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ASCO 2013: Routine Surveillance Imaging Scans Add Little to Detection of Relapse in Patients with Diffuse Large B-cell Lymphoma

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Key Points

  • In a prospective, multi-institutional study of patients with diffuse large B-cell lymphoma, only 1.5% of patients in remission had a relapse before clinical signs appeared.
  • At the time of relapse, 68% of patients had symptoms, 42% had an abnormal finding on physical exam, and 55% had abnormalities in blood tests.
  • Surveillance scans expose patients to radiation, can increase patient anxiety, and may lead to unnecessary biopsies, researchers said.

A large study reports that the vast majority of diffuse large B-cell lymphoma relapses are detected based on symptoms, abnormal blood tests or abnormal findings on physical exam, suggesting that CT scans, which are currently a routine part of follow-up, may be unnecessary. Researchers found that just 1.5% of patients in remission had a relapse that was detected solely through a scheduled imaging scan. These findings will help physicians develop guidelines for following patients in remission for diffuse large B-cell lymphoma and spare patients from the excess radiation exposure and costs associated with unnecessary CT scans. The results will be reported at the 2013 ASCO Annual Meeting in Chicago (Abstract 8504).

Current surveillance guidelines for diffuse large B-cell lymphoma recommend CT scans no more than every 6 months for 2 years after the completion of treatment, and as clinically indicated thereafter. Generally, patients also receive physical exams and blood tests during follow-up. However, optimal surveillance strategies have been unclear.

“Scans expose patients to radiation and that theoretically increases the risk of a second cancer. Surveillance scans can also increase patient anxiety and lead to biopsies that may not be necessary,” said lead study author Carrie A. Thompson, MD, a hematologist at Mayo Clinic, Rochester, Minnesota. “While our study shows that the majority of relapses are detected by patient symptoms, the decision of whether to do surveillance scans and how often should be tailored to each individual patient.”

Study Details

Researchers assessed post-treatment outcomes (relapse, retreatment, and death) in 644 patients enrolled in a prospective, multi-institutional cohort of patients with newly diagnosed diffuse large B-cell lymphoma. All patients had received initial treatment with standard anthracycline based immunochemotherapy.

During a median follow-up period of 59 months, 109 out of 537 patients (20%) who entered post-treatment follow-up experienced a relapse. Overall, at the time of relapse 68% of patients had symptoms, 42% had an abnormal finding on physical exam, and 55% had abnormalities in blood tests. Planned surveillance scans detected relapses in only 8 out of 537 (1.5%) of patients before clinical signs appeared.

Vigilance Needed

Given that so many relapses are accompanied by symptoms, patients should be vigilant about reporting symptoms between scheduled visits, Dr. Thompson said. Some signs of a possible relapse in diffuse large B-cell lymphoma include enlarged lymph nodes, night sweats, unexplained fever, and unintentional weight loss.

Diffuse large B-cell lymphoma is the most common form of lymphoma, accounting for 30% of non-Hodgkin lymphoma cases. The disease is aggressive but potentially curable with a combination of chemotherapy and targeted immunotherapy (rituximab [Rituxan]). However, up to one-third of patients experience a relapse after achieving remission. Relapsed diffuse large B-cell lymphoma is often treated with stem cell transplantation and high-dose chemotherapy.

“The oncology community has already begun to reevaluate the utility of advanced imaging scans and some aspects of surveillance in the routine follow-up of patients with certain cancers,” commented ASCO President-Elect Clifford A. Hudis, MD. “This study is one case in which the benefits of such scans do not appear to outweigh their potential burdens on patients, in terms of anxiety, physical risks, or financial costs. Patients should discuss with their doctors how these findings pertain to their care.”

This research was supported in part by the National Cancer Institute and Mayo Clinic Center for the Science of Health Care Delivery.

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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