Use of (18)F FDG PET and the short temporal response of Hodgkin's disease to RIT

Radioimmunotherapy (RIT) has been available for some time to treat patients with non-Hodgkin's lymphoma, but its use in Hodgkin's lymphoma has been less available, partly because of the need to find an appropriate antibody. A new radioiodinated chimeric antibody directed against the CD25 epitope ((131)I basiliximab) seems promising, but assessment of response has been difficult. (18)F-fluorodeoxyglucose-positron emission tomography ((18)F-FDG-PET) has become a standard method by which the response of Hodgkin's disease to chemotherapy is both predicted and assessed with well-understood criteria of response. The aim of this study is to determine (18)F-FDG-PET can be used to assess response to RIT. Pre- and post-treatment (18)F-FDG-PET imaging was performed in a series of 13 patients with advanced Hodgkin's disease who had failed conventional therapy and had been enrolled on a compassionate use program for treatment with (131)I basiliximab. The (131)I basiliximab was given at an activity of 1200MBq/m(2) with one patient receiving 2 cycles and the rest a single cycle. The (18)F-FDG-PET studies were compared using the “Deauville” criteria and by comparing the maximum standardized uptake value (SUVmax) of target tumors before and 4 and 8 weeks after treatment. All patients survived long enough for their initial (18)F-FDG-PET-computed tomography scan at 4 weeks after their (131)I basiliximab therapy. One out of ten patients with “Deauville” Grade 4 or 5 response died during the 6-month follow-up period. Two out of three patients with a “Deauville” Grade 2 or 3 response died in the follow-up period. The mean SUVmax pretreatment was 11.9 (±4.7); at 4-week posttreatment, the mean SUVmax was significantly lower at 6.5 (±5.8) (P = 0.02). At 8 weeks, the mean SUVmax was 8.8 (±7.0), which was not significantly different from the pretreatment level. (18)F-FDG-PET imaging is able to predict the short-term response to treatment of Hodgkin's disease by RIT, and an initial poor response appears to predict poor outcome. Early changes in (18)F-FDG-PET uptake did not predict sustained response and by 8 weeks all but one patient had recurrent disease.