Among patients with human immunodeficiency virus (HIV)-associated Hodgkin lymphoma (HL), high total metabolic tumor volume (TMTV) by baseline positron emission tomography (PET1) reading is linked with poor outcomes, according to research published in the Journal of Clinical Oncology.
HIV infection has been repeatedly linked with an increased risk of cancer, including HL, with some data suggesting that the risk of HL may be 15-fold higher than that seen in the general population. HIV-associated HL is, furthermore, more likely to be diagnosed at an advanced disease stage, though novel treatments for HIV have helped to improve outcomes among these patients.
Although many prognostic factors have been established in HL not related to HIV, no previous research had identified any such factors in HL-related HIV for which 18F-labeled fluorodeoxyglucose PET with computed tomography (18F-FDG PET-CT) is used. For this study, researchers aimed to determine 18F-FDG PET-CT prognostic factors, both at PET1 and interim 18F-FDG PET-CT (iPET), among patients with HIV-related HL.
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Of 144 patients with HIV-related HL identified in the study, data from 109 were included in this study. The median age was 46 years (range, 41-51), 84% of patients were male sex, the median period since HIV diagnosis was 11 years, 43% of patients had stage IV disease, 64% of patients had B symptoms, and the median TMTV was 121.4 cm3.
The median follow-up was 6.7 years, at which point 11% of patients had relapsed and 12% had died. The 5-year progression-free survival rate (PFS) was 75.1%, and the 5-year overall survival rate was 86.1%.
Analysis showed that TMTV at PET1 was the only prognostic factor that predicted PFS, with an optimal TMTV cutoff for analysis of 527 cm3. Among patients with a TMTV of greater than 527 cm3, the 2-year PFS was 71%; among those with a TMTV of 527 cm3 or less, the 2-year PFS was 91% (P =.004).
“In conclusion, this large series of patients with HIV-HL homogeneously managed demonstrated that (1) despite the advent of combination antiretroviral therapy, 18F-FDG PET-CT highlights that HIV-HL remains a disseminated disease and (2) high baseline TMTV, a parameter directly linked to the tumor burden, is associated with poor prognosis, and could help to select a subgroup of patients that could benefit from a frontline adapted therapy,” the authors wrote.
Disclosure: The study author(s) declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference
Louarn N, Galicier L, Bertinchamp R, et al. First extensive analysis of 18F-labeled fluorodeoxyglucose positron emission tomography-computed tomography in a large cohort of patients with HIV-associated Hodgkin lymphoma: baseline total metabolic tumor volume affects prognosis. J Clin Oncol. Published online January 24, 2021. doi:10.1200/JCO.21.01228
