The Role of [(68)Ga]Ga-Pentixafor PET/CT or PET/MRI in Lymphoma: A Systematic Review

SIMPLE SUMMARY: Preliminary evidence about the useful impact of [(68)Ga]Ga-Pentixafor PET/CT or PET/MRI in lymphoma is available but reveals heterogeneous findings. The aim of this systematic review was to analyze the published data about the role of [(68)Ga]Ga-Pentixafor PET/CT or PET/MRI in lymphoma and to focus on different lymphoma variants and clinical fields. [(68)Ga]Ga-Pentixafor PET may be considered a useful imaging method for staging and treatment response evaluation of several lymphomas, mainly FDG-not-avid variants. These findings may change the diagnostic flow-chart of lymphoma in the future. ABSTRACT: The aim of this systematic review was to investigate published data about the role of gallium-68 Pentixafor positron emission tomography/computed tomography ([(68)Ga]Ga-Pentixafor PET/CT) or PET/magnetic resonance imaging (PET/MRI) in patients affected by lymphoma. A comprehensive computer literature search of the Scopus, PubMed/MEDLINE, and Embase databases was conducted including articles indexed up to June 2022. In total, 14 studies or subsets in studies were eligible for inclusion. From the analyses of the selected studies, the following main findings have been found: (1) lymphomas can be considered [(68)Ga]Ga-Pentixafor avid diseases, also in cases of fluorine-18 fluorodeoxyglucose [(18)F]FDG-not avid forms such as lymphoplasmacytic lymphoma (LPL), chronic lymphocytic leukemia (CLL), marginal zone lymphoma (MZL) and central nervous system lymphoma (CNSL); (2) among lymphomas, mantle cell lymphoma (MCL) and MZL are those with highest [(68)Ga]Ga-Pentixafor uptake; (3) [(68)Ga]Ga-Pentixafor PET/CT or PET/MRI is a useful tool for the staging and treatment response evaluation; (4) [(68)Ga]Ga-Pentixafor PET seems to have a better diagnostic performance than [(18)F]FDG PET in evaluating lymphomas. Despite several limitations affecting this analysis, especially related to the heterogeneity of the included studies, [(68)Ga]Ga-Pentixafor PET may be considered a useful imaging method for staging and treatment response evaluation of several lymphomas, especially MZL, CNSL and LPL.