PET scanning and prognosis in Hodgkin's lymphoma

Risk-adapted treatment strategies are currently under investigation in the management of patients with lymphoma. This review presents the latest evidence for the use of early interim [(18)F]-fluorodeoxyglucose-positron emission tomography for risk-adapted treatment in Hodgkin's lymphoma.

In recent years, PET after two cycles of ABVD (adriamycin, bleomycin, vincristin, and dexamethasone) was shown to be the only independent prognostic factor for the prediction of relapse in Hodgkin's lymphoma and to have at least the same prognostic accuracy as end-of-treatment PET. A high prognostic value of PET was reported even earlier, before the second cycle of chemotherapy. The earlier PET becomes negative, the more chemosensitive the disease, which may offer opportunities toward the limitation of the therapy. However, more false-positive lesions occur at earlier time points, and preliminary results indicate that accuracy of PET results differs after BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) and immunotherapy.

[(18)F]-Fluorodeoxyglucose-positron emission tomography after two cycles of ABVD is now recognized as the single most important factor in defining disease-specific outcome and is highly promising for investigation of response-adapted treatment strategies. It is now recognized that the optimal time point of PET for response evaluation is crucial and dependent on the administered treatment. Standardization of PET-response is essential and should be adapted to time-dependent and therapy-dependent changes.