CT scans provide little help detecting relapse of aggressive lymphoma

Volume 2, Issue 3, 2013

Summary

Most patients already have symptoms, an abnormal physical exam or an abnormal blood test at the time of relapse.

Photograph showing Carrie A. Thompson, M.D., a Mayo Clinic Cancer Center hematologist

Carrie A. Thompson, M.D.

Computerized tomography (CT) scans following treatment for diffuse large B-cell lymphoma do little to help detect a relapse, a Mayo Clinic Cancer Center study has found.

The overwhelming majority of patients with this aggressive lymphoma already have symptoms, an abnormal physical exam or an abnormal blood test at the time of relapse, the study concluded.

"Our results were surprising because the current standard of care is to include scans for the follow-up of this disease," said lead author Carrie A. Thompson, M.D., a Mayo Clinic Cancer Center hematologist. "We found that scans detected relapse in only a handful of patients who didn't have any of those other signs or symptoms. I think our study suggests that we are getting closer to understanding how to optimize follow-up in this patient population."

Diffuse large B-cell lymphoma is the most common type of non-Hodgkin lymphoma, with nearly 20,000 new cases diagnosed in the United States each year. The aggressive lymphoma can be cured if treated in its early stages.

But this type of lymphoma comes back in 20 to 30 percent of cases, and the best strategy for detecting that relapse is unclear. In this study, Dr. Thompson and her colleagues looked at patients in remission to identify how relapses were detected.

Researchers followed 537 patients who were treated with anthracycline-based immunochemotherapy and enrolled in the Molecular Epidemiology Resource, part of the Clinical Research Core of the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence (SPORE) Grant. Of the 109 patients who relapsed, 62 percent went to the doctor before their planned follow-up visit because of the re-emergence of signs and symptoms, such as enlarged lymph nodes, fever, night sweats, pain or weight loss.

At the time of relapse, 68 percent had symptoms, 42 percent had an abnormal physical exam and 55 percent had an abnormal blood test. Performing surveillance scans detected relapse in only eight patients whose symptoms had not yet reappeared.

"Sometimes scans can provide reassurance, but at the same time, the anticipation of a scan can provoke quite a bit of anxiety," Dr. Thompson said. "And we know from this data that scans detected relapses only in a minority of patients. So we need to think about how we can individualize care to particular patients, keeping in mind their disease, their experience and their fears. Further studies are necessary to determine the optimal follow-up strategy."

The findings were presented at the 2013 American Society of Clinical Oncology annual meeting in Chicago.

Watch a video of Dr. Thompson discussing this study.