Toward a paradigm shift in prognostication and treatment of early‐stage Hodgkin lymphoma

Abstract

SummaryTwenty years after the conceptual revolution that occurred in the millennium turnaround upon the introduction of PET/CT in lymphoma staging, restaging, and prognostication, a number of new parameters for PET reading have been proposed: (1) the shift from a qualitative to a semi‐quantitative reading for PET reporting, (2) an international consensus on these novel interpretation keys, (3) a standardized and agreed procedure to measure the total metabolic tumour volume (TMTV), and (4) the proposition of new indexes to portray the tumour spread: (D‐Max and Total Lesion Surface –TLS). These proved to be very powerful prognosticators, able to revolutionize the traditional Ann Arbor four‐stage lymphoma staging. During the 17° Lugano meeting on lymphoma, one main question was asked to experts attending a closed workshop dedicated to new metrics for lymphoma diagnosis, staging, restaging, and prognostication: “Should the traditional 4‐stage anatomic staging system be simplified to a more clinically relevant 2‐stage system (e.g., limited vs. extensive disease)?” Early‐stage HL is an example of how these new metrics could fit with this proposal.