RATHL: adapted treatment guided by interim PET-CT in advanced Hodgkin lymphoma
Using a PET scan after two cycles to decide the rest of treatment let patients with a clear scan drop bleomycin, sparing their lungs without losing cure, while those with a positive scan were escalated to stronger chemotherapy.
Overview
International randomised trial of 1,214 patients with advanced Hodgkin lymphoma who had an interim PET-CT after two cycles of ABVD; PET-negative patients were randomised to continue ABVD or switch to AVD (omitting bleomycin), and PET-positive patients were escalated to BEACOPP.
Three-year progression-free survival was 85.7 percent with ABVD and 84.4 percent with AVD, with fewer pulmonary adverse events after bleomycin was dropped; PET-positive patients escalated to BEACOPP had a three-year progression-free survival of 67.5 percent, better than expected. PET-adapted therapy became standard.
- Three-year progression-free survival 85.7 percent with continued ABVD versus 84.4 percent with AVD after a negative interim PET.
- Fewer pulmonary and other toxic effects without bleomycin; PET-positive patients escalated to BEACOPP had 67.5 percent three-year progression-free survival.
An interim PET scan after two cycles guides treatment of advanced Hodgkin lymphoma: drop bleomycin if negative, intensify if positive.
- The non-inferiority margin for AVD was not formally met in the intention-to-treat analysis, though the difference was small.
- Predates brentuximab vedotin and nivolumab combinations, which now often replace ABVD.
Similar pages
not linked directly; found by shared links- TechnologyPET-adapted (response-adapted) therapy
- TechnologyFDG PET