Surveillance Imaging in Patients in Remission From Hodgkin and Diffuse Large B-Cell Lymphoma

Nabhan, Chadi; Smith, Sonali M.; Cifu, Adam S.

doi:10.1001/jama.2016.4913

Cited by 7 publications

(3 citation statements)

References 9 publications

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“…A proportion of lymphomas are considered potentially curable diseases due to improvements in treatment protocols [3]. The Lugano classification is used for lymphoma staging and response assessment, and imaging modalities such as positron emission tomography (PET)/CT and computed tomography (CT) play key roles in response assessment and surveillance to evaluate lymph nodes and spleen [4][5][6][7]. Due to their long life expectancy, patients with lymphoma require multiple CT examinations to evaluate treatment response and surveillance after treatment.…”

Section: Introductionmentioning

confidence: 99%

Low-dose abdominopelvic computed tomography in patients with lymphoma: An image quality and radiation dose reduction study

et al. 2022

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This study aimed to evaluate image quality, the detection rate of enlarged lymph nodes, and radiation dose exposure of ultralow-dose and low-dose abdominopelvic computed tomography (CT) in patients with lymphoma. Patients with lymphoma who underwent abdominopelvic CT using dual-source scanner were retrospectively recruited from a single center. CT images were obtained at 90 kVp dual-source mode reformatted in three data sets using the advanced modelled iterative reconstruction algorithm: 100% (standard-dose CT), 66.7% (low-dose CT), and 33.3% (ultralow-dose CT). Two radiologists analyzed subjective image quality and detection of abdominal enlarged lymph nodes on ultralow-dose, low-dose, and standard-dose CT blindly and independently. The results were compared with reference standards. Three readers (two radiologists and one hematologist) reviewed overall image quality and spleen size. In total, 128 consecutive CT scans (77 complete response, 44 partial response, 6 progressive disease, and 1 initial evaluation) from 86 patients (64 B-cell lymphoma, 14 T/NK-cell lymphoma, and 8 Hodgkin’s lymphoma cases) were assessed. The enlarged lymph node-based detection rates for two readers were 97.0% (96/99) and 94.0% (93/99) on standard-dose CT, 97.0% (96/99) and 94.0% (93/99) on low-dose CT, and 94.0% (93/99) and 89.9% (89/99) on ultralow-dose CT. Overall image quality was 3.8 ± 0.5, 3.9 ± 0.5, and 4.1 ± 0.5 on ultralow-dose CT; 4.7 ± 0.4, 4.6 ± 0.5, and 4.8 ± 0.3 on low-dose CT; and 4.8 ± 0.4, 4.7 ± 0.4, and 4.9 ± 0.2 on standard-dose CT, according to two radiologists and one hematologist, respectively. Intraclass correlation coefficients of spleen size were 0.90 (95% confidence interval [CI], 0.87–0.93), 0.91 (95% CI, 0.88–0.93), and 0.91 (95% CI, 0.88–0.93) on ultralow-dose, low-dose, and standard-dose CT, respectively. Mean effective radiation doses of standard-dose, low-dose, and ultralow-dose CT were 5.7 ±1.8 mSv, 3.8 ± 1.2 mSv, and 1.9 ± 0.6 mSv, respectively. Our findings suggest that ultralow-dose and low-dose CT, even with radiation doses reduced by 66.7% and 33.3%, respectively, maintained adequate image quality. These imaging modalities may be employed for follow-up lymphoma evaluation in consideration of the long surveillance periods.

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Section: Introductionmentioning

confidence: 99%

Low-dose abdominopelvic computed tomography in patients with lymphoma: An image quality and radiation dose reduction study

et al. 2022

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“…The use of surveillance computed tomography (CT) in patients with aggressive non-Hodgkin lymphoma (aNHL) who have achieved complete remission (CR) is generally recommended in the guidelines of various medical professional societies [ 1 – 4 ]. The rationale for this recommendation is based on the belief that surveillance CT might contribute to the early detection of asymptomatic relapse, which might translate to a favorable clinical outcome in patients with relapsed aNHL.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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“…Moreover, with the improvement of remission rates in DLBCL patients, early detection of recurrence is urgently needed. Although minimal residual disease (MRD) is thought to contribute to disease relapse, its detection via image scans remains a challenge [22]. CtDNA has advantages over PET-CT examinations, such as high sensitivity and the convenience of multi-point noninvasive detection.…”

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confidence: 99%

Clinical implications of circulating tumor DNA in predicting the outcome of first line treatment in diffuse large B-cell lymphoma (DLBCL) patients

Wang

et al. 2022

Preprint

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Background: The clinical implication of circulating tumor DNA (ctDNA) as a prognostic or predictive biomarker in DLBCL patients receiving standard immunochemotherapy is uncertain. Methods: Here, using targeted next-generation sequencing, we assessed the prognostic and predictive utility of ctDNA in 73 DLBCL patients before, during and after the first line therapy Results: Pretreatment ctDNA level was an independent prognostic factor for both progression-free survival (PFS, adjusted HR 2.42; 95% CI 1.27 - 4.6; p = 0.007) and overall survival (OS, adjusted HR 2.58; 95% CI 1.204 - 5.5; p = 0.015) by multivariate analysis. Besides, we found for the first time that the phase after two cycles of therapy was also an appropriate timing to predict survival and patients with higher ctDNA levels had an inferior PFS (6.5 months vs. unreached; HR 2.604; 95% CI 0.996 - 6.807; p = 0.043) and OS (6.5 months vs. unreached; HR 2.604; 95% CI 0.996 - 6.807; p = 0.043). Furthermore, the patients classified as molecular responders who presented larger decrease in ctDNA levels after the initial two treatment cycles had more favorable PFS (unreached vs. 6.25 months; HR 5.348; 95% CI 1.698 - 16.85; p = 0.0015) and OS (unreached vs. 25.87; HR 4.0; 95% CI 1.051 - 15.22; p = 0.028) compared with non-responders. Beyond that, interim ctDNA clearance may be an alternative noninvasive method of PET-CT for predicting better PFS (HR 3.65; 95% CI 1.452 - 9.178; p = 0.0033) and OS (HR 3.536; 95% CI 1.192 - 10.49; p = 0.016). In addition, ctDNA was a potential biomarker for tracking minimal residue disease (MRD) at radiographic CR status and ctDNA-MRD identified patients at high risk of recurrence (HR 6.471; 95% CI 1.177 - 35.58; p = 0.014) after treatment. Conclusions: ctDNA was a promising noninvasive tool for prognosis prediction, response assessment, and early relapse prediction of first line treatment in DLBCL patients.

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Surveillance Imaging in Patients in Remission From Hodgkin and Diffuse Large B-Cell Lymphoma

Cited by 7 publications

References 9 publications

Low-dose abdominopelvic computed tomography in patients with lymphoma: An image quality and radiation dose reduction study

Low-dose abdominopelvic computed tomography in patients with lymphoma: An image quality and radiation dose reduction study

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

Clinical implications of circulating tumor DNA in predicting the outcome of first line treatment in diffuse large B-cell lymphoma (DLBCL) patients

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