Prognostic impact of pretransplantation computed tomography and gallium scans in patients with Hodgkin lymphoma with poor prognosis undergoing hematopoietic stem cell transplantation

Background: The present study evaluated computed tomography (CT) and Gallium-67 scanning (Ga-67) before transplantation as prognostic factors for overall survival (OS) and event-free survival (EFS) in patients with relapsed or primary refractory Hodgkin lymphoma undergoing high-dose chemotherapy and stem cell transplantation. Patients and Methods: Forty-five patients were included. Of these, 10 (22%) had positive CT and 67Ga scan results, 21 (47%) had negative results of both techniques, 12 (27%) had positive CT/ negative Ga-67 scan results, and 2 (5%) had negative CT/positive Ga-67 scan results. Results: Patients with positive CT/Ga-67 scan results had a significantly worse EFS and OS at 5 years than those with negative Ga-67 scan results, whether it was associated with positive or negative CT scan results (0 and 25% vs. 83% and 90% vs. 74% and 83%, respectively; P< 0.001). With a median follow-up of 59 months (range, 6-150 months), no differences were observed between patients with negative CT/Ga-67 scan results and those with positive CT/ negative Ga-67 scan results, with an EFS and OS at 5 years of 74% vs. 83% and 83% vs. 90%, respectively. In multivariate analysis, the presence of pretransplantation positive CT/Ga-67 scan results adversely influenced EFS and OS (hazard ratio, 39; 95% confidence interval, 8-202 [P < 0.001] and hazard ratio, 24; 95% confidence interval, 4-135 [P < 0.001], respectively). Conclusion: Gallium-67 scans help to identify pretransplantation CT-positive patients with a different outcome. A group of patients with positive CT/negative Ga-67 scan results before transplantation who showed a favorable outcome with a low rate of relapse and another group of patients with positive CT/Ga-67 scan results before transplantation who showed poor prognosis did not benefit from autologous stem cell transplantation. They should be offered other therapeutic strategies.