SIGNIFICANT advancements in tailoring salvage therapy for pediatric patients with relapsed or refractory classic Hodgkin lymphoma (cHL) have been revealed in a recent clinical trial. The findings emphasize the role of FDG-PET imaging in risk stratification, enabling a more personalized approach to treatment that balances efficacy with toxicity.
Conducted across 68 sites in 13 European countries, the EuroNet-PHL-R1 trial involved 118 patients under 18 years of age diagnosed with relapsed or refractory cHL. Researchers evaluated the use of FDG-PET response and clinical risk factors to determine whether patients should undergo transplant-free salvage therapy or more intensive high-dose chemotherapy (HDCT) with autologous stem cell transplant (aSCT).
Key Findings
Low-Risk Group (n=59): Patients demonstrating favorable FDG-PET responses underwent nontransplant salvage therapy, achieving a 5-year progression-free survival (PFS) rate of 89.7% and overall survival (OS) of 97.4%. An additional subgroup who underwent HDCT/aSCT off protocol achieved similar outcomes with a 5-year PFS of 88.9%.
High-Risk Group (n=59): Patients with inadequate PET responses or primary progression required HDCT/aSCT, yielding a 5-year PFS rate of 53.3% and OS of 66.5%.
Clinical Relevance
These findings suggest that FDG-PET imaging can effectively identify low-risk patients who may avoid the toxicities associated with HDCT/aSCT while still achieving high cure rates. Conversely, patients with high-risk disease benefit from intensive therapy.
Implications for Practice
This approach allows clinicians to customize salvage therapy, sparing many pediatric patients from the long-term effects of intensive treatments. The study underscores the importance of integrating imaging biomarkers into clinical decision-making to optimize outcomes.
Reference: Daw S et al. Transplant and Nontransplant Salvage Therapy in Pediatric Relapsed or Refractory Hodgkin Lymphoma. JAMA Oncol. 2025. doi:10.1001/jamaoncol.2024.5636
