Impact of imaging modality on clinical outcome in Hodgkin lymphoma in a resource constraint setting.

Treatment of Hodgkin lymphoma (HL) has evolved with risk-stratified therapy based on PET-CT scan at multiple timepoints. In a resource constraint setting even a single PET-CT scan ($400) is inaccessible to many patients, who are re-assessed with only clinical examination, abdominal ultrasonogram and/or x-ray (C/U/X) ($10). To compare clinical outcomes in patients with HL who have had suboptimal imaging after completion of chemotherapy for HL, with those who had a CT or PET-CT, 283 patients were treated for HL from 2011 to 2015, and 268 patients completed six cycles of ABVD therapy with response assessment modality by CT/PET in 185 patients and by C/U/X in 83. There was no difference in the number of patients with advanced (64 center dot 1% vs. 61 center dot 1%; P = 0 center dot 650) or bulk disease (8 center dot 1% vs. 7 center dot 2%). A significantly higher number of patients in the CT/PET group received IFRT (25 center dot 4% vs. 7 center dot 7%; P = 0 center dot 0005). The three-year overall survival and progression-free survival of all treated patients (n = 283) was 83 center dot 5 +/- 2 center dot 3% and 76 center dot 7 +/- 2 center dot 6% respectively [median follow-up 36 months (range 2-93)]. At three years, the overall relapse-free survival (RFS) was 80 center dot 1 +/- 2 center dot 5%, with RFS of 77 +/- 3 center dot 2% vs. 85 +/- 4 center dot 0% in the CT/PET group and C/U/X groups respectively (P = 0 center dot 349). There was no difference in RFS between the two groups either in early-stage disease (88 center dot 1 +/- 4 center dot 6% vs. 91 center dot 8 +/- 5 center dot 6%; P = 0 center dot 671) or late-stage disease (73 center dot 9 +/- 4 center dot 8% vs. 81 center dot 3 +/- 6 center dot 0%; P = 0 center dot 747). The only significant factor adversely affecting RFS was advanced disease (P = 0 center dot 004). Factors not affecting RFS were age (P = 0 center dot 763), sex (P = 0 center dot 925), bulk disease (P = 0 center dot 889) and imaging modality (P = 0 center dot 352). There was no difference in relapse rates between patients who had suboptimal imaging compared to those who had a PET/CT. It is possible to use these basic imaging modalities when resources are a constraint, with acceptable outcomes.