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Showed that patients whose PET scan is clear after two cycles can safely drop bleomycin and its lung toxicity.
RATHL, trial NCT00678327 sponsored by the UK NCRI and Cancer Research UK and published in the New England Journal of Medicine in 2016, showed that patients with advanced Hodgkin lymphoma whose PET scan is clear after two cycles can safely drop bleomycin and its lung toxicity. It enrolled 1,214 patients, randomised those with a negative interim PET to continue ABVD or switch to AVD, met its non-inferiority endpoint on progression-free survival with fewer pulmonary events, and escalated PET-positive patients to BEACOPP. OnCo links it to Hodgkin lymphoma, PET-adapted therapy, FDG PET, the Deauville scale term, Cancer Research UK, Peter Johnson and the bleomycin caution pairing, and it is concordant with GHSG HD18. It established interim PET as a treatment-steering tool, and whether PET can guide even deeper de-escalation is the open question.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
1,214 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Progression-free survival at 3 years (PET2-negative)primary | ABVD | 470 | 85.7% | - | - | link |
| AVD | 465 | 84.4% |
Confirmation, by a different route from HD18, that the interim scan can safely direct de-escalation in advanced Hodgkin lymphoma, and that most of the toxicity of escalated BEACOPP can be avoided in the 84 per cent of patients who respond early.
An interim PET scan after two cycles guides treatment of advanced Hodgkin lymphoma: drop bleomycin if negative, intensify if positive.
Shares Escalated chemotherapy or ABVD in advanced Hodgkin lymphoma: more cures, more late harm, and what the interim scan changed, PET-adapted (response-adapted) therapy, British and American lymphoma practice: where they differ, and why, AHL2011.
Shares AHL2011, PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study, EORTC/LYSA/FIL H10, GHSG HD18.
Shares Caution: bleomycin lung toxicity, especially with brentuximab or G-CSF, Escalated chemotherapy or ABVD in advanced Hodgkin lymphoma: more cures, more late harm, and what the interim scan changed, Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs, Advanced-stage classical Hodgkin lymphoma (stage III to IV).
Shares RATHL: adapted treatment guided by interim PET-CT in advanced Hodgkin lymphoma, GHSG HD18, Deauville five-point scale, Bleomycin.
Shares AHL2011, PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study, EORTC/LYSA/FIL H10, GHSG HD18.
Shares EORTC/LYSA/FIL H10, Deauville five-point scale, Bleomycin, Cancer Research UK.
Shares RATHL: adapted treatment guided by interim PET-CT in advanced Hodgkin lymphoma, AHL2011, PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study, EORTC/LYSA/FIL H10.
Shares EORTC/LYSA/FIL H10, Deauville five-point scale, Bleomycin, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting.