Since the first edition we have seen a number of important changes in the diagnosis, staging and therapy for many lymphoma subtypes. We are beginning to observe how molecular and cytogenetic characteristics can profoundly influence prognosis and that such tools should now be as much a part of our diagnostic armamentarium as histology and immunophenotyping.
In the near future we expect that “next generation” sequencing will also have a considerable impact not only on our understanding of the pathogenesis of lymphoma, but also on our selection of therapy. We can also envisage how such techniques will themselves also lead to less toxic and more targeted therapies.
We have seen the steady increase in the incorporation of PET and PET CT into staging, risk-adapted therapy, and reassessment such that the presence of a PET/CT scanner and radiologic expertise should now be an essential in every major Lymphoma centre. The promise and precautions for this important tool are summarized within this edition.
In terms of therapy, the steady progress in both the use of monoclonal antibodies and new treatment regimens is reflected in the updated chapters. Lymphoma specialists are also beginning to see the incorporation of agents that block intra-cellular signaling pathways into clinical practice, notably ibrutinib in CLL/SLL and mantle cell lymphoma, and idelalisib in indolent B-cell lymphoproliferative disorders. These specifically targeted therapies give us hope that, in the very near future, the management of lymphoma will be both more effective and less toxic.
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