{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T17:27:42Z","timestamp":1772818062339,"version":"3.50.1"},"reference-count":36,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T00:00:00Z","timestamp":1759708800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Despite the high complete response (CR) rate to first-line therapy, approximately one-third of patients with advanced-stage Hodgkin lymphoma (HL) eventually relapse. In up to 30\u201350% of cases, relapses are subclinical, i.e., initially detected only by imaging procedures. However, there is no definitive consensus on the optimal surveillance strategy for high-risk HL patients. Methods: The purpose of this cohort study is to evaluate the long-term outcome of stage II-B\/IV HL patients who relapsed under routine imaging surveillance (imaging cohort) compared to those who relapsed under conventional clinical monitoring (standard cohort). Follow-up in the imaging cohort systematically included FDG-PET\/CT, ultrasonography, and\/or chest X-ray. At relapse, patients were treated with the same approach (salvage therapy and autologous hematopoietic stem cell transplantation [AHSCT]) in both cohorts. Results: A total of 123 high-risk HL patients were assessed at their first relapse: 80 in the imaging cohort and 43 in the standard cohort. The 2-year event-free survival (EFS) was significantly higher in the imaging cohort compared to the standard cohort (70% vs. 37.2%, respectively; p = 0.001). Similarly, the CR rate following salvage treatment was greater in the imaging cohort as compared to the standard cohort (68.8% vs. 41.9%, respectively; p &lt; 0.004). These differences were due to the capability of routine imaging surveillance to detect disease with more limited extension (early onset of clinically silent relapses) as compared to standard clinical monitoring, which was associated with relapsed disease in a more advanced stage. Conclusions: Our findings suggest that routine imaging surveillance in patients with high-risk HL leads to improved EFS detecting relapses, which were characterized by more favorable prognostic factors (low tumor burden), thus enabling the timely administration of salvage therapy.<\/jats:p>","DOI":"10.3390\/cancers17193242","type":"journal-article","created":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T11:42:49Z","timestamp":1759750969000},"page":"3242","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Routine Imaging Surveillance After Frontline ABVD Improves Outcome in High-Risk Hodgkin Lymphoma"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2714-5109","authenticated-orcid":false,"given":"Novella","family":"Pugliese","sequence":"first","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Hematology Section, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Picardi","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Hematology Section, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5975-9388","authenticated-orcid":false,"given":"Annamaria","family":"Vincenzi","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Hematology Section, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Giordano","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Hematology Section, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Lucania","sequence":"additional","affiliation":[{"name":"Hematology Unit, Azienda Sanitaria Locale Napoli 1 Centro, 80147 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8159-7539","authenticated-orcid":false,"given":"Alessandro","family":"Severino","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Hematology Section, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Salvatore","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2576-220X","authenticated-orcid":false,"given":"Massimo","family":"Mascolo","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, Pathology Section, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"Della Cioppa","sequence":"additional","affiliation":[{"name":"Hematology Unit, Azienda Sanitaria Locale Napoli 1 Centro, 80147 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2563-4125","authenticated-orcid":false,"given":"Fabrizio","family":"Pane","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Hematology Section, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1002\/hon.2589","article-title":"Treating Hodgkin lymphoma in the new millennium: Relapsed and refractory disease","volume":"37","author":"LaCasce","year":"2019","journal-title":"Hematol. