ΔSUVmax adds prognostic value to early response assessment during the first-line treatment of classical hodgkin lymphoma: a retrospective cohort study.

Background: In classical Hodgkin lymphoma (HL), optimizing early risk stratification and response assessment are the cornerstones of therapy. The advanced interpretation of positron emission tomography - computed tomography (PET/CT) results can provide prognostic information beyond the Deauville score (DS). The aim of our study was to explore the prognostic value of the change in maximum standardized uptake value (ΔSUVmax) to predict disease progression during the first-line treatment of adult HL.

Methods: All patients were treated with curative intent, standard therapy. PET/CT assessments were performed at baseline, interim and end-of-treatment timepoints. ΔSUVmax cut-off values were determined by the receiver operating characteristics (ROC) analysis. Overall- (OS) and progression-free survival (PFS) were determined as primary endpoints.

Results: Baseline SUVmax did not differ in patients who progressed during or after first-line therapy compared to patients in remission. However, patients with progressive disease had a higher mean SUVmax and lower ΔSUVmax at interim analysis. The presence of a ΔSUVmax > 88% after 2 cycles of therapy was associated with longer PFS (P = 0.013 [HR, 5.21]), with a negative predictive value exceeding the DS. The combination of ΔSUVmax with DS further stratified PET-negative patients: the 5-year PFS of low-risk and high-risk patients were 92.1% and 79.1%, respectively (P = 0.047 [HR, 2.87]). The ΔSUVmax cut-off of 55% in patients with DS 3-5 revealed high-risk patients with significantly lower 5-year OS and PFS (P = 0.008 [HR, 13] and P < 0.001 [HR, 11.5], respectively).

Conclusions: Altogether, ΔSUVmax is a promising standalone prognostic marker or combination partner of DS in the early risk stratification and response assessment of HL.