Routine Imaging Not Necessary Part of DLBCL Follow-Up Post Remission

Patients who are in complete remission from diffuse large B-cell lymphoma (DLBCL) may not need to undergo routine imaging follow-up, a new study showed. A comparison of two national lymphoma registries indicated that the use of routine imaging did not result in improved post-treatment survival for patients after first complete remission.

“Although relapsed DLBCL can be fatal, it is relatively uncommon in patients in first complete response,” wrote Tarec Christoffer El-Galaly, MD, of Aalborg University Hospital, Denmark, and colleagues in the Journal of Clinical Oncology. “No solid evidence points to a survival benefit with routine imaging. Therefore, routine imaging for DLBCL in first complete response is not recommended.”

According to the study, more than half of patients diagnosed with DLBCL will have long-term remission after first-line treatment with combined immunotherapy and chemotherapy. Although follow-up programs are designed to detect relapse, the role of routine imaging in these programs is controversial.

“Previous studies of routine imaging in DLBCL have been limited by their retrospective comparison of patients with clinical and imaging-detected relapse, leading to serious biases and inconsistent results,” the researchers wrote. “In the absence of randomized studies, we believe that observational population-based studies comparing different follow-up strategies provide the best possible evidence for (or against) the use of routine imaging.”

In this study, El-Galaly and colleagues conducted a population-based study of outcomes in patients with DLBCL after first complete remission taken from lymphoma patient registries in Sweden and Denmark. All patients included in the study from both registries had newly diagnosed DLBCL from 2007 to 2012 and were aged 18 to 65. In addition, all patients were in complete remission after treatment with R-CHOP/CHOEP.

Patients in the Swedish registry (n = 696) underwent follow-up that included symptom assessment, clinical exams, and blood tests every 3 to 4 months for 2 years. No routine imaging was used. Patients in the Danish registry (n = 525) underwent similar follow-up procedures but also underwent routine imaging with CT every 6 months for 2 years.

The cumulative 2-year progression rate after complete response was higher in patients with an International Prognostic Index of > 2 compared with a score of 2 or less (21% vs 6%).

Whether or not patients underwent routine imaging as part of their follow-up had no effect on survival. The researchers found that an age greater than 60 years (hazard ratio [HR], 2.3 [95% confidence interval (CI), 1.6–3.4]), elevated lactate dehydrogenase (HR, 2.3 [95% CI, 1.4–3.8]), B symptoms (HR, 1.7 [95% CI, 1.1-2.5]), and ECOG performance status of 2 or higher (HR, 1.8 [95% CI, 1.0–3.0]) were associated with worse survival after first complete remission. A patient’s country of follow-up was not associated with post-remission overall survival.

“DLBCL relapse after first complete remission is infrequent, and the widespread use of routine imaging in Denmark did not translate into better survival,” the researchers concluded. “This favors follow-up without routine imaging and, more generally, a shift of focus from relapse detection to improved survivorship.”