Pretransplant positive positron emission tomography/gallium scans predict poor outcome in patients with recurrent/refractory Hodgkin lymphoma

BACKGROUND. The objective was to determine the prognostic value of functional imaging (FI) in predicting outcome of patients with recurrent/ refractory Hodgkin lymphoma (HL) before undergoing high-dose chemotherapy with autologous stem cell transplantation (ASCT). METHODS. Clinical and imaging data were retrospectively reviewed in 211 consecutive patients treated with ASCT from February 1993 to May 2004. The FI results were correlated with progression-free survival (PFS) and overall survival (OS) using Kaplan-Meier survival analysis. RESULTS. Responses were assessed by conventional criteria and evaluated by positron emission tomography (PET) (n = 68) and gallium scans (n - 144) before ASCT. A complete response (CR) or unconfirmed CR (CRu) was seen in 51% of patients, a partial response (PR) in 41% of patients, and stable or progressive disease in 7% of patients. 171 was positive in only 6 of 110 (5%) of CR/CRu patients, in 48 of 86 (56%) of PR patients, and in all 3 patients with progressive disease. The 3-year PFS was 69% for patients with negative FI versus 23% for patients with positive FI (P <.0001). The 3-year OS rates were 87% and 58%, respectively (P <.0001). The 3-year PFS for patients in PR with negative FI was 51% comparable to patients in CR (76%) versus 27% for patients in PR with positive FI (P <.0001). In a multivariate model, positive FI was found to be independently prognostic of PFS. CONCLUSIONS. Pretransplant FI status predicts outcome in patients with recurrent/refractory HL. Positive Fl confers a poor prognosis, independent of other traditional presalvage prognostic factors.