Pugliese, Novella (2020) Impact on survival of early detection of recurrence in the follow-up of high-risk hodgkin lymphoma in the first complete remission. [Tesi di dottorato]

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Despite the high complete response (CR) rate to first-line therapy, approximately one-third of patients with high risk Hodgkin lymphoma (HL) eventually relapses. In up to 30 to 50% of patients, relapses are initially evident only by imaging procedures, however a definitive consensus on the best surveillance procedure for high risk HL patients has not been reached yet. The purpose of this cohort study is to evaluate the long-term outcome after salvage treatment and ASCT, of high risk HL patients who relapse under imaging surveillance compared to the conventional clinical monitoring. We evaluated a total of 123 high risk HL patients in first relapse followed, after remission, either with a systematic imaging-based surveillance (Imaging cohort, n= 80) or with the standard clinical-based surveillance (Standard cohort, n = 43). Follow-up procedures within the imaging group involved either FDG/PET CT or ultrasound plus chest X-Ray. The 2-years EFS was significantly longer in the patients of the Imaging cohort with respect to the standard cohort (70% vs 37.2%, respectively - p=0.004) and the quality of responses was better in the former cohort (CR rate 68.8% vs 41.9% - p<0.004). Those differences were most likely due to the capability of imaging surveillance to identify early onset of clinically silent relapses whose EFS at 2 years is significantly better (78% vs 43%, respectively – p<0.0001). Our data indicate that the early detection of HL recurrence allows a timely administration of salvage therapy to patients with a more limited disease and, consequently, an EFS improvement.

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