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Routine imaging during first complete remission fails to improve DLBCL survival
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Widespread use of routine imaging of patients with diffuse large B-cell lymphoma in first complete remission did not improve survival outcomes, according to the results of a population-based study conducted in Denmark and Sweden.
Most patients with diffuse large B-cell lymphoma (DLBCL) achieve long-term remission after first-line immunotherapy and chemotherapy. However, 20% of patients relapse after their first complete remission, most of which occur within the first 2 years of follow-up.
Tarec Christoffer El-Galaly, MD, clinical associate professor and consultant at Aalborg University in Denmark, and colleagues compared the survival outcomes of 525 Danish and 696 Swedish patients aged 18 to 65 years with DLBCL who achieved a complete remission after treatment. Patients in Sweden underwent follow-up with symptom assessment, clinical examinations and blood tests every 3 months to 4 months for 2 years, with longer intervals as time progressed. Danish patients underwent these strategies, as well as routine imaging with CT every 6 months for 2 years.
The cumulative 2-year progression rate after complete remission was 6% (95% CI, 4-9) for patients with an International Prognostic Index (IPI) of 2 or less vs. 21% (95% CI, 13-28) for those with an IPI greater than 2.
Shorter survival after complete remission appeared associated with patient age older than 60 years (HR = 2.3; 95% 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 an ECOG performance status score of 2 or higher (HR = 1.8; 95% CI, 1-3).
The imaging-based strategy employed in Denmark had no effect on survival for the entire population of the study, nor in the IPI–specific subgroups.
“A majority of patients with recurrent DLBCL experience symptoms preceding a relapse diagnosis,” El-Galaly and colleagues wrote. “Routine imaging contributed significantly to the detection of recurrent disease in less than 26% of the patients, whereas symptoms or clinical signs were present in 71% to 86% of patients at the time of relapse.”
The researchers indicated that this was the first population-based study to report the effect of imaging-based follow-up protocols after complete remissions in DLBCL. In the absence of randomized trials, population-based observational studies comparing follow-up strategies provide the best evidence regarding routine imaging.
“Screening for asymptomatic DLBCL relapse is potentially beneficial if three essential conditions are present: the relapse is life-threatening, the risk of relapse is high, and early treatment of relapse is more effective,” El-Galaly and colleagues concluded. “Although relapsed DLBCL can be fatal, it is relatively uncommon in patients in first [complete remission]. Last but not least, no solid evidence points to survival benefit with routine imaging. Therefore, routine imaging for DLBCL in first [complete remission] is not recommended.” – by Anthony SanFilippo
Reference:
El-Galaly TC, et al. J Clin Oncol. 2015;doi:10.1200/JCO.2015.62.0229.
Disclosure: The researchers report no relevant financial disclosures.