Should Response-Adapted Therapy Now Be the Standard of Care for Advanced Hodgkin's Lymphoma?

The choice of treatment for advanced Hodgkin's lymphoma has traditionally been made using an assessment of the baseline risk factors and a judgement of the balance between efficacy and toxicity for the group in question. The use of functional imaging with 2-(18F)-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) early in the course of therapy offers a way to make treatment better adjusted to the most important feature of Hodgkin's lymphoma: the response to therapy. Recent studies have shown that excellent results can be achieved by using early FDG-PET to modulate therapy, with escalation for those with an unsatisfactory response and treatment reduction for those with the most chemosensitive disease. The results of these trials indicate that response-adapted therapy should now become part of the standard approach to care, offering opportunities to improve the results further by indicating those subgroups in need of new approaches such as the emerging antibody-based treatments.