Positive End of Treatment PET after Esc.BEACOPP

Hi again and good to see you navigated across to this corner.

I am sure that some of the HL group members will pick up on your post soon.

As I said in your other post, I had an area light up in my post treatment scan but further investigation found it so be scar tissue.

It is a wise move not to jump straight in with radiotherapy as if this is not a problem you would end up being over treated and reducing the availability of treatments if required further down the line..... there are other routes if required.

Lets hope that your follow up showed nothing to be concerned about.

Hi Hodgemk,

 I was diagnosed with stage 4 (but I had a specialist refer to it as stage 2E for extra nodal activity) cHL. I had escalated BEACOPP after 2 cycles of ABVD and an interim pet. My pet after the BEACOPP was positive as well. My mediastinal mass shrank only a little to 6x4 cm and I developed activity in a new lymph node in my neck (both relative to the pet I had right before starting BEACOPP). They removed the node in my neck and biopsied it. It was positive and the same type of HL as before. 

At that point I was referred to a specialist. The plan was to get me into remission, do an auto stem cell transplant, radiation, and follow up chemo. This is the specialist that classified my tumor as 2E. 

The first step went according to plan. I had 3 cycles of Brentuximab Vedotin and Bendamustine (BvB). This got me into remission.

Unfortunately, by bone marrow did not cooperate, and I was unable to produce stem cells for the transplant. We went to plan B and did two more cycles of just the brentuximab vedotin, but my bone marrow still refused. So we went to plan C and did the radiation. I had another pet scan 6 weeks after the radiation therapy and I was still in remission. We decided not to attempt the sct and just monitor things. 

It has been over 13 months since my last treatment, and 17 months since I first was in remission. So far, so good. It’s been 5 months since my last scan, and I have another one in a few weeks. 

In your case, the remaining mass seems so small (4mm) that I can understand why your oncologist suspects that it is just inflammation (which is common after chemo).

 In my case, radiation was always part of the plan (ABVD then radiation). If that was the case for you, then it might make sense to do the radiation without waiting, but I’d talk to my oncologist to learn all of the complications (for example, if the radiation won’t be as effective if there still is a mass, then waiting may be better). 

Please let know what you decide. Take care.