The Role of Surveillance CT Scans in Patients with Diffuse Large B-cell Non-Hodgkin's Lymphoma

Guppy, Amy; Tebbutt, Niall C.; Norman, A.; Cunningham, David

doi:10.1080/1042819021000040323

Cited by 75 publications

(40 citation statements)

References 12 publications

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“…This is in contrast to the use of CT surveillance in patients with DLBCL in which only 6% of recurrences are identified by CT scanning in asymptomatic patients. 10 In the present study there were no differences in the median response duration according to whether recurrences were diagnosed clinically or based on surveillance investigations. In this sense, our surveillance strategy would not have fulfilled the objective of allowing early detection of the disease, had this been the purpose of the investigations.…”

Section: Discussionmentioning

confidence: 47%

Surveillance investigations after high-dose therapy with stem cell rescue for recurrent follicular lymphoma have no impact on management

Gerlinger¹,

Rohatiner²,

Matthews³

et al. 2010

Haematologica

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BackgroundThe impact of active surveillance, comprising annual computed tomography scanning and bone marrow biopsies, in the follow-up of patients after high-dose therapy with autologous stem cell rescue for recurrent follicular lymphoma was analyzed. Design and MethodsSeventy-one of 99 patients who received high-dose therapy commenced the surveillance program. Response duration, time to next treatment and overall survival were compared according to whether disease progression had been diagnosed on the basis of surveillance investigations or on clinical grounds. ResultsAfter a median follow-up of 16 years, progression was documented by surveillance in 16 patients and clinically in 18, the median response duration being 2.4 and 2.3 years, respectively (P=NS). Ten patients with a relapse detected clinically started treatment immediately, contrasting with one patient whose relapse was detected by surveillance investigations. Five patients with relapses detected by surveillance investigations have not required treatment after a median follow-up of 18 years, whereas all but two patients with a relapse detected clinically have been treated. The median time to next treatment was 7 years for patients with a relapse identified by surveillance investigations and 4 years for those whose relapse was manifested clinically (P=0.03). Overall survival was not significantly different between the two groups. ConclusionsSurveillance investigations, consisting of annual computed tomography scanning and bone marrow biopsies, have no impact on the management of patients with recurrent follicular lymphoma and do not improve the outcome of these patients. Haematologica 2010;95:11130-1135. doi:10.3324/haematol.2009

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Section: Discussionmentioning

confidence: 47%

Surveillance investigations after high-dose therapy with stem cell rescue for recurrent follicular lymphoma have no impact on management

Gerlinger¹,

Rohatiner²,

Matthews³

et al. 2010

Haematologica

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“…[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Thompson et al analyzed 2 separate DLBCL cohorts in 1 publication. 7 All of the included studies were retrospective except Zinzani et al and Picardi et al 16,21 In total, 3099 patients were included in the summarized studies, among which 20% of patients experienced relapse.…”

Section: Resultsmentioning

confidence: 99%

“…In another study of CT surveillance, asymptomatic relapse occurred in 5.7% of patients, and 86% of relapses were associated with clinical signs/symptoms. 8 …”

Section: Dlbclmentioning

confidence: 99%

Evaluating surveillance imaging for diffuse large B-cell lymphoma and Hodgkin lymphoma

Cohen

Behera

Thompson

et al. 2017

Blood

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Up to 50% of patients with Hodgkin lymphoma and diffuse large B-cell lymphoma will relapse, requiring additional therapy. Although surveillance imaging is commonly performed in clinical practice, its ability to identify asymptomatic relapses and improve survival for patients is not well defined. We evaluated the surveillance imaging role in relapse detection and reviewed its impact on survival for relapsed patients, and found that current imaging approaches do not detect most relapses prior to clinical signs and symptoms or improve survival.

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“…Of the remaining patients who relapsed, 30 (86%) experienced clinical signs or symptoms and 3 (8.6%) had abnormal laboratory evaluations that led to the diagnosis of relapse. 35 In a historical series by Weeks et al, only 1 of 35 patients with relapsed DLBCL was identified due to a routine surveillance scan, although the frequency of chest CT was low in this older cohort from 1991. 36 A more recent series of 100 relapsed patients with DLBCL, all of whom achieved a CR/unconfirmed CR (CRu) to initial therapy, reported that only 22% of the relapses were identified on routine surveillance CT; the remaining patients were identified based on symptoms, physical examination, or laboratory evaluations.…”

Section: Surveillance For Relapse In Dlbcl Ct Imagingmentioning

confidence: 99%

Optimal disease surveillance strategies in non-Hodgkin lymphoma

Cohen

Flowers

2014

Hematology

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Given the paucity of randomized controlled trial data, defining the ideal strategy for surveillance imaging in patients with non-Hodgkin lymphoma (NHL) has become increasingly challenging. The routine use of frequent surveillance scans has been a common component of patient care. Emerging data from prospective and retrospective observational studies and modeling approaches have highlighted the performance characteristics of imaging modalities and the challenges with this form of secondary screening. The majority of patients with relapsed lymphoma have clinical signs or symptoms that prompt further evaluation, and only a small proportion of patients experience relapse detected on a routine scan while being otherwise asymptomatic. Surveillance imaging is costly, may expose patients to minimal risks of mortality due to radiation-related secondary malignancies, and can lead to false-positive findings, leading to unnecessary biopsies. In addition, no prospective study has demonstrated a significant improvement in overall survival for those patients whose disease is discovered on a routine scan versus those who present with clinical symptoms. In this chapter, we examine the baseline risks of relapse for various NHL subtypes that provide the context for surveillance, review the data on imaging modalities, and establish a framework for discussing optimal surveillance strategies with individual patients. Patients should be counseled on the risks and benefits of routine surveillance imaging and decisions regarding surveillance should be made on an individual basis using patient-specific risk factors, response to induction therapy, and patient preferences with a bias toward using surveillance imaging in the 2 years after treatment only in those NHL patients with the greatest likelihood of benefit. Learning Objectives• To review recent literature regarding the use of routine imaging surveillance for patients with NHL achieving a CR to induction therapy • To develop an approach for counseling patients regarding the risks and benefits of surveillance imaging Baseline risks of relapse for various NHL subtypesThe completion of induction therapy and achievement of a complete response (CR) is a significant milestone for patients with lymphoma, but the optimal follow-up for these patients remains a subject of intense debate, especially with regard to the appropriate use of routine surveillance imaging. Unfortunately, a significant portion of patients with non-Hodgkin lymphoma (NHL) who achieve a CR will relapse and require additional treatment. In diffuse large B-cell lymphoma (DLBCL), for example, the CR rate for current standard therapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) is 75%-86%, but up to 1/3 of these patients will ultimately relapse. 1,2 The International Prognostic Index (IPI) can assist with risk stratification for newly diagnosed patients. Patients with a high-risk IPI who achieve a CR have an estimated 5-year relapse-free survival of 40% compared with 70% for patients wit...

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The Role of Surveillance CT Scans in Patients with Diffuse Large B-cell Non-Hodgkin's Lymphoma

Cited by 75 publications

References 12 publications

Surveillance investigations after high-dose therapy with stem cell rescue for recurrent follicular lymphoma have no impact on management

Surveillance investigations after high-dose therapy with stem cell rescue for recurrent follicular lymphoma have no impact on management

Evaluating surveillance imaging for diffuse large B-cell lymphoma and Hodgkin lymphoma

Optimal disease surveillance strategies in non-Hodgkin lymphoma

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