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"755","DOI":"10.6004\/jnccn.2020.0026","article-title":"Hodgkin Lymphoma, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology","volume":"18","author":"Hoppe","year":"2020","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2122","DOI":"10.1002\/cncr.28698","article-title":"Limited utility of routine surveillance imaging for classical Hodgkin lymphoma patients in first complete remission","volume":"120","author":"Pingali","year":"2014","journal-title":"Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1111\/bjh.13943","article-title":"No survival benefit associated with routine surveillance imaging for Hodgkin lymphoma in first remission: A Danish-Swedish population-based observational study","volume":"173","author":"Jakobsen","year":"2016","journal-title":"Br. J. Haematol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1111\/bjh.12687","article-title":"Hodgkin lymphoma patients in first remission: Routine positron emission tomography\/computerized tomography imaging is not superior to clinical follow-up for patients with no residual mass","volume":"164","author":"Dann","year":"2013","journal-title":"Br. J. Haematol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3835","DOI":"10.1002\/cncr.25240","article-title":"Surveillance imaging of Hodgkin lymphoma patients in first remission","volume":"116","author":"Lee","year":"2010","journal-title":"Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4116","DOI":"10.1200\/JCO.2006.07.0409","article-title":"Cost-Effectiveness Analysis of Computerized Tomography in the Routine Follow-Up of Patients After Primary Treatment for Hodgkin\u2019s Disease","volume":"24","author":"Guadagnolo","year":"2006","journal-title":"J. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1097\/01.mph.0000243648.66734.eb","article-title":"Routine Use of PET Scans After Completion of Therapy in Pediatric Hodgkin Disease Results in a High False Positive Rate","volume":"28","author":"Levine","year":"2006","journal-title":"J. Pediatr. Hematol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1148\/radiol.14132154","article-title":"Advanced-stage Hodgkin Lymphoma: US\/Chest Radiography for Detection of Relapse in Patients in First Complete Remission\u2014A Randomized Trial of Routine Surveillance Imaging Procedures","volume":"272","author":"Picardi","year":"2014","journal-title":"Radiology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1080\/10428190701559140","article-title":"Randomized comparison of consolidation radiation versus observation in bulky Hodgkin\u2019s lymphoma with post-chemotherapy negative positron emission tomography scans","volume":"48","author":"Picardi","year":"2007","journal-title":"Leuk. Lymphoma"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.ejca.2020.03.008","article-title":"2-deoxy-2[F-18] fluoro-D-glucose positron emission tomography Deauville scale and core-needle biopsy to determine successful management after six doxorubicin, bleomycin, vinblastine and dacarbazine cycles in advanced-stage Hodgkin lymphoma","volume":"132","author":"Picardi","year":"2020","journal-title":"Eur. J. Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1093\/annonc\/mdi248","article-title":"High-dose sequential chemotherapy followed by autologous stem cell transplantation in relapsed and refractory aggressive non-Hodgkin\u2019s lymphoma: Results of a multicenter phase II study","volume":"16","author":"Josting","year":"2005","journal-title":"Ann. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"35","DOI":"10.3324\/haematol.10661","article-title":"Ifosfamide, gemcitabine, and vinorelbine: A new induction regimen for refractory and relapsed Hodgkin\u2019s lymphoma","volume":"92","author":"Santoro","year":"2007","journal-title":"Haematologica"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1038\/bmt.2009.318","article-title":"Fotemustine plus etoposide, cytarabine and melphalan (FEAM) as a new conditioning regimen for lymphoma patients undergoing auto-SCT: A multicenter feasibility study","volume":"45","author":"Musso","year":"2009","journal-title":"Bone Marrow Transplant."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1038\/bmt.2015.273","article-title":"Thiotepa-based high-dose therapy for autologous stem cell transplantation in lymphoma: A retrospective study from the EBMT","volume":"51","author":"Sellner","year":"2015","journal-title":"Bone Marrow Transplant."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1200\/JCO.1999.17.4.1244","article-title":"Report of an International Workshop to Standardize Response Criteria for Non-Hodgkin\u2019s Lymphomas","volume":"17","author":"Cheson","year":"1999","journal-title":"J. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1200\/JCO.2006.09.2403","article-title":"Revised Response Criteria for Malignant Lymphoma","volume":"25","author":"Cheson","year":"2007","journal-title":"J. Clin. Oncol."},{"key":"ref_18","unstructured":"Swerdlow, S.H., Campo, E., Harris, N.L., Jaffe, E.S., Pileri, S.A., Stein, H., Thiele, J., and Vardiman, J. (2008). WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, International Agency for Research on Cancer."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2375","DOI":"10.1182\/blood-2016-01-643569","article-title":"The 2016 revision of the World Health Organization classification of lymphoid neoplasms","volume":"127","author":"Swerdlow","year":"2016","journal-title":"Blood"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1200\/JCO.1989.7.11.1630","article-title":"Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin\u2019s disease: Cotswolds meeting","volume":"7","author":"Lister","year":"1989","journal-title":"J. Clin. