huntington, S.F. (2017) Cost-effectiveness analysis of consolidation with brentuximab vedotin for high-risk Hodgkin lymphoma after autologous stem cell transplantation. Cancer, 123, 3763-3771.
Norum, J., Angelsen, V., Wist, E. & Olsen, J.A. (1996) Treatment costs in Hodgkin's disease: a cost-utility analysis. European Journal of Cancer, 32A, 1510-1517.
Parikh, R.R., Grossbard, M.L., Green, B.L., Harrison, L.B. & Yahalom, J. (2015) Disparities in survival by insurance status in patients with Hodgkin lymphoma. Cancer, 121, 3515-3524.
Parker, C., Woods, B., Eaton, J., Ma, E., Selby, R., Benson, E., Engstrom, A., Sajosi, P., Briggs, A. & Bonthapally, V. (2017) Brentuximab vedotin in relapsed/refractory Hodgkin lymphoma post-autologous stem cell transplant: a cost-effectiveness analysis in Scotland. Journal of Medical Economics, 20, 8-18.
Rigacci, L., Kovalchuk, S., Berti, V., Puccini, B., Mannelli, L., Benelli, G., Dini, C., Pupi, A. & Bosi, A. (2018) The use of Deauville 5-point score could reduce the risk of false-positive fluorodeoxyglucose-positron emission tomography in the posttherapy evaluation of patients with primary bone lymphomas. World Journal of Nuclear Medicine, 17, 157-165.
Stefan, D.C. & Stones, D. (2009) How much does it cost to treat children with Hodgkin lymphoma in Africa? Leukemia & Lymphoma, 50, 196-199.
Wikipedia. (2019) List of countries by GNI (nominal) per capita. Available at: https://en.wikipedia.org/wiki/List_of_countries_by_GDP_(nominal)_per_capita (accessed on 1 July 2019).