Tamayo P, Martín A, Díaz L, Cabrero M, García R, García-Talavera P, Caballero D
Servicio de Medicina Nuclear, Hospital Universitario de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España.
Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España.
Rev Esp Med Nucl Imagen Mol. 2017 Sep-Oct;36(5):312-321. doi: 10.1016/j.remn.2017.03.004. Epub 2017 May 5.
The aim of this work was to review the current recommendations for staging and response assessment of patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) in routine clinical practice after chemotherapy and/or stem cell transplantation. A five-point scale (5-PS) from the First International Workshop on PET in Lymphoma in Deauville, France, in 2009, was recommended as the standard tool to score imaging to assess treatment response in patients with lymphoma using F-Fluorodeoxyglucose (FDG) PET/CT. Following the recommendations of the 11th and 12th International Conferences on Malignant Lymphoma held in Lugano (Switzerland), in 2011 and 2013, respectively, a consensus (the so-called Lugano Classification) was reached regarding the use of PET/CT for staging and response assessment in FDG-avid lymphomas. As a result, F-FDG PET/CT was formally incorporated into standard staging for FDG-avid lymphomas. A bone marrow biopsy is no longer indicated for the routine staging of HL and most diffuse large B-cell lymphomas. PET/CT will be used to assess response in FDG-avid histologies using the 5-point scale. The recent introduction of biological agents with immune mechanisms requires flexibility in interpretations of the Lugano criteria due to tumour flare or a pseudo-progression effect produced by these agents. Provisional criteria have been proposed (Lymphoma Response to Immunomodulatory Therapy Criteria) with the introduction of the term 'Indeterminate Response' in order to identify this phenomenon until confirmed as flare/pseudoprogression or true progression. All these recommendations will improve evaluations of patients with lymphoma, and allow comparison of results from clinical practice and trials.
这项工作的目的是回顾目前关于霍奇金淋巴瘤（HL）和非霍奇金淋巴瘤（NHL）患者在化疗和/或干细胞移植后的常规临床实践中分期及反应评估的建议。2009年在法国迪耶普举行的第一届淋巴瘤PET国际研讨会上推荐的五分制量表（5-PS），被用作使用F-氟脱氧葡萄糖（FDG）PET/CT对淋巴瘤患者进行影像评分以评估治疗反应的标准工具。分别遵循2011年和2013年在瑞士卢加诺举行的第11届和第12届恶性淋巴瘤国际会议的建议，就PET/CT在FDG摄取型淋巴瘤分期及反应评估中的应用达成了共识（即所谓的卢加诺分类）。因此，F-FDG PET/CT被正式纳入FDG摄取型淋巴瘤的标准分期。对于HL和大多数弥漫性大B细胞淋巴瘤的常规分期，不再需要进行骨髓活检。PET/CT将用于使用五分制量表评估FDG摄取型组织学类型的反应。由于这些具有免疫机制的生物制剂会产生肿瘤flare或假进展效应，因此最近这些制剂的引入要求在对卢加诺标准的解释上具有灵活性。已提出临时标准（淋巴瘤对免疫调节治疗的反应标准），引入了“不确定反应”一词，以便在被确认为flare/假进展或真正进展之前识别这种现象。所有这些建议将改善对淋巴瘤患者的评估，并允许对临床实践和试验结果进行比较。
