Utility of routine post-therapy surveillance imaging in diffuse large B-cell lymphoma

• Published in: Journal of clinical oncology Vol. 32; no. 31; pp. 3506 - 3512
• Main Authors: Thompson, Carrie A, Ghesquieres, Herve, Maurer, Matthew J, Cerhan, James R, Biron, Pierre, Ansell, Stephen M, Chassagne-Clément, Catherine, Inwards, David J, Gargi, Thérèse, Johnston, Patrick B, Nicolas-Virelizier, Emmanuelle, Macon, William R, Peix, Marie, Micallef, Ivana N, Sebban, Catherine, Nowakowski, Grzegorz S, Porrata, Luis F, Weiner, George J, Witzig, Thomas E, Habermann, Thomas M, Link, Brian K
• Format: Journal Article
• Language: English
• Published: United States American Society of Clinical Oncology 01.11.2014
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; Female; France - epidemiology; Humans; Lymphatic Metastasis; Lymphoma, Large B-Cell, Diffuse - diagnostic imaging; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large B-Cell, Diffuse - epidemiology; Lymphoma, Large B-Cell, Diffuse - pathology; Male; Middle Aged; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Staging; ORIGINAL REPORTS; Prospective Studies; Remission Induction; Survival Rate; Tomography, X-Ray Computed
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/jco.2014.55.7561

We examined the utility of post-therapy surveillance imaging in a large, prospectively enrolled cohort of patients with diffuse large B-cell lymphoma (DLBCL) from the United States and confirmed our results in an independent cohort of patients from France. Patients with newly diagnosed DLBCL and treated with anthracycline-based immunochemotherapy were identified from the Molecular Epidemiology Resource (MER) of the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence and the Léon Bérard Cancer Center, Lyon, France. In those with relapse, details at relapse and outcomes were abstracted from records. 680 individuals with DLBCL were identified from the MER, 552 (81%) of whom achieved remission after induction. 112 of the 552 patients (20%) suffered a relapse. The majority (64%) of relapses were identified before a scheduled follow-up visit. Surveillance imaging detected DLBCL relapse before clinical manifestations in nine out of 552 patients (1.6%) observed after therapy. In the Lyon cohort, imaging identified asymptomatic DLBCL relapse in four out of 222 patients (1.8%). There was no difference in survival after DLBCL relapse in patients detected at scheduled follow-up versus before scheduled follow-up in both the MER (P = .56) and Lyon cohorts (P = .25). The majority of DLBCL relapses are detected outside of planned follow-up, with no difference in outcome in patients with DLBCL detected at a scheduled visit compared with patients with relapse detected outside of planned follow-up. These data do not support the use of routine surveillance imaging for follow-up of DLBCL.