Lack of usefulness of computed tomography for surveillance in patients with aggressive non-Hodgkin lymphoma

Abstract

Surveillance computed tomography (CT) is usual practice for patients with aggressive non-Hodgkin lymphoma (aNHL) in complete remission (CR). However, evidence to support this strategy is lacking. We retrospectively analyzed our institutional lymphoma registry, including patients with lymphoma consecutively enrolled from June 1995 to October 2016. Of 1,385 patients with aNHL, 664 achieved CR and were followed up with or without surveillance CT. Surveillance CT was performed for 609 patients every 3 or 6 months for the first 2 years, then every 6 or 12 months thereafter. Relapse was detected in 171 patients, of whom 152 underwent surveillance CT during follow-up. Of these 152 patients, asymptomatic relapse was detected in 67 (44%) using surveillance CT, and symptomatic relapse outside the surveillance interval was detected in the remaining 85 (56%). Detection of asymptomatic relapse using surveillance CT did not improve the overall or post-relapse survival in patients with relapsed aNHL. Surveillance CT interval (3 or 6 months) did not affect survival. No subgroups were identified that favored the use of surveillance CT to detect relapse. The results of this study suggest that routine surveillance CT in patients with aNHL to detect asymptomatic relapse might have a limited role in improving survival. CT is recommended when a relapse is clinically suspected.

Evaluation of routine CT scans in the follow-up of diffuse large B-cell lymphomas

“…Nevertheless, since most DLBCL patients achieved a sustained CMR, our cohort did not provide us enough relapsed patients to perform a subgroup analysis from time of relapse. However, some observational studies have already addressed the impact of detection by surveillance CT scan on survival, obtaining no differences between symptomatic and asymptomatic patients detected by routine CT scan [13][14][15]. Consequently, there are no data to clearly support routine imaging in asymptomatic DLBCL after first-line therapy, and especially in the PET-era.…”

“…Physical examination and blood tests, including serum lactate dehydrogenase (LDH), are recommended, along with clinical judgment [10]. Routine CT scans during follow-up have been assessed in several observational studies, with the rationale that early detection of lymphoma relapse might have a favorable impact on survival [11][12][13][14][15]. However, these retrospective studies have failed to show significant differences in survival derived from routine surveillance CT scans [12][13][14][15].…”

“…Routine CT scans during follow-up have been assessed in several observational studies, with the rationale that early detection of lymphoma relapse might have a favorable impact on survival [11][12][13][14][15]. However, these retrospective studies have failed to show significant differences in survival derived from routine surveillance CT scans [12][13][14][15]. A workshop, held in Lugano, that included major international lymphoma clinical groups discouraged the routine use of surveillance CT scans, reserving them only when clinically indicated [10].…”

The role of surveillance computed tomography in patients with follicular lymphoma

“…However, previous studies of patients with curable lymphoma subtypes, such as diffuse large B-cell lymphoma (DLBCL) and Hodgkin lymphoma (HL), have reported that routine surveillance imaging with CT or positron emission tomography (PET) detects relapse in only few cases; most relapse cases are detected clinically, based on patient-reported symptoms, abnormal physical findings, and blood workup abnormalities. 1 – 10 Moreover, most previous studies have revealed that surveillance imaging offers no survival benefit for patients with curable lymphoma subtypes, mainly DLBCL and HL. 2 , 5 – 7 , 10 , 11 Given the excessive radiation exposure, medical costs, and unclear survival benefit associated with surveillance imaging, the 2014 Lugano classification discouraged its use for curable lymphoma subtypes, and the American Society of Hematology Choosing Wisely Campaign recommended limiting the use of surveillance CT for curable non-Hodgkin lymphoma (NHL).…”

“…[1][2][3][4][5][6][7][8][9][10] Moreover, most previous studies have revealed that surveillance imaging offers no survival benefit for patients with curable lymphoma subtypes, mainly DLBCL and HL. 2,[5][6][7]10,11 Given the excessive radiation exposure, medical costs, and unclear survival benefit associated with surveillance imaging, the 2014 Lugano classification discouraged its use for curable lymphoma subtypes, and the American Society of Hematology Choosing Wisely Campaign recommended limiting the use of surveillance CT for curable non-Hodgkin lymphoma (NHL). 12,13 Follicular lymphoma (FL) is the second commonest subtype of NHL, accounting for 7-20% of NHL cases.…”