Symptoms, Not Scans, Offer Better Measure of Relapse for DLBCL Patients

Imaging spotted relapses for just a tiny fraction of patients with diffuse large B-cell lymphoma (DLBCL) before symptoms appeared, according to a new multi-institutional study, prompting recommendations that the radiation exposure of follow-up scans may not be worthwhile for all patients.

The study’s results were unveiled today in Chicago, at the Annual Meeting of the American Society of Clinical Oncology (ASCO).

DLBCL is the most common form of non-Hodgkin’s lymphoma in adults, with approximately 20,000 new cases diagnosed every year in the United States. Because the disease is potentially curable if it recurs, it can be argued that identifying early relapse is especially important, noted Carrie A. Thompson, MD, a hematologist at the Mayo Clinic in Rochester, Minnesota, and the study’s lead author. She said that the optimal strategy for following patients in remission from DLBCL is not clear, but follow-up has typically included physical exam, laboratory tests, and imaging studies.

Thompson and colleagues at the Mayo Clinic, the University of Iowa, and the Centre Léon Bérard in Lyon, France, looked at post-treatment outcomes, including relapse and death, in 644 newly diagnosed DLBCL patients enrolled in the Molecular Epidemiology Resource (MER) project. The MER is part of the University of Iowa/Mayo Clinic National Cancer Institute Specialized Program of Research Excellence, known as the Lymphoma SPORE.

Researchers conducted post-treatment surveillance in 537 patients, 20% of whom (n = 109) experienced relapse of their disease. The median age of patients in this study was 63 (range: 18-92), and the median range of follow-up was 59 months (8-116).

Sixty-eight percent of patients had symptoms at the time of relapse, 55% had abnormal blood tests, and 42% had an abnormal physical exam finding.

Notably, only eight relapses were detected through a planned surveillance scan before symptoms appeared—equivalent to just 1.5%.

Thompson said these findings show that scans add little value for DLBCL patients in remission who had no other symptoms or abnormal findings. Because so many relapses in this study were accompanied by symptoms, she said that patients should be especially vigilant about reporting them. Among the signs of relapse of DLBCL are enlarged lymph nodes, night sweats, unexplained fever, and unintentional weight loss.

“These findings are important to help guide physicians in making decisions on how frequently to order scans for patients in remission following treatment for DLBCL,” said Thompson. “This decision should be discussed with, and tailored for, the individual patient.”

ASCO’s President-Elect Clifford A. Hudis, MD, concurred, noting before the conference that these results mirror observations from other studies involving other common malignancies. “These findings will help physicians develop guidelines for following patients who are in remission from DLBCL and will spare patients from the cost and excessive radiation exposure of unnecessary CT scans, not to mention the impact of false-positive findings,” he said.

Thompson CA, Maurer MJ, Ghesquieres H, et al. Utility of post-therapy surveillance scans in DLBCL. J Clin Oncol. 2013(suppl; abstr 8504).