Our understanding of the diverse biology and clinical presentation of the multitude of non-Hodgkin lymphomas is coupled with an increasingly sophisticated appreciation of the role of imaging in staging, prognostication and response assessment.  This spotlight session will focus primarily on the most significant technological advancement in lymphoma care of the past decade – the standardisation of PET-CT (PET) scanning in the staging and response assessment - which has facilitated major improvements in survival. To help the treating haematologist navigate the role of PET in lymphoma management this session will use cases from large randomised trials to illustrate the specific strengths and limitations of PET for each histology.

 

Dr Trotman will focus primarily of the role of PET in diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL) and peripheral T-cell lymphoma (PTCL).   PET demonstrates greater sensitivity compared to CT translating into stage migration and better outcomes in limited stage DLBCL and FL using modern treatment.  PET has excellent sensitivity in identifying BM involvement in DLBCL, making this invasive test redundant in this histology. The 5-point scale, and changes in SUVmax, used for PET-CT reporting can discriminate patients with aggressive lymphoma likely to be cured at the end of first-line treatment from those at high risk of treatment failure. The inferior prognosis of patients who remain PET positive has driven the study of interim PET assessment which identifies chemo-sensitive disease early in patients with DLBCL, but does not predict treatment failure well enough to modify treatment. Furthermore PET-directed intensification of therapy in DLBCL has been unsuccessful to date. PET at end-of-treatment is currently being evaluated as a platform for response-adapted treatment in follicular lymphoma. 

 

Dr Gallamini will address the role of PET in the management of Hodgkin Lymphoma (HL). Perhaps no lymphoma ignites greater discussion and polarisation over the optimal management, than this most curable one.  PET imaging has indeed revolutionized the entire paradigm of HL management including staging, prognostication, first-line therapy, consolidation radiotherapy and salvage treatment. To help the treating haematologist understand the different global approaches to management this session will use both case-studies aligned to the Randomized Clinical Trials (RCT) in HL, and synoptic overviews of the most important PET-adapted clinical trials in early and advanced stage HL tested by co-operative groups, which have been central to tremendous advances in the survival of HL globally.  Again, applying the 5-point scale to interim PET assessment is critical to separating good-risk patients from those who warrant more intensive approaches but in HL the different cut-offs applied in this scale in different trials merit specific attention. Unmet needs in HL imaging include awaiting longer-term overall survival data for each approach as the role of TMTV as possible alternative to Ann Arbor staging, and response assessment in the setting of PD-1 inhibitor therapy.