A trial looking at PET scans and treatment for advanced Hodgkin lymphoma (RATHL)

The team found that it was safe for people who had a negative scan to stop having bleomycin. And that more intensive chemotherapy helped people who had a positive scan.

This was a phase 3 trial.

Of the 1,203 people who agreed to join, the team were able to look at the PET scans of 1,119.

For:

• 937 people ABVD had worked well (negative scan)
• 182 people ABVD hadn’t worked quite as well (positive scan)

People with a negative scan
For people who had a negative scan this part of the trial was randomised.

935 people out of 937 were put into 1 of 2 treatment groups at random by a computer.

• 470 people continued to have ABVD
• 465 people stopped having bleomycin and continued with AVD

The team looked at the number of people who were alive after 3 or more years of follow up. This is called overall survival. They found that:

• 97 out of every 100 people (97.2%) had ABVD were alive
• 97 out of every 100 people (97.6%) had AVD were alive

They also looked at the number of people who were alive and their lymphoma had not come back. This is called progression free survival. They found that it was:

• 85 out of every 100 people (85.7%) for those who had ABVD
• 84 out of every 100 people (84.4%) for those who had AVD

Because bleomycin causes lung damage the researchers particularly looked at this side effect. They found that the number of people who had lung problems such as shortness of breath was lower in the AVD group than those in the ABVD group.

The side effects were worse for people who had ABVD than for those who had AVD. These side effects included:

• a drop in white blood cells
• tiredness
• high temperature (fever) when the white blood cells were low
• shortness of breath
• inflammation of the lung

People with a positive scan
Everyone who had a positive scan had intensive chemotherapy called BEACOPP. This was to see if the response of their lymphoma could be improved.

Previously only about 15 out of every 100 people (15%) with a positive PET scan who continued treatment with ABVD remained free from lymphoma.  

At 3 years the team found that 88 out of every 100 people (87.8%) were alive. And that 67 out of every 100 people (67.5 %) were alive and had no sign of their lymphoma.

The worst side effects of BEACOPP were:

• a drop in white blood cells and platelets
• extreme tiredness
• early menopause
• infection requiring admission to hospital for antibiotics

The trial team concluded that:

• a PET scan could be used to make decisions about further treatment
• stopping bleomycin for people with a negative scan reduced damage to the lungs and was safe
• more intensive chemotherapy helped people who had positive scans

We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed ) and published in a medical journal. The figures we quote above were provided by the trial team who did the research. We have not analysed the data ourselves.