Routine Imaging for DLBCL Post-Remission Does Not Improve Survival

Routine imaging for diffuse large B-cell lymphoma (DLBCL) in patients after first complete remission does not translate into better survival, suggests a study in the online Journal of Clinical Oncology. Considering these results alongside the costs and potential harm of serial imaging, the researchers involved do not recommend it.

“Although it is rational to believe that preclinical relapse detection can improve patient outcome as a result of lower tumor burden, the actual value of routine imaging for DLBCL is controversial,” researchers wrote, “and there are no data to clearly support its use.”

The observational, population-based study looked at survival of patients from the population-based Danish Lymphoma Group Registry and Swedish Lymphoma Registry, which include at least 90% of adults with lymphoma in the two neighboring countries. The study centered on patients diagnosed between 2007 and 2012, aged 18–65 years, and in complete remission after treatment with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) or CHOEP (cyclophosphamide, doxorubicin, etoposide, vincristine, and prednisone).

The study compared 525 patients with DLBCL in Denmark, where routine CT scans of the neck, thorax, and abdomen are encouraged for asymptomatic patients every 6 months for 2 years; and of 696 patients with DLBCL in Sweden, where imaging is recommended only when relapse is clinically suspected. Follow-up care is otherwise similar in both countries and includes symptom assessment, clinical examinations, and blood tests every 3–4 months for 2 years and at longer intervals afterward.

DLBCL relapse occurs in less than 20% of patients who achieve complete remission after first-line therapy, the researchers wrote. “Risk of relapse peaks in the first 2 years of follow-up,” they continued, “but relapse rarely occurs after 5 years in complete remission.”

Although the study did identify patient factors linked with worse post-remission survival—older than 60 years of age, elevated lactate dehydrogenase, the presence of B symptoms at diagnosis, and Eastern Cooperative Oncology Group performance status of 2 or higher—their country’s imaging strategy was not associated with post-remission survival. The 3-year overall survival was 92%, the study found, with no difference between Danish patients and Swedish patients.

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

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El-Galaly TC, Jakobsen LH, Hutchings M, et al. Routine imaging for diffuse large B-cell lymphoma in first complete remission does not improve post-treatment survival: a Danish-Swedish population-based study [published online ahead of print October 5, 2015]. J Clin Oncol. doi:10.1200/JCO.2015.62.0229.