Background/Objectives: Despite the high complete response (CR) rate to first-line therapy, approximately one-third of patients with advanced-stage Hodgkin lymphoma (HL) eventually relapse. In up to 30–50% of cases, relapses are subclinical, i.e., initially detected only by imaging procedures. However, there is no definitive consensus on the optimal surveillance strategy for high-risk HL patients.Methods: The purpose of this cohort study is to evaluate the long-term outcome of stage II-B/IV HL patients who relapsed under routine imaging surveillance (imaging cohort) compared to those who relapsed under conventional clinical monitoring (standard cohort). Follow-up in the imaging cohort systematically included FDG-PET/CT, ultrasonography, and/or chest X-ray. At relapse, patients were treated with the same approach (salvage therapy and autologous hematopoietic stem cell transplantation [AHSCT]) in both cohorts.Results: A total of 123 high-risk HL patients were assessed at their first relapse: 80 in the imaging cohort and 43 in the standard cohort. The 2-year event-free survival (EFS) was significantly higher in the imaging cohort compared to the standard cohort (70% vs. 37.2%, respectively;p= 0.001). Similarly, the CR rate following salvage treatment was greater in the imaging cohort as compared to the standard cohort (68.8% vs. 41.9%, respectively;p< 0.004). These differences were due to the capability of routine imaging surveillance to detect disease with more limited extension (early onset of clinically silent relapses) as compared to standard clinical monitoring, which was associated with relapsed disease in a more advanced stage.Conclusions: Our findings suggest that routine imaging surveillance in patients with high-risk HL leads to improved EFS detecting relapses, which were characterized by more favorable prognostic factors (low tumor burden), thus enabling the timely administration of salvage therapy.
背景/目的：尽管一线治疗在晚期霍奇金淋巴瘤（HL）患者中获得了较高的完全缓解（CR）率，但仍有约三分之一的患者最终会复发。其中高达30%至50%的复发为亚临床复发，即最初仅通过影像学检查发现。然而，对于高危HL患者的最佳监测策略，目前尚无明确共识。 方法：本队列研究旨在评估在常规影像监测（影像队列）下复发的II-B/IV期HL患者，与在常规临床监测（标准队列）下复发的患者相比的长期预后。影像队列的随访系统性地包括FDG-PET/CT、超声检查和/或胸部X光检查。复发时，两组患者均接受相同的治疗（挽救性治疗和自体造血干细胞移植[AHSCT]）。 结果：共评估了123例高危HL患者的首次复发情况：其中80例属于影像队列，43例属于标准队列。影像队列的2年无事件生存率（EFS）显著高于标准队列（分别为70% vs. 37.2%，p=0.001）。同样，挽救性治疗后的CR率在影像队列中也高于标准队列（分别为68.8% vs. 41.9%，p<0.004）。这些差异归因于常规影像监测相较于标准临床监测，能够检测到疾病范围更局限的复发（即临床无症状复发的早期发现），而标准临床监测则与疾病在更晚期阶段复发相关。 结论：我们的研究结果表明，对高危HL患者进行常规影像监测能够通过检测具有更有利预后因素（低肿瘤负荷）的复发，从而提高无事件生存率，从而使得挽救性治疗能够及时实施。
Routine Imaging Surveillance After Frontline ABVD Improves Outcome in High-Risk Hodgkin Lymphoma
肿瘤(癌症)患者之家