Unanswered Questions in Hodgkin Lymphoma

At the 2^nd Annual HemOnc Pulse Live!, Mehdi H. Hemadani, MD, professor of Medicine and chief of Hematologic Malignancies at the Medical College of Wisconsin leads experts in a panel discussion around unanswered questions and controversies in Hodgkin lymphoma.

Panelists:

• Philippe Armand, MD, PhD, Dana-Farber Cancer Institute
• Urshila Durani, MD, MPH, The University of Texas MD Anderson Cancer Center
• Narendranath Epperla, MD, MS, Huntsman Cancer Institute
• Timothy S. Fenske, MD Methodist Hospital

The discussion tackles the nuanced topic of PET scan interpretation and treatment decisions in Hodgkin lymphoma and other lymphoid malignancies, especially in the era of checkpoint inhibitors. As therapies evolve, clinicians are often faced with ambiguous imaging and the critical task of distinguishing true progression from pseudoprogression—a challenge with significant implications for patient outcomes and treatment strategy.

The panelists debate the use and timing of interim PET scans, including whether routine PET after two cycles of therapy is clinically warranted or merely a relic of outdated practice. The conversation also addresses the Duvall score, SUV changes, and the limitations of interpreting static PET data without broader clinical context. Physicians share their personal approaches to biopsy decisions, when to continue treatment despite uncertain imaging, and how delta SUV values can sometimes offer more insight than Duvall scoring alone.

The session closes with a thoughtful discussion on risk stratification at relapse, criteria for avoiding transplant, and the evolving role of clinical trials in defining next-generation standards. Real-world dilemmas, expert disagreements, and patient-centered considerations make this a must-watch for clinicians navigating complex lymphoma cases.