Present and Emerging Strategies for Disease Assessment in Hodgkin Lymphoma

Emerging treatment paradigms in classic Hodgkin lymphoma (cHL), which increasingly incorporate immunotherapy and response-adapted strategies, have increased the need for more accurate disease assessment tools. PET/CT remains the cornerstone for staging and response evaluation, but has limited sensitivity for low-volume residual disease, interobserver variability, and a high false-positive in the setting of immunotherapy. Baseline clinical scores and erythrocyte sedimentation rate (ESR) provide baseline prognostic information but offer little insight into tumor biology or treatment response. Further, tissue-based molecular profiling is constrained by the paucity of Hodgkin Reed-Sternberg (HRS) cells. We summarize emerging strategies, including total metabolic tumor volume (TMTV), serum thymus and activation-regulated chemokine (TARC), and circulating tumor DNA (ctDNA) for more accurate disease burden quantification, noninvasive genotyping, molecular subtyping, and minimal residual disease detection. Together, these tools have the potential to enable a multimodal approach to disease assessment, risk stratification, and response evaluation in cHL.