Molecular imaging in diagnostics and therapy of lymphoprolifertive disorders

Lymphomas are a group of heterogeneous malignancies that derive from lymphoid cells of B-cell and T-cell origin at varying stages of differentiation. With a yearly incidence of about 4500 cases in the Netherlands, lymphomas belong to the 10 most common forms of cancer in the western world. Molecular imaging is defined as the visualisation of molecular processes in living organisms. In lymphoma, molecular imaging in the form of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG PET) plays an integral part in staging, response evaluation and follow-up. This thesis evaluated the impact of novel analysis techniques and the performance of the established molecular imaging modality 18F-FDG PET in the lymphoma subtypes diffuse large B cell lymphoma (DLBCL), classical Hodgkin lymphoma (cHL), and post-transplant lymphoproliferative disorder (PTLD). With improved understanding of the molecular processes in lymphoma and novel treatment options arises a growing need for the molecular characterisation of tumours. Molecular imaging with novel radionuclide tracers could provide whole-body information to investigate cancer biology, evaluate phenotypic heterogeneity, identify resistance to targeted therapy, and assess the biodistribution of drugs in patients. This thesis reviewed and identified past, present, and future efforts in the development of molecular tracers, other than 18F-FDG, for imaging in lymphomas. With the armamentarium of targeted immunotherapy for lymphoma steadily growing, biosimilars offer an opportunity to limit the ever-increasing financial burden on modern health care systems. This thesis investigated whether the 3-year overall survival of Dutch patientes with DLBCL who received rituximab (R)-biosimilars was equivalent to that of patients treated with R-originator