Personalized treatment of lymphoma: promise and reality

Lymphoma comprises two groups of diseases: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Within both subsets are numerous variations with distinct biologic, molecular, and cytogenetic characteristics. The World Health Organization (WHO) classification of NHL, for example, now identifies several dozen broad entities and nearly 60 unique clinicopathologic subtypes. In addition to pathologic heterogeneity, there is clinical diversity within lymphomas, with some patients achieving cure, others having prolonged disease stabilization, and still others experiencing a rapidly fulminant decline and death. It is increasingly appreciated that both clinical and biological features strongly influence outcome. Practical implementation of a personalized approach to treatment is urgently needed, but efforts thus far have focused primarily on prognostication, with much less emphasis on determining therapeutic options. Nevertheless, better prognostic tools will facilitate the design of "risk-stratified" trials that will ultimately benefit patients. Thus far, the development of personalized treatment in lymphomas clusters into several broad approaches: refinement of clinical prognostic models for better risk stratification, use of high-throughput technology to identify biologic subtypes within pathologically similar diseases, "response-adapted" changes in therapy via imaging with [(18)F]fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET), and anti-idiotype vaccines. An important unmet need is the implementation of these tools into treatment choices for individual patients, and this is the focus of intense ongoing research.