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Danish-Swedish Study Indicates No Survival Benefit of Routine Imaging for Diffuse Large B-Cell Lymphoma in Patients in First Complete Remission

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Key Points

  • Three-year overall survival did not differ between Danish patients (routine imaging) and Swedish patients (imaging when relapse was clinically suspected).
  • No survival difference between groups was observed in analysis by IPI risk group.

In a Danish-Swedish population-based study reported in the Journal of Clinical Oncology, El-Galaly et al found that routine imaging for diffuse large B-cell lymphoma in patients in first complete remission does not improve post-treatment survival.

Study Details

The study included 525 Danish and 696 Swedish patients from national lymphoma registries who had newly diagnosed diffuse large B-cell lymphoma from 2007 to 2012, aged 18 to 65 years, and complete remission after R-CHOP (rituximab [Rituxan], cyclophosphamide, doxorubicin, vincristine, prednisone)/CHOEP (cyclophosphamide, doxorubicin, vincristine, prednisone, etoposide).

Follow-up for Swedish patients included symptom assessment, clinical examinations, and blood tests every 3 or 4 months for 2 years, with longer intervals later in follow-up; imaging was recommended only when relapse was clinically suspected. Follow-up for Danish patients was similar but included routine imaging, usually with computed tomography every 6 months for 2 years.

Factors Affecting Survival

Overall, the cumulative 2-year progression rate after complete remission was 6% for International Prognostic Index (IPI) ≤ 2 vs 21% for IPI > 2. Age > 60 years (hazard ratio [HR] = 2.3, 95% confidence interval [CI] =1.6­3.4), elevated lactate dehydrogenase (HR = 2.3, 95% CI = 1.4–3.8), B symptoms (HR = 1.7, 95% CI = 1.1–2.5), and Eastern Cooperative Oncology Group performance status ≥ 2 (HR = 1.8, 95% CI = 1.0–3.0) were associated with worse post–complete remission survival.

No Difference by Imaging Strategy

Three-year overall survival was 92% among Danish patients and 91% among Swedish patients (P = .7). There were also no significant differences between Danish and Swedish patients in postremission overall survival (P = .45) or in overall survival among patients with IPI ≤ 2 (P = .3) or > 2 (P =.9). Country of follow-up was not significantly associated with poorer survival in Cox simple or multiple regression analyses including predictive factors.

The investigators concluded: “[Diffuse large B-cell lymphoma] relapse after first [complete remission] is infrequent, and the widespread use of routine imaging in Denmark did not translate into better survival. This favors follow-up without routine imaging and, more generally, a shift of focus from relapse detection to improved survivorship.”

Tarec Christoffer El-Galaly, MD, of Aalborg University Hospital, Denmark, is the corresponding author for the Journal of Clinical Oncology article.

The study was supported in part by the North Denmark Region.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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