Surveillance imaging during first remission in follicular lymphoma does not impact overall survival

Abstract

Background Although many patients with follicular lymphoma (FL) undergo routine radiographic surveillance during their first remission, no consensus exists on the modality, duration, frequency, or need for routine imaging studies. The authors retrospectively examined the effect of surveillance imaging on relapse detection and overall survival (OS) in patients with FL. Methods Patients with newly diagnosed FL who had a response to induction therapy were identified from the Lymphoid Malignancies Enterprise Architecture Database (LEAD) at Emory University and from the Molecular Epidemiology Resource (MER) of the University of Iowa/Mayo Clinic. Patients were evaluated for both relapse and method of relapse detection (ie, clinical concerns vs radiologic detection through surveillance imaging in an asymptomatic patient). Results Of 148 patients in the LEAD cohort, 55 (37%) relapsed, and the majority (n = 35; 64%) of relapses were detected clinically. In the MER cohort, 63 of 177 relapses (54%) were detected clinically. There was no significant difference in OS from the date of diagnosis between the 2 methods of relapse detection in the LEAD (hazard ratio [HR], 0.61; 95% CI, 0.13‐2.94; P = .54) and MER (HR, 1.02; 95% CI, 0.47‐2.21; P = .96) cohorts. Similarly, there was no significant difference in OS from the date of relapse between the 2 methods of relapse detection in the LEAD (HR, 0.47; 95% CI, 0.10‐2.27; P = .35) and MER (HR, 1.02; 95% CI, 0.47‐2.21; P = .96) cohorts. Conclusions These findings suggest a limited role for routine surveillance imaging in patients with FL who complete front‐line therapy. Future studies should evaluate which patients may benefit from a more aggressive surveillance approach and should explore novel methods of relapse detection.

The role of surveillance computed tomography in patients with follicular lymphoma

“…Goldman et al 20 reported that surveillance imaging did not contribute to survival improvement in patients with FL; this was consistent with our study for both groups. OS is the most relevant endpoint; however, it has become more challenging to use OS for FL patients as an endpoint because of its long-term clinical course and treatment improvement.…”

“…Moreover, the interval at which the surveillance CT was performed was not regular. In another study by Goldman et al, 20 18/55 (33%) patients in a retrospective cohort and 50/117 (43%) in a prospective validation cohort had asymptomatic imaging-detected relapses, and there was no significant difference in the OS between patients with surveillance imagingdetected relapse and clinically detected relapse. However, in their study, surveillance imaging methods were not defined, and they used CT or PET.…”

“…There are few studies on the clinical benefit of surveillance CT in patients with FL, [18][19][20] compared to studies on DLBCL and HL. These studies have not supported routine surveillance imaging, and the 2014 Lugano classification also describes that judicious use of follow-up scans may be considered in indolent lymphomas with residual intra-abdominal or retroperitoneal disease in the follow-up evaluations section.…”

Disparity and Diversity in NSCLC Imaging and Genomics: Evaluation of a Mature, Multicenter Database

“…This additional prognostication resource provides the treating physician with a tool to add further precision concerning therapy decision, i.e., for early intensification or maybe also change of the therapeutic goals. However, while several therapies are very imaging-dependent these days, i.e., several types of lymphoma therapies are heavily PET/CT driven, this is not a universal finding [ 37 , 38 ].…”

Positron Emission Tomography Molecular Imaging for Phenotyping and Management of Lymphoma

“…In a retrospective study of 116 DLBCL patients, PET/CT showed a limited role in disease surveillance for patients achieving complete remission after primary therapy (Cheah et al 2013). For FL, a retrospective study examined the effect of surveillance imaging on relapse detection and OS and suggested that no OS benefit was associated with imaging-detected relapse (Goldman et al 2021). Owing to the lack of sufficient evidence demonstrating an improved outcome for the detection of relapse, the latest NCCN Guidelines do not recommend 18 F-FDG PET as routine surveillance for patients with stage I-II disease who have achieved complete metabolic response after the initial therapy (NCCN Clinical Practice Guidelines in Oncology 2021).…”