Healthy Tissue Metabolism Assessed by 18FFDG PET/CT as a Marker of Prognosis and Adverse Events in Advanced Hodgkin Lymphoma Patients

Abstract The aim of the study was to assess healthy tissue metabolism (HTM) using 18FFDG-PET/CT during chemotherapy in Hodgkin lymphoma (HL) and the association of HTM with baseline metabolic tumour volume (MTV), haematological parameters, adverse events (AEs), early response and progression-free survival (PFS). We retrospectively identified 200 patients with advanced HL from the RATHL trial with PET/CT before (PET0) and following 2 cycles of chemotherapy (PET2). 18FFDG-uptake was measured in bone marrow (BM), spleen, liver and mediastinal blood pool (MBP). Deauville score (DS)1-3 was used to classify responders and DS 4-5, non-responders. 18FFDG-uptake decreased significantly in BM and spleen and increased in liver and MBP at PET2 (all p< 0.0001), but was not associated with MTV. BM uptake at PET0 was associated with lower baseline haemoglobin and higher absolute neutrophil counts, platelets and white blood cells. BM, spleen and liver uptake at PET0 was associated with neutropenia after cycles 1-2. BM uptake at PET0 was associated with treatment failure at PET2 and non-responders with higher BM uptake at PET2 had significantly inferior PFS (p = 0.006; hazard ratio = 2.31). Change in HTM during chemotherapy was most likely a direct impact of chemotherapy rather than a change in MTV. BM uptake has a prognostic value in HL.