Eva Domingo-Domènech1, Carmen Martínez2, M. del Pilar Perlaza3, Montserrat Cortes4, Gonzalo Gutiérrez2, Rocio Parody1, María Suárez-Lledó2, Francesc Fernández-Avilés2, Isabel Sanchez-Ortega1, Montserrat Rovira2, Xavier Setoain3, Valentín Ortíz2, Anna Sureda1
1 Hematology Department, Institut Català d’Oncologia. Hospital Duran i Reynals, L’Hospitalet de Llobregat, Barcelona, 2 Hematopoietic Transplant Unit, Hematology Department, Institute of Hematology and Oncology, IDIBAPS, Institute Josep Carreras, Hospital Clínic, Barcelona, 3 Nuclear Medicine Department, CDI, Hospital Clínic, Barcelona, 4 Nuclear Medicine Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona
Introduction: (18) F-Fluorodeoxyglucose-Positron Emision Tomography (FDG-PET) has a recognized prognostic value before autologous stem cell transplantation (ASCT) in patients with relapsed/refractory Hodgkin lymphoma (HL), but its impact before allogeneic SCT (alloSCT) remains unclear.
Methods: We retrospectively evaluated the impact of pre-transplant FDG-PET status on the outcomes of HL patients who had undergone an alloSCT in two Spanish institutions between May/2005 and May/2016.
Results: Forty one patients [median age at alloSCT of 32 years (20–65), 49% males] were included. Time interval between diagnosis and alloSCT was of 31 (7–247) months. Median number of treatment lines before transplant were 4 (2–8), 59% had primary refractory disease and 89% had failed a previous ASCT. Disease status at alloSCT was: 17 patients in complete response, 15 patients in partial and 9 patients with progressive disease. Sixteen patients underwent HLA identical sibling, 15 matched unrelated donor and 9 an haploidentical transplant, of them 36 were reduced-intensity conditioning (RIC) and 5 myeloablative conditioning (MAC). Twenty-four (58%) had a positive FDG-PET pre-alloSCT and in 13 out of 36 (31%) remained positive post-transplant. Twenty-three (56%) patients presented acute GVHD and 23 (56%) chronic GVHD. Nineteen patients relapsed post-alloSCT, at a median time of 6 (1–36) months after transplant.
Univariate analysis indicated that haploidentical donor source (p = 0.03) improved PFS after transplant, negative FDG-PET pre alloSCT (p = 0.05) and non-relapse after transplant (p = 0.007) improved OS and that HLA-identical sibling (p = 0.025) increased relapse rate after transplant.
The median OS was of 58 months and the median PFS of 14 months. Patients with negative PET studies before alloSCT had significantly better outcomes in terms of median OS (87 months vs. 21 months; p = 0.048) and median PFS (36 months vs. 7 months; p = 0.012)
Conclusions: Our findings suggest that FDG-PET status before alloSCT in patients with HL has an impact on survival outcomes. These results should be confirmed with larger prospective series.