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Routine Imaging in Patients with DLBCL in
First Complete Remission Does Not Improve
Post-Treatment Survival
Most patients with diffuse large
B-cell lymphoma (DLBCL) do
not experience a relapse after first
complete remission (CR), and the
risk of relapse drops dramatically
after five years in CR. Follow-up
programs routinely include imaging to detect early relapse but, according to a new report published
in the Journal of Clinical Oncology, this serial routine imaging
does not benefit patients.
“Although it is rational to
believe that preclinical relapse
detection can improve patient outcome as a result of [treating] lower
tumor burden, the actual value
of routine imaging for DLBCL is
controversial, and there are no
data to clearly support its use,” the
authors of the study, led by Tarec
Christoffer El-Galaly, MD, from
the department of hematology at
Aalborg University Hospital in
Denmark, wrote. Unnecessary
imaging, they added, can lead to
radiation-related cancers, extra
medical costs, and increased patient anxiety and concern.
Dr. El-Galaly and colleagues
conducted an observational,
population-based study comparing the survival of Danish and
Swedish patients with DLBCL
who underwent different imaging
protocols. These two countries
have similar health-care systems,
the authors noted, though their
practices for routine imaging in
this patient population are completely different.
Standard of care for DLBCL
patients in both countries includes
symptom assessment, clinical
examination, and blood tests at
two- to four-month intervals for
the first two years starting at the
time of CR, followed by every six
months for three years. In Denmark, routine imaging with computed tomography (CT) scans of
the neck, thorax, and abdomen is
also encouraged every six months
for two years; in Sweden, however,
routine imaging is discouraged in
the national guidelines.
ASHClinicalNews.org
A total of 1,221 patients were
selected from the Danish Lymphoma Group Registry (n=525)
and Swedish Lymphoma Registry
(n=696). All patients were18 to
65 years old, had been newly
diagnosed with DLBCL between
2007 and 2012, and had reached
CR after R-CHOP (rituximab plus
cyclophosphamide, doxorubicin,
vincristine, and prednisone)/
CHOEP (cyclophosphamide,
doxorubicin, etoposide, vincristine, and prednisone) therapy.
Over a median follow-up of
51 months, 69 percent of relapses
occurred in the first 24 months
post-CR, 15 percent occurred
within 24 to 36 months, and
16 percent occurred after 36 or
more months. The three-year
overall survival for all patients
was 92 percent, with no difference between Danish and Swedish
patients (92% vs. 91%; p=0.7).
The following patient characteristics were associated with
worse overall survival post-CR:
age over 60 years, elevated lactate
dehydrogenase, presence of B
symptoms at diagnosis, and Eastern Cooperative Oncology Group
performance status of 2 or higher
(TABLE 1).
Dr. El-Galaly and co-authors
also calculated progression-free
survival rates according to International Prognostic Index (IPI)
score and updated relapse information (which were available only
for the 512 patients in the Danish
cohort). Cumulative incidences
for relapse or death in the first
two years of follow-up were 10
percent for the entire cohort, six
percent for those with IPI score
≤2, and 21 percent for those with
IPI score >2.
“Including serial routine
imaging in the follow-up protocol
for young DLBCL patients in first
CR following R-CHOP does not
seem to improve overall survival,”
Dr. El-Galaly F