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Early serum TARC reduction predicts prognosis in advanced-stage Hodgkin lymphoma patients treated with a PET-adapted strategy |
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| Authors: | Simonetta Viviani Arabella Mazzocchi Chiara Pavoni Francesca Taverna Andrea Rossi Caterina Patti Alessandra Romano Livio Trentin Roberto Sorasio Anna Guidetti Daniela Gottardi Corrado Tarella Michele Cimminiello Roberta Zanotti Lucia Farina Andrés José Maria Ferreri Marina Galbiati Paolo Corradini Alessandro Massimo Gianni Andrea Gallamini Alessandro Rambaldi |
| Institution: | 1. Department of Hemato-Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;2. Immuno-hematology and Transfusion Medicine Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;3. Department of Oncology and Hematology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy;4. Division of Hematology 1, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy;5. Department of Medical and Surgery Science, Hematology Unit, University of Catania, Catania, Italy;6. Department of Hematology, University of Padova, Padova, Italy;7. Division of Hematology, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy;8. Division of Hematology, Ospedale Mauriziano Umberto I di Torino, Turin, Italy;9. Hemato-Oncology Division, European Institute of Oncology IRCCS, Milan, Italy
University Department “Scienze della Salute” (DISS), University of Milan, Milan, Italy;10. Divisione Universitaria di Ematologia, Ospedale San Carlo, Potenza, Italy;11. Hematology Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy;12. Lymphoma Unit, Department of Onco-Hematology, IRCCS Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy;13. Department of Oncology and Hematology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy Department of Oncology and Hematology, University of Milan, Milan, Italy |
| Abstract: | Among patients with advanced-stage classical Hodgkin lymphoma (cHL) receiving ABVD chemotherapy, PET performed after the first two treatment cycles (PET-2) has prognostic value. However, 15% of patients with a negative PET-2 will experience treatment failure. Here we prospectively evaluated serum thymus and activation-regulated chemokine (TARC) levels, to improve risk assessment in patients treated according to HD0607 PET-driven trial (#NCT00795613). In 266 patients with available serum samples, who have agreed to participate in a sub-study for assessment of the role of TARC monitoring, serum TARC levels were measured at baseline and at time of PET-2 by commercially available ELISA test kits. The primary end-point was to evaluate the association between TARC after 2 ABVD cycles and PFS. Median TARC-2 values were significantly higher in PET-2-positive patients compared to PET-2-negative patients (P = .001), and in patients with treatment failure compared to those in continuous CR (P = .01). The 4-year PFS significantly differed between patients with TARC-2 >800 pg/mL vs ≤800 pg/mL (64% vs 86%, P = .0001). Moreover, among PET-2-negative patients, elevated TARC-2 identified those with a worse prognosis (74% vs 89%; P = .01). In multivariable analysis, TARC-2 >800 pg/mL was a significant independent predictor of PFS in the whole study population (HR 2.39, P = .004) and among the PET-2-negative patients (HR 2.49, P = .02). In conclusion, our results indicate that TARC-2 serum levels above 800 pg/mL suggest the need for a stringent follow-up in PET-2-negative patients, and the evaluation of new drugs in PET-2-positive, who will likely fail to respond to intensification with escalated BEACOPP. |
| Keywords: | advanced stage biomarker Hodgkin lymphoma PET-2 PET-adapted strategy TARC |