FDG PET and high-dose therapy for aggressive lymphomas: Toward a risk-adapted strategy

Purpose of review: Functional metabolic imaging through fluorine-18 fluorodeoxyglucose positron emission tomography has recently come to the forefront in the management of various solid and hematologic malignancies. This review summarizes the developments in risk assessment through positron emission tomography in patients with lymphoma and the implications for management. Recent findings: In addition to improving staging and response assessment, positron emission tomography has emerged as a strong prognostic tool in patients with aggressive lymphomas. A positron emission tomographic scan performed after only a few cycles of chemotherapy can accurately predict relapse risk, and most studied patients with abnormal positron emission tomographic scans have had distinctly poorer clinical outcomes than patients with negative scans. Summary: With confirmation of these findings, a more individualized, risk-adapted approach to the treatment of aggressive lymphomas will be feasible. Early identification of high-risk patients through the combination of positron emission tomography and existing prognostic indices could lead to earlier implementation of intensive therapies and improved clinical outcomes.