The emergence of new technologies impacts the care of patients with non-Hodgkin's lymphomas (NHLs). The advent of new functional imaging techniques, such as fluorodeoxyglucose positron emission tomography (FDG-PET) is being evaluated not only as a staging investigation, but also as a method for assessing response to therapy, and determining prognosis. The use of molecular techniques for the detection of residual disease after completion of therapy raises questions regarding currently used definitions of response. The prognostic significance of disease detected at the molecular level is under evaluation, as is the use of molecular studies for follow-up. The clinical prognostic factors identified by the International Prognostic Index (IPI) have provided a model for risk stratification of patients with diffuse large B-cell lymphoma (DLBCL). A similar index, the Follicular Lymphoma International prognostic Index (FLIPI), has now gained widespread use for low-grade follicu-lar lymphoma (FL). These clinical indices have proved useful for risk stratification and for providing general prognostic information to patients with these diseases. However, there is marked variability in outcome within the risk groups identified by these prognostic models, indicating the biologic and clinical heterogeneity of these diseases. Recent gene expression profile (GEP) and tissue microarray (TMA) studies have identified patterns of gene expression and immunohistochemical features which have prognostic value independent of the IPI or FLIPI. It is likely that future prognostic models will incorporate this information.

Optimum follow up strategies for patients with NHL are unclear. The value of new (and established) imaging technologies for early detection of relapse has been systematically evaluated in only a small number of studies. The potential role of molecular techniques for early detection of subclinical relapse is also being explored.

The advent of these new techniques is therefore leading to redefinition of many of the criteria used for the assessment of prognosis, remission, and follow-up in malignant lymphomas, particularly the most common subtypes, namely DLBCL and FL.

0 0

Post a comment