Hematologic Malignancies: PET/CT for Response Assessment of Hematologic Malignancies Following Immunotherapy

  • Angelo Castello
  • Egesta Lopci


Immunotherapy with checkpoint inhibitors has dramatically changed the oncological scenario in the last years. The outbreak in response also for cancers heavily pre-treated and the unpreceded duration of disease control have promoted the introduction in clinical practice of several immune checkpoint inhibitors (ICI). Monoclonal antibodies such as nivolumab (anti-PD1), pembrolizumab (anti-PD1), atezolizumab (anti-PD-L1), avelumab (anti-PD-L1), and durvalumab (anti-PD-L1) have been FDA or EMA approved and become nowadays the standard therapy for multiple malignancies. This comprises hematologic malignancies, such as relapsed or refractory classical Hodgkin lymphoma (cHL). Along with conventional response patterns, immunotherapy with ICI has promoted pseudo-progression, as part of the therapeutic effect, frequently leading to unnecessary treatment withdrawal. Consequently, several response criteria have been adapted to overcome the problem. In cHL, the LYRIC (lymphoma response to immunomodulatory therapy criteria) have been suggested. Although, Deauville score might still be a valid approach to define patients likely to benefit from ICI. In the current chapter, a collection of typical case reports is proposed to illustrate cHL response to immunotherapy.


Malignant lymphoma Hodgkin lymphoma Checkpoint inhibitors Immunotherapy Response 


  1. 1.
    Hodi FS, O’Day SJ, McDermott DF, et al. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010;363(8):711–23.CrossRefGoogle Scholar
  2. 2.
    Herbst RS, Baas P, Kim DW, et al. Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial. Lancet. 2016;387(10027):1540–50.CrossRefGoogle Scholar
  3. 3.
    Motzer RJ, Escudier B, McDermott DF, et al. Nivolumab versus everolimus in advanced renal-cell carcinoma. N Engl J Med. 2015;373(19):1803–13.CrossRefGoogle Scholar
  4. 4.
    Balar AV, Galsky MD, Rosenberg JE, et al. Atezolizumab as first-line treatment in cisplatin-ineligible patients with locally advanced and metastatic urothelial carcinoma: a single-arm, multicentre, phase 2 trial. Lancet. 2017;389(10064):67–76.CrossRefGoogle Scholar
  5. 5.
    Ferris RL, Blumenschein G Jr, Fayette J, et al. Nivolumab for recurrent squamous-cell carcinoma of the head and neck. N Engl J Med. 2016;375(19):1856–67.CrossRefGoogle Scholar
  6. 6.
    Green MR, Monti S, Rodig SJ, et al. Integrative analysis reveals selective 9p24.1 amplification, increased PD-1 ligand expression, and further induction via JAK2 in nodular sclerosing Hodgkin lymphoma and primary mediastinal large B-cell lymphoma. Blood. 2010;116(17):3268–77.CrossRefGoogle Scholar
  7. 7.
    Chen BJ, Chapuy B, Ouyang J, et al. PD-L1 expression is characteristic of a subset of aggressive B-cell lymphomas and virus-associated malignancies. Clin Cancer Res. 2013;19(13):3462–73.CrossRefGoogle Scholar
  8. 8.
    Armand P, Shipp MA, Ribrag V, et al. Programmed death-1 blockade with pembrolizumab in patients with classical Hodgkin lymphoma after brentuximab vedotin failure. J Clin Oncol. 2016;34:3733–9.CrossRefGoogle Scholar
  9. 9.
    Ansell SM, Lesokhin AM, Borrello I, et al. PD-1 blockade with nivolumab in relapsed or refractory Hodgkin’s lymphoma. N Engl J Med. 2015;372:311–9.CrossRefGoogle Scholar
  10. 10.
    Cheson BD, Ansell S, Schwartz L, et al. Refinement of the Lugano classification lymphoma response criteria in the era of immunomodulatory therapy. Blood. 2016;128:2489–96.CrossRefGoogle Scholar
  11. 11.
    Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014;32:3059–68.CrossRefGoogle Scholar
  12. 12.
    Dercle L, Seban RD, Lazarovici J, et al. 18F-FDG PET and CT scans detect new imaging patterns of response and progression in patients with Hodgkin lymphoma treated by anti-programmed death 1 immune checkpoint inhibitor. J Nucl Med. 2018;59:15–24.CrossRefGoogle Scholar
  13. 13.
    Castello A, Grizzi F, Qehajaj D, Rahal D, Lutman F, Lopci E. 18FFDG PET/CT for response assessment in Hodgkin lymphoma undergoing immunotherapy with checkpoint inhibitors. Leuk Lymphoma. 2018;22:1–9.Google Scholar
  14. 14.
    Lopci E, Meignan M. Deauville score: the Phoenix rising from ashes. Eur J Nucl Med Mol Imaging. 2018;46(5):1043–5. Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Angelo Castello
    • 1
  • Egesta Lopci
    • 1
  1. 1.Nuclear MedicineHumanitas Clinical and Research Hospital - IRCCSRozzanoItaly

Personalised recommendations