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"iv19","DOI":"10.1093\/annonc\/mdy080","article-title":"Hodgkin lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"29","author":"Eichenauer","year":"2018","journal-title":"Ann. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1080\/10428194.2023.2298273","article-title":"High-dose chemotherapy and autologous stem cell transplant as first salvage treatment for relapsed or refractory Hodgkin Lymphoma in the era of PET-adapted strategies","volume":"65","author":"Viviani","year":"2024","journal-title":"Leuk. Lymphoma"},{"key":"ref_23","first-page":"451.e1","article-title":"Impact of Risk Factors and Long Term Survival Analysis of Patients with Primary Refractory Hodgkin Lymphoma Who Underwent High Dose Chemotherapy and Autologous Stem Cell Transplant","volume":"29","author":"Akhtar","year":"2023","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.ygyno.2010.01.014","article-title":"Surveillance for the detection of recurrent ovarian cancer: Survival impact or lead-time bias?","volume":"117","author":"Tanner","year":"2010","journal-title":"Gynecol. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12885-020-07609-3","article-title":"Breast cancer distant recurrence lead time interval by detection method in an institutional cohort","volume":"20","author":"Kaplan","year":"2020","journal-title":"BMC Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e70066","DOI":"10.1002\/hon.70066","article-title":"Newly Diagnosed Classical Hodgkin Lymphoma: Optimizing Outcomes in a New Therapeutic Era","volume":"43","author":"Evens","year":"2025","journal-title":"Hematol. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1080\/14712598.2025.2519524","article-title":"Tight competition for the first-line treatment of Hodgkin\u2019s lymphoma: A comprehensive review of practice-changing developments in recent years","volume":"25","year":"2025","journal-title":"Expert Opin. Biol. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.bjhh.2017.05.003","article-title":"New agents in relapsed\/refractory Hodgkin\u2019s lymphoma","volume":"39","author":"Biasoli","year":"2017","journal-title":"Rev. Bras. de Hematol. e Hemoter."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Xing, Z., Mi, L., Li, Z., Zhu, J., Wei, T., and Wu, W. (2022). Novel Agents for Relapsed and Refractory Classical Hodgkin Lymphoma: A Review. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.929012"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1007\/s00277-009-0752-4","article-title":"Role of 18FDG-PET\/CT in detecting relapse during follow-up of patients with Hodgkin\u2019s lymphoma","volume":"88","author":"Crocchiolo","year":"2009","journal-title":"Ann. Hematol."},{"key":"ref_31","first-page":"931","article-title":"Positron emission tomography\/computed tomography surveillance in patients with Hodgkin lymphoma in first remission has a low positive predictive value and high costs","volume":"97","author":"Mylam","year":"2011","journal-title":"Haematologica"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s00277-010-1044-8","article-title":"The role of routine imaging procedures in the detection of relapse of patients with Hodgkin lymphoma and aggressive non-Hodgkin lymphoma","volume":"90","author":"Goldschmidt","year":"2010","journal-title":"Ann. Hematol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1200\/JCO.2003.12.086","article-title":"Randomized Comparison of ABVD and MOPP\/ABV Hybrid for the Treatment of Advanced Hodgkin\u2019s Disease: Report of an Intergroup Trial","volume":"21","author":"Duggan","year":"2003","journal-title":"J. Clin. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1200\/JCO.1997.15.3.1123","article-title":"Detection of relapse in early-stage Hodgkin\u2019s disease: Role of routine follow-up studies","volume":"15","author":"Torrey","year":"1997","journal-title":"J. Clin. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1002\/ajh.23688","article-title":"Role of routine imaging in detecting recurrent lymphoma: A review of 258 patients with relapsed aggressive non-Hodgkin and Hodgkin lymphoma","volume":"89","author":"Mylam","year":"2014","journal-title":"Am. J. Hematol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1093\/annonc\/mdp519","article-title":"Hodgkin\u2019s lymphoma in remission after first-line therapy: Which patients need FDG\u2013PET\/CT for follow-up?","volume":"21","author":"Petrausch","year":"2009","journal-title":"Ann. Oncol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/19\/3242\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T08:11:37Z","timestamp":1759997497000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/19\/3242"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,6]]},"references-count":36,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["cancers17193242"],"URL":"https:\/\/doi.org\/10.3390\/cancers17193242","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,6]]}}}