Deauville Score 2: Clinical Interpretation and Management
A Deauville score of 2 indicates uptake less than or equal to the mediastinum and represents a complete metabolic response (CMR) in lymphoma patients, signifying an excellent prognosis with standard treatment. 1
Definition and Metabolic Significance
- Deauville score 2 is defined as FDG uptake ≤ mediastinal blood pool activity, representing minimal to no residual metabolic activity 1
- This score falls within the CMR category (Deauville scores 1-3), indicating no evidence of metabolically active residual disease 1
- Patients with Deauville score 2 have a favorable prognosis and typically continue with standard treatment without intensification 1
Clinical Management Based on Deauville Score 2
For Hodgkin Lymphoma - Limited Stage Disease
After 2 cycles of ABVD chemotherapy with interim PET showing Deauville score 2:
- Complete treatment with 2 additional cycles of ABVD (total of 4 cycles) followed by 20 Gy involved-site radiotherapy (ISRT) 1
- Alternatively, if chemotherapy-alone approach is preferred, administer 1-2 additional cycles of ABVD (total of 3-4 cycles) or 4 cycles of AVD for initial stage IIB or ≥3 sites 1
- Radiotherapy may be omitted in selected patients, though this carries a small increased risk of progression despite excellent overall survival 1
For Hodgkin Lymphoma - Advanced Stage Disease
After 2 cycles of ABVD with Deauville score 2:
- Continue with 4 additional cycles of ABVD (total of 6 cycles) 1
- Consider omitting bleomycin in cycles 3-6 (switching to AVD) to reduce pulmonary toxicity risk, especially in elderly patients 1
- Observation or ISRT to initially bulky sites are options after completing 6 cycles 1
For patients receiving escalated BEACOPP:
- Treatment can be safely reduced to only 4 total cycles (versus 6 cycles) when interim PET after 2 cycles shows Deauville score ≤2 1
- No consolidating radiotherapy is necessary for Deauville score 1-2 after completing chemotherapy 1
For Diffuse Large B-Cell Lymphoma (DLBCL)
- Deauville score 2 represents complete metabolic response and indicates excellent prognosis with standard R-CHOP therapy 1
- Continue standard treatment without modification 1
- Post-treatment FDG-PET/CT with Deauville score 2 confirms CMR and requires only routine surveillance without additional therapy 1
Important Clinical Caveats
- The Deauville score should always be incorporated into the nuclear medicine PET report, as subsequent management depends on this score 1
- While Deauville score 2 indicates CMR, careful evaluation is still recommended as part of comprehensive response assessment 1
- Deauville score 2 is considered "negative" for disease and does not warrant treatment intensification or biopsy 1
- The distinction between Deauville 2 and 3 can be subtle; Deauville 2 (uptake ≤ mediastinum) has more favorable outcomes than Deauville 3 (uptake > mediastinum but ≤ liver) 1
Prognostic Implications
- Patients achieving Deauville score 2 after initial chemotherapy cycles have excellent event-free survival and overall survival rates 1
- This score reliably predicts favorable outcomes and supports de-escalation strategies in risk-adapted treatment protocols 1
- In Hodgkin lymphoma trials, Deauville score ≤2 has been validated as the threshold for negative interim PET in multiple international studies 1