The role of PET in first-line treatment of Hodgkin lymphoma.

Abstract

PET using ¹⁸F-fluorodeoxyglucose is central to the management of patients with Hodgkin lymphoma, and PET-adapted strategies have facilitated major improvements in overall survival. Although unmet needs include addressing fertility preservation, cardiovascular health, and survivorship issues, along with a need for better cure rates in the older patient, the improved survival of most patients with Hodgkin lymphoma globally is a triumph of the complementary approaches and collaboration of many cooperative groups in the study of PET-guided therapy. The optimal strategy for this highly curable lymphoma, however, remains a topic of intense discussion and polarises opinion among clinicians. In this Review, we seek not to debate the many controversies that exist but to better inform the treating haematologist to assist in navigating a patient-specific approach. Focusing primarily on phase 3 studies, we chart the changes in management based on the most relevant technological advance in the past decade, the standardisation of PET-CT for staging, interim, and end-of-treatment response assessment of Hodgkin lymphoma.