Lymphoma: Diagnostic and Therapeutic Applications of Radiopharmaceuticals

  • Angelika Bischof Delaloye


Lymphoma is a heterogeneous family of diseases of the lymphatic system. There are two main entities, Hodgkin’s disease (HD) and non-Hodgkin’s lymphoma (NHL), the latter emerging either from B cells or T cells. Positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) assisted by in-line CT (PET/CT) plays a pivotal role in patient management. HD shows high FDG uptake in close to 100% of the patients whereas FDG avidity greatly varies among patients with NHL subtypes. Aggressive lymphomas, such as diffuse large B cell lymphoma (DLBCL), the most current form of NHL, and mantle cell lymphomas (MCL) as well as Burkitt lymphomas and even plasmocytomas take up FDG very avidly. Follicular lymphomas (FL) also show high uptake in more than 90% of the cases whereas extranodal marginal zone lymphomas (MZL), such as splenic or mucosaassociated lymphoid tissue (MALT) MZL, are positive in only 67 and 54%, respectively [1].


Follicular Lymphoma Mantle Cell Lymphoma Focal Liver Lesion Primary Gastric Lymphoma Refractory Celiac Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Weiler-Sagie M, Bushelev O, Epelbaum R et al (2010) 18FFDG avidity in lymphoma readdressed: A study of 766 patients. J Nucl Med 51:25–30CrossRefPubMedGoogle Scholar
  2. 2.
    Hutchings M, Loft A, Hansen M et al (2006) Different histopathological subtypes of Hodgkin’s lymphoma show significantly different levels of FDG uptake. Hematol Oncol 24:146–150CrossRefPubMedGoogle Scholar
  3. 3.
    Schoder H, Noy A, Gonen M et al (2005) Intensity of 18fluorodeoxyglucose uptake in positron emission tomography distinguishes between indolent and aggressive non-Hodgkin’s lymphoma. J Clin Oncol 23:4643–4651CrossRefPubMedGoogle Scholar
  4. 4.
    Yi JH, Kim SJ, Choi JY (2009) (18)F-FDG uptake and its clinical relevance in primary gastric lymphoma. Hematol Oncol EpubGoogle Scholar
  5. 5.
    Lee WK, Lau EW, Duddalwar VA et al (2008) Abdominal manifestations of extranodal lymphoma: spectrum of imaging findings. AJR Am J Roentgenol 191:198–206CrossRefPubMedGoogle Scholar
  6. 6.
    Tateishi U, Terauchi T, Inoue T, Tobinai K (2009) Nodal status of malignant lymphoma in pelvic and retroperitoneal lymphatic pathways: PET/CT. Abdom Imaging EpubGoogle Scholar
  7. 7.
    Hoffmann M, Wohrer S, Becherer A et al (2006) 18F-Fluorodeoxy-glucose positron emission tomography in lymphoma of mucosa-associated lymphoid tissue: histology makes the difference. Ann Oncol 17:1761–1765CrossRefPubMedGoogle Scholar
  8. 8.
    Perry C, Herishanu Y, Metzer U et al (2007) Diagnostic accuracy of PET/CT in patients with extranodal marginal zone MALT lymphoma. Eur J Haematol 79:205–209CrossRefPubMedGoogle Scholar
  9. 9.
    Raderer M, Wohrer S, Streubel B et al (2006) Assessment of disease dissemination in gastric compared with extragastric mucosa-associated lymphoid tissue lymphoma using extensive staging: a single-center experience. J Clin Oncol 24:3136–3141CrossRefPubMedGoogle Scholar
  10. 10.
    Takahashi H, Ukawa K, Ohkawa N et al (2009) Significance of (18)F-2-deoxy-2-fluoro-glucose accumulation in the stomach on positron emission tomography. Ann Nucl Med 23:391–397CrossRefPubMedGoogle Scholar
  11. 11.
    Wong MT, Eu KW (2006) Primary colorectal lymphomas. Colorectal Dis 8:586–591CrossRefPubMedGoogle Scholar
  12. 12.
    Civardi G, Vallisa D, Berte R et al (2002) Focal liver lesions in non-Hodgkin’s lymphoma: investigation of their prevalence, clinical significance and the role of Hepatitis C virus infection. Eur J Cancer 38:2382–2387CrossRefPubMedGoogle Scholar
  13. 13.
