Abstract
242401
Introduction: FDG PET/CT plays a critical role in the classification and management of lymphoma. Initial, interim and post treatment staging may be acquired throughout the entire process allotting for the assessment of initial staging, treatment response and conclusive evidence of complete remission. Certain criteria may be utilized during the decision-making process. FDG PET/CT also provides critical biopsy guidance and evaluation of disease relapse and transformation. Furthermore, there may be pitfalls along the way.
Methods: Therapeutic options for lymphoma include chemotherapy, monoclonal antibody therapy, radiation therapy, stem cell transplant and chimeric antigen receptor therapy (CAR-T). Chimeric Antigen Receptor Therapy is a type of immunotherapy in which patient-derived T cells are genetically modified by means of viral vectors to express chimeric antigen receptors (CAR); reinjected T cells will recognize and destroy CD19 antigens expressed on B-cell malignancies, such as non-Hodgkin’s lymphoma.
Results: FDG PET/CT plays an integral part in therapeutic decision making, including staging, treatment response assessment, biopsy guidance and evaluation of disease relapse or transformation. Pretreatment staging of lymphoma with FDG PET/CT utilizes the Lugano staging classification. Interim treatment FDG PET/CT allows for response-adapted treatment with either reduction in the number of chemotherapy cycles or early use of more aggressive treatment. Treatment response assessment by FDG PET/CT should be guided by Lugano criteria, however in patients receiving CAR-T, response assessment on FDG PET/CT should be guided by LYRIC criteria which accounts for pseudo progression.
Interpretation of interim and post treatment FDG PET/CT can be confounded by thymic hyperplasia, brown fat, infection/inflammation, immune related adverse events, or marrow stimulation by granulocyte colony-stimulating factor (G-CSF).
Conclusions: FDG PET/CT is essential in management of lymphoma, and plays a critical role in pretreatment staging, interim and end of treatment response assessment, and in detection of suspected recurrence or transformation.
In this issue
Jump to section
Related Articles
Cited By...
- No citing articles found.