BACKGROUND:The objective of this study was to compare the outcomes of patients with classical Hodgkin lymphoma (cHL) who achieved complete remission with frontline therapy and then underwent either clinical surveillance or routine surveillance imaging. METHODS: In total, 241 patients who were newly diagnosed with cHL between January 2000 and December 2010 at 3 participating tertiary care centers and achieved complete remission after first-line therapy were retrospectively analyzed. Of these, there were 174 patients in the routine surveillance imaging group and 67 patients in the clinical surveillance group, based on the intended mode of surveillance. In the routine surveillance imaging group, the intended plan of surveillance included computed tomography and=or positron emission tomography scans; whereas, in the clinical surveillance group, the intended plan of surveillance was clinical examination and laboratory studies, and scans were obtained only to evaluate concerning signs or symptoms. Baseline patient characteristics, prognostic features, treatment records, and outcomes were collected. The primary objective was to compare overall survival for patients in both groups. For secondary objectives, we compared the success of second-line therapy and estimated the costs of imaging for each group. RESULTS: After 5 years of follow-up, the overall survival rate was 97% (95% confidence interval, 92%-99%) in the routine surveillance imaging group and 96% (95% confidence interval, 87%-99%) in the clinical surveillance group (P 5.41). There were few relapses in each group, and all patients who relapsed in both groups achieved complete remission with second-line therapy. The charges associated with routine surveillance imaging were significantly higher than those for the clinical surveillance strategy, with no apparent clinical benefit. CONCLUSIONS: Clinical surveillance was not inferior to routine surveillance imaging in patients with cHL who achieved complete remission with frontline therapy. Routine surveillance imaging was associated with significantly increased estimated imaging charges. Cancer 2014;120:2122-9.
8505 Background: Routine surveillance imaging (RSI) for patients in complete remission from classical Hodgkin lymphoma (cHL) is common practice. RSI offers the theoretical benefit of detecting asymptomatic relapse, which may allow for more successful second-line therapy. Despite this, evidence for a clinical benefit of RSI is lacking. We compared outcomes in cHL patients undergoing RSI versus clinical surveillance (CS) in which scans are only obtained to evaluate concerning signs or symptoms. Methods: Patients with cHL diagnosed at three tertiary care centers from 2001-2010, who achieved complete remission (CR) following frontline therapy, were analyzed retrospectively. Patients were stratified into two groups based on the surveillance strategy employed. Baseline patient characteristics, prognostic features, treatment records, and outcomes were collected. The primary objective was to compare overall survival for patients undergoing RSI versus CS. As a secondary objective we compared the success of second-line therapy for relapsed patients in each group. Results: 207 patients met eligibility criteria, with 131 RSI patients and 76 CS patients. Patient characteristics (age, gender, stage, sedimentation rate, Hasenclever index, bulky disease and B symptoms) were similar in each group. Chemotherapy consisted of ABVD in 79% and Stanford V in 15%. Patients in the RSI group more commonly received ABVD (91% vs. 57%) and less often radiation therapy (38% vs. 68%). Mean number of scans was 4.77 in RSI and 1.11 in CS groups, respectively. With a median follow up of 4 years, the overall survival was similar in both groups (p=0.74), with 5 (3.8%) deaths in the RSI group and 4 (5.3%) in the CS group. Six (4.6%) relapses occurred in the RSI group (4 of which were detected by RSI), and 5 (6.6%) in the CS group (p=0.64 for relapse at 5 years). All relapsed patients achieved second CR with second-line therapy. Conclusions: RSI did not yield a survival advantage in cHL patients who achieved CR after frontline therapy.Given the radiation exposure, cost, and risk for additional procedures associated with RSI, we conclude CS is the preferred strategy in cHL patients in first complete remission.
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