UZH-Logo

Maintenance Infos

Definition of bulky disease in early stage Hodgkin lymphoma in computed tomography era: prognostic significance of measurements in the coronal and transverse planes


Kumar, Anita; Burger, Irene A; Zhang, Zhigang; Drill, Esther N; Migliacci, Jocelyn C; Ng, Andrea; LaCasce, Ann; Wall, Darci; Witzig, Thomas E; Ristow, Kay; Yahalom, Joachim; Moskowitz, Craig H; Zelenetz, Andrew D (2016). Definition of bulky disease in early stage Hodgkin lymphoma in computed tomography era: prognostic significance of measurements in the coronal and transverse planes. Haematologica, 101(10):1237-1243.

Abstract

Disease bulk is an important prognostic factor in early stage Hodgkin lymphoma, but its definition is unclear in the computed tomography-era. This retrospective analysis investigated the prognostic significance of bulky disease measured in transverse and coronal planes on computed tomography imaging. Early stage Hodgkin lymphoma patients (n=185) treated with chemotherapy with or without radiotherapy from 2000-2010 were included. The longest diameter of the largest lymph node mass was measured in transverse and coronal axes on pre-treatment imaging. The optimal cutoff for disease bulk was maximal diameter greater than 7 cm measured in either the transverse or coronal plane. Thirty patients with maximal transverse diameter ≤7 cm were found to have bulk in coronal axis. The 4-year overall survival was 96.5% (CI 93.3%, 100%) and 4-year relapse-free survival was 86.8% (CI 81.9%, 92.1%) for all patients. Relapse free survival at 4-years for bulky patients was 80.5% (CI 73%, 88.9%) compared to 94.4% (CI 89.1%, 100%) for non-bulky, Cox HR 4.21 (CI 1.43, 12.38), P = 0.004. In bulky patients, relapse free survival was not impacted in patients treated with chemoradiotherapy; however, was significantly inferior in patients treated with chemotherapy alone. In an independent validation cohort of 38 patients treated with chemotherapy alone, patients with bulky disease had an inferior relapse-free survival (at 4-years, 71.1% (CI 52.1%, 97%) versus 94.1% (CI 83.6%, 100%), Cox HR 5.27 (CI 0.62, 45.16), P = 0.09). Presence of bulky disease on multidimensional computed tomography imaging is a significant prognostic factor in early stage Hodgkin lymphoma. Coronal reformations may be included for routine Hodgkin lymphoma staging evaluation. In future, our definition of disease bulk may have utility in identifying patients who are most appropriate for chemotherapy-alone.

Abstract

Disease bulk is an important prognostic factor in early stage Hodgkin lymphoma, but its definition is unclear in the computed tomography-era. This retrospective analysis investigated the prognostic significance of bulky disease measured in transverse and coronal planes on computed tomography imaging. Early stage Hodgkin lymphoma patients (n=185) treated with chemotherapy with or without radiotherapy from 2000-2010 were included. The longest diameter of the largest lymph node mass was measured in transverse and coronal axes on pre-treatment imaging. The optimal cutoff for disease bulk was maximal diameter greater than 7 cm measured in either the transverse or coronal plane. Thirty patients with maximal transverse diameter ≤7 cm were found to have bulk in coronal axis. The 4-year overall survival was 96.5% (CI 93.3%, 100%) and 4-year relapse-free survival was 86.8% (CI 81.9%, 92.1%) for all patients. Relapse free survival at 4-years for bulky patients was 80.5% (CI 73%, 88.9%) compared to 94.4% (CI 89.1%, 100%) for non-bulky, Cox HR 4.21 (CI 1.43, 12.38), P = 0.004. In bulky patients, relapse free survival was not impacted in patients treated with chemoradiotherapy; however, was significantly inferior in patients treated with chemotherapy alone. In an independent validation cohort of 38 patients treated with chemotherapy alone, patients with bulky disease had an inferior relapse-free survival (at 4-years, 71.1% (CI 52.1%, 97%) versus 94.1% (CI 83.6%, 100%), Cox HR 5.27 (CI 0.62, 45.16), P = 0.09). Presence of bulky disease on multidimensional computed tomography imaging is a significant prognostic factor in early stage Hodgkin lymphoma. Coronal reformations may be included for routine Hodgkin lymphoma staging evaluation. In future, our definition of disease bulk may have utility in identifying patients who are most appropriate for chemotherapy-alone.

Altmetrics

Downloads

9 downloads since deposited on 01 Sep 2016
9 downloads since 12 months
Detailed statistics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:6 July 2016
Deposited On:01 Sep 2016 09:40
Last Modified:01 Oct 2016 01:02
Publisher:Ferrata Storti Foundation
ISSN:0390-6078
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.3324/haematol.2016.141846
PubMed ID:27390360

Download

[img]
Preview
Content: Published Version
Filetype: PDF
Size: 1MB
View at publisher
Licence: Creative Commons: Attribution 3.0 Unported (CC BY 3.0)

TrendTerms

TrendTerms displays relevant terms of the abstract of this publication and related documents on a map. The terms and their relations were extracted from ZORA using word statistics. Their timelines are taken from ZORA as well. The bubble size of a term is proportional to the number of documents where the term occurs. Red, orange, yellow and green colors are used for terms that occur in the current document; red indicates high interlinkedness of a term with other terms, orange, yellow and green decreasing interlinkedness. Blue is used for terms that have a relation with the terms in this document, but occur in other documents.
You can navigate and zoom the map. Mouse-hovering a term displays its timeline, clicking it yields the associated documents.

Author Collaborations