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Published on: February 17, 2022
Routine Imaging for Diffuse Large B-Cell Lymphoma in First Complete Remission Does Not Improve Post-Treatment
Tarec Christoffer El-Galaly1, Lasse Hjort Jakobsen2, Martin Hutchings2
1Tarec Christoffer El-Galaly, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University Hospital; Tarec Christoffer El-Galaly, Lasse Hjort Jakobsen, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University, Aalborg; Martin Hutchings and Peter de Nully Brown, Rigshospitalet, Copenhagen University Hospital, Copenhagen; Karen Juul Mylam, Odense University Hospital, Odense, Denmark; Herman Nilsson-Ehle, Sahlgrenska University Hospital, Gothenburg; Elisabeth Székely and Mats Jerkeman, Lund University Hospital, Lund; and Viktoria Hjalmar, Karolinska Institutet, Stockholm University Hospital, Stockholm, Sweden. tarec.galaly@gmail.com.
Purpose:
Routine imaging for diffuse large B-cell lymphoma (DLBCL) in first complete remission (CR) is controversial and plays a limited role in detecting relapse. This population-based study compared the survival of Danish and Swedish patients with DLBCL for whom traditions for routine imaging have been different.
Patients And Methods:
Patients from the Danish and Swedish lymphoma registries were included according to the following criteria: newly diagnosed DLBCL from 2007 to 2012, age 18 to 65 years, and CR after R-CHOP/CHOEP. Follow-up for Swedish patients included symptom assessment, clinical examinations, and blood tests at 3- to 4-month intervals for 2 years, with longer intervals later in follow-up. Imaging was only recommended when relapse was clinically suspected. Follow-up for Danish patients was similar but included routine imaging (usually computed tomography every 6 months for 2 years).
Results:
Danish (n = 525) and Swedish (n = 696) patients with DLBCL had comparable baseline characteristics. Cumulative 2-year progression rate after CR was 6% (95% CI, 4 to 9) for International Prognostic Index (IPI) ≤ 2 versus 21% (95% CI, 13 to 28) for IPI > 2. Age > 60 years (hazard ratio [HR], 2.3; 95% CI, 1.6 to 3.4), elevated lactate dehydrogenase (HR, 2.3; 95% CI, 1.4 to 3.8), B symptoms (HR, 1.7; 95% CI, 1.1 to 2.5), and Eastern Cooperative Oncology Group performance status ≥ 2 (HR, 1.8; 95% CI, 1.0 to 3.0) were associated with worse post-CR survival. Imaging-based follow-up strategy had no impact on survival, neither for all patients nor for IPI-specific subgroups.
Conclusion:
DLBCL relapse after first CR is infrequent, and the widespread use of routine imaging in Denmark did not translate into better survival. This favors follow-up without routine imaging and, more generally, a shift of focus from relapse detection to improved survivorship.