    Hadithi M, Mallant M, Oudejans J et al (2006) 18F-FDG PET versus CT for the detection of enteropathy-associated T-cell lymphoma in refractory celiac disease. J Nucl Med 47:1622–1677PubMedGoogle Scholar
  14. 14.
    Zafar SY, Howell DN, Gockerman JP (2008) Malignancy after solid organ transplantation: an overview. Oncologist 13:769–778CrossRefPubMedGoogle Scholar
  15. 15.
    Hutchings M, Loft A, Hansen M et al (2006) FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin’s lymphoma. Blood 107:52–59CrossRefPubMedGoogle Scholar
  16. 16.
    Jerusalem G, Beguin Y, Fassotte MF et al (2000) Persistent tumor 18F-FDG uptake after a few cycles of polychemotherapy is predictive of treatment failure in non-Hodgkin’s lymphoma. Haematologica 85:613–618PubMedGoogle Scholar
  17. 17.
    Mikhaeel NG, Hutchings M, Fields PA et al (2005) FDG-PET after two to three cycles of chemotherapy predicts progressionfree and overall survival in high-grade non-Hodgkin’s lymphoma. Ann Oncol 16:1514–1523CrossRefPubMedGoogle Scholar
  18. 18.
    Mikhaeel NG, Timothy AR, O’Doherty MJ et al (2000) 18-FDG-PET as a prognostic indicator in the treatment of aggressive Non-Hodgkin’s Lymphoma-comparison with CT. Leuk Lymphoma 39:543–553PubMedGoogle Scholar
  19. 19.
    Spaepen K, Stroobants S, Dupont P et al (2002) Early restaging positron emission tomography with (18)F-fluorodeoxyglucose predicts outcome in patients with aggressive non-Hodgkin’s lymphoma. Ann Oncol 13:1356–1363CrossRefPubMedGoogle Scholar
  20. 20.
    Brepoels L, Stroobants S, De Wever W et al (2007) Aggressive and indolent non-Hodgkin’s lymphoma: response assessment by integrated international workshop criteria. Leuk Lymphoma 48:1522–1530CrossRefPubMedGoogle Scholar
  21. 21.
    Cheson BD, Pfistner B, Juweid ME et al (2007) Revised response criteria for malignant lymphoma. J Clin Oncol 25: 579–586CrossRefPubMedGoogle Scholar
  22. 22.
    Juweid ME, Wiseman GA, Vose JM et al (2005) Response assessment of aggressive non-Hodgkin’s lymphoma by integrated International Workshop Criteria and fluorine-18-fluorodeoxyglucose positron emission tomography. J Clin Oncol 23:4652–4661CrossRefPubMedGoogle Scholar
  23. 23.
    Engles JM, Quarless SA, Mambo E et al (2006) Stunning and its effect on 3H-FDG uptake and key gene expression in breast cancer cells undergoing chemotherapy. J Nucl Med 47: 603–608PubMedGoogle Scholar
  24. 24.
    Rodriguez-Vigil B, Gomez-Leon N, Pinilla I et al (2006) PET/CT in lymphoma: prospective study of enhanced fulldose PET/CT versus unenhanced low-dose PET/CT. J Nucl Med 47:1643–1648PubMedGoogle Scholar
  25. 25.
    Schaefer NG, Hany TF, Taverna C et al (2004) Non-Hodgkin’s lymphoma and Hodgkin’s disease: coregistered FDG PET and CT at staging and restaging-do we need contrast-enhanced CT?. Radiology 232:823–829CrossRefPubMedGoogle Scholar
  26. 26.
    Horning SJ, Juweid ME, Schoder H et al (2009) Interim positron emission tomography (PET) scans in diffuse large B-cell lymphoma: an independent expert nuclear medicine evaluation of the Eastern Cooperative Oncology Group E3404 study. Blood EpubGoogle Scholar
  27. 27.
    Juweid ME, Stroobants S, Hoekstra OS et al (2007) Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J Clin Oncol 25:571–578CrossRefPubMedGoogle Scholar
  28. 28.
    Lin C, Itti E, Haioun C et al (2007) Early 18F-FDG PET for prediction of prognosis in patients with diffuse large B-cell lymphoma: SUV-based assessment versus visual analysis. J Nucl Med 48:1626–1632CrossRefPubMedGoogle Scholar
  29. 29.
    Sugawara Y, Zasadny KR, Kison PV et al (1999) Splenic fluorodeoxyglucose uptake increased by granulocyte colonystimulating factor therapy: PET imaging results. J Nucl Med 40:1456–1462PubMedGoogle Scholar
  30. 30.
