Here we critically analyze the role of PET/CT in the early assessment of Hodgkin lymphoma.
Bruce D. Cheson, MD
FDG-PET for Early Response Assessment in Lymphomas: Part 2—Diffuse Large B-Cell Lymphoma, Use of Quantitative PET Evaluation
Here we review the role of interim PET/CT in diffuse large B-cell lymphoma (DLBCL), and also explore the question of whether new approaches to quantitative assessment improve the prognostic value of interim PET scans in both Hodgkin lymphoma and DLBCL.
With each passing year, chemotherapy is less and less a focus of interest. Instead, the focus is on the abundance of exciting new biologic and targeted agents that are bulldozing the therapeutic landscape in the lymphomas and chronic lymphocytic leukemia.
Bone Marrow Biopsy for the Initial Staging of Patients With Lymphoma: It’s Time to Eliminate This Procedure in Selected Patients
Clearly, eliminating a bone marrow biopsy in appropriate patients would be another step in the direction of minimizing the torture to which they are subjected.
To find a new cure for a disease, or at least to significantly prolong patient survival, requires a bit of insight and a lot of luck.
A number of recent treatment advances in the management of follicular lymphoma (FL), including the introduction of the anti-CD20 monoclonal antibody rituximab, have effectively shifted the primary therapeutic goal away from palliation and avoidance of toxicity toward the more proactive objective of extending survival. This paper reviews recent practice patterns in the broad context of the published findings from major phase III randomized trials; it documents potential gaps between trial results and actual practice, and the implications of these for continuing education of oncologists. Forty-three US-based community oncologists participated in a cross-sectional case survey during which 40 documented their management of 186 patients with newly diagnosed FL and 133 patients with relapsed FL, all of whom were treated after January 1, 2008. The findings from this initiative indicate that the majority of these patients did not have any major symptoms at presentation. Additionally, tolerance of and response to treatment, regardless of the regimen employed, were similar across the different age groups studied (
he treatment of B-cell malignancies has been revolutionized by the availability of safe and effective monoclonal antibodies. The addition of rituximab to standard chemotherapy regimens prolongs the survival of patients with diffuse large B-cell lymphoma (DLBCL) and follicular non-Hodgkin lymphoma. Nevertheless, indolent and mantle cell lymphomas remain incurable, and 30% to 40% of patients with DLBCL still die from their disease. Much ongoing research has focused on optimizing monoclonal antibody use, integrating them into multiagent regimens, and developing newer antibodies. Attempts to improve on the efficacy of monoclonal antibody–based therapy have included altering the dosing schedule, optimizing patient selection, maintenance therapy, improving upon the rituximab molecule, radioimmunotherapy, as well as combinations with cytotoxic molecules and other novel agents. Preliminary data with a number of treatment regimens are promising in indolent and aggressive lymphomas. The eventual goal of targeted therapies is to individualize treatment to increase response and survival, while reducing treatment-related toxicity.
Mantle cell lymphoma (MCL) accounts for approximately 6% of non-Hodgkin’s lymphomas. Patients usually present with advanced disease, with a tendency for extranodal involvement. MCL is an aggressive lymphoma with moderate chemosensitivity, but it remains one of the most difficult therapeutic challenges. Complete response rates to chemotherapy range from 20% to 40%, with median survivals of 2½ to 3 years. Anthracycline-containing regimens do not prolong survival compared with nonanthracycline regimens. Single-agent rituximab (Rituxan) has produced response rates of about 30%, and when combined with an anthracycline-containing regimen, response rates increase to above 90%; however, an impact on survival has not yet been demonstrated. More intensive regimens such as hyperCVAD (hyperfractionated cyclophosphamide [Cytoxan, Neosar], vincristine, doxorubicin [Adriamycin], dexamethasone, methotrexate, cytarabine) with either stem cell transplant or rituximab have been associated with promising results.
Anyone who attended the
2002 American Society of
Hematology (ASH) meeting
in Philadelphia could
not help but be impressed
by the number of reports
of clinical trials of biologic
agents. In particular,
based strategies were described
in a broad range of malignant and
benign conditions. As the reports of singleagent
activity of drugs such as rituximab (Rituxan)
diminished for lymphoma trials, the
number of chemotherapy regimens to which the
antibody has been added blossomed. When
single-agent data were presented, they often
represented longer-term follow-up with additional
patients, confirming the safety and efficacy
of these agents. Some studies described
attempts at improving the activity of antibodies,
whereas others have been evaluating their role
in new malignant and benign indications.
The non-Hodgkin’s lymphomas (NHL) are the fifth most common cause of cancer in men and women in the United States, and the fifth and sixth leading causes of cancer deaths, respectively. Approximately 54,000 new cases are projected to be diagnosed in the United States this year, 25% to 30% of which are indolent histologies, with the remainder being aggressive tumors.