    Brepoels L, Stroobants S, Verhoef G (2007) PET and PET/CT for response evaluation in lymphoma: current practice and developments. Leuk Lymphoma 48:270–282CrossRefPubMedGoogle Scholar
  31. 31.
    Hutchings M, Barrington SF (2009) PET/CT for therapy response assessment in lymphoma. J Nucl Med 50 Suppl 1: 21S–30SCrossRefPubMedGoogle Scholar
  32. 32.
    Kobe C, Dietlein M, Franklin J et al (2008) Positron emission tomography has a high negative predictive value for progression or early relapse for patients with residual disease after first-line chemotherapy in advanced-stage Hodgkin’s lymphoma. Blood 112:3989–3994CrossRefPubMedGoogle Scholar
  33. 33.
    Kaminski MS, Tuck M, Estes J et al (2005) 131I-tositumomab therapy as initial treatment for follicular lymphoma. N Engl J Med 352:441–449CrossRefPubMedGoogle Scholar
  34. 34.
    Morschhauser F, Illidge T, Huglo D et al (2007) Efficacy and safety of yttrium-90 ibritumomab tiuxetan in patients with relapsed or refractory diffuse large B-cell lymphoma not appropriate for autologous stem-cell transplantation. Blood 110:54–58CrossRefPubMedGoogle Scholar
  35. 35.
    Sharkey RM, Brenner A, Burton J et al (2003) Radioimmunotherapy of non-Hodgkin’s lymphoma with 90Y-DOTA humanized anti-CD22 IgG (90Y-Epratuzumab) do tumor targeting and dosimetry predict therapeutic response? J Nucl Med 44:2000–2018PubMedGoogle Scholar
  36. 36.
    Witzig TE, Gordon LI, Cabanillas F et al (2002) Randomized controlled trial of yttrium-90-labeled ibritumomab tiuxetan radioimmunotherapy versus rituximab immunotherapy for patients with relapsed or refractory low-grade, follicular, or transformed B-cell non-Hodgkin’s lymphoma. J Clin Oncol 20:2453–2463CrossRefPubMedGoogle Scholar
  37. 37.
    Buchegger F, Antonescu C, Bischof Delaloye A et al (2006) Long-term complete responses after 131I-tositumomab therapy for relapsed or refractory indolent non-Hodgkin’s lymphoma. Br J Cancer 94:1770–1776CrossRefPubMedGoogle Scholar
  38. 38.
    Fisher RI, Kaminski MS, Wahl RL et al (2005) Tositumomab and iodine-131 tositumomab produces durable complete remissions in a subset of heavily pretreated patients with lowgrade and transformed non-Hodgkin’s lymphomas. J Clin Oncol 23:7565–7573CrossRefPubMedGoogle Scholar
  39. 39.
    Witzig TE, Molina A, Gordon LI et al (2007) Long-term responses in patients with recurring or refractory B-cell non-Hodgkin’s lymphoma treated with yttrium 90 ibritumomab tiuxetan. Cancer 109:1804–1810CrossRefPubMedGoogle Scholar
  40. 40.
    Buchegger F, Press OW, Delaloye AB, Ketterer N (2008) Radiolabeled and native antibodies and the prospect of cure of follicular lymphoma. Oncologist 13:657–667CrossRefPubMedGoogle Scholar
  41. 41.
    Morschhauser F, Radford J, Van Hoof A et al (2008) Phase III trial of consolidation therapy with yttrium-90-ibritumomab tiuxetan compared with no additional therapy after first remission in advanced follicular lymphoma. J Clin Oncol 26:5156–5164CrossRefPubMedGoogle Scholar
  42. 42.
    Bischof Delaloye A, Antonescu C, Louton T et al (2009) Dosimetry of 90Y-ibritumomab tiuxetan as consolidation of first remission in advanced-stage follicular lymphoma: results from the international phase 3 first-line indolent trial. J Nucl Med 50:1837–1843CrossRefGoogle Scholar
  43. 43.
    Gisselbrecht C, Vose J, Nademanee A et al (2009) Radioimmunotherapy for stem cell transplantation in non-Hodgkin’s lymphoma: in pursuit of a complete response. Oncologist 14 Suppl 2:41–51CrossRefPubMedGoogle Scholar

Copyright information

© Springer Verlag Italia 2010

Authors and Affiliations

  • Angelika Bischof Delaloye
    • 1
  1. 1.Service de Médecine NucléaireCentre Hospitalier Universitaire VaudoisLausanneSwitzerland

Personalised recommendations