Routine imaging for diffuse large B-cell lymphoma in first remission is not associated with better survival: A danish-Swedish population-based study

T. C. El-Galaly, L. H. Jakobsen, M. Hutchings, P. De Nully Brown, H. Nilsson-Ehle, E. Szekely, V. Hjalmar, Karen Juul Mylam, H. E. Johnsen, M. Bøgsted, M. Jerkeman

Research output: Contribution to journalConference abstract in journalResearchpeer-review

Abstract

Background: Routine surveillance imaging plays a limited role in detecting recurrent diffuse large B-cell lymphoma (DLBCL), and the value of routine imaging is controversial. The present population-based study compares the post-remission survival of Danish and Swedish DLBCL patients-two neighbouring countries with comparable treatment guidelines but with completely different traditions for routine surveillance imaging. Methods: Patients enroled in the Danish (LYFO) and Swedish population-based lymphoma registries were included by following criteria: (a) newly diagnosed DLBCL in the period 2007-2012, (b) age 18-65 years, and (c) CR after 1st line treatment with R-CHOP/CHOEP. We selected the age category 18-65 years, since 1st and 2nd line therapies are highly standardized for these patients (2nd line: high-dose therapy if feasible). The Danish and Swedish haematology/oncology services are fully publicly funded. Follow-up (FU) for Swedish patients included symptom assessment, clinical examinations, and blood tests with 3-month intervals for 2 years and with longer intervals later in follow-up. Imaging was only performed in response to suspected relapse. FU for Danish patients was equivalent but included additional routine surveillance imaging (usually half-yearly CT for 2 years as a minimum). Clinico-pathological features were retrieved from the national lymphoma registries, and vital status was updated using the civil registries. OS was defined as the time from end of treatment until death/censoring. Relapse data are continuously updated in the LYFO, and cumulative incidence rates for progression (relapse and death) were calculated for the Danish patients. Results: A total of 525 Danish and 696 Swedish patients were included. Danish and Swedish patients had similar male:female ratio, median age, and proportion of IPI high risk disease (IPI > 2). After a median FU of 51months, the 3-yr OS for the entire patient cohort was 92% (95% CI 90-93). There was no survival difference between Danish and Swedish patients (P = 0.5, log-rank). Age >60 years (HR 2.3, P <0.01), elevated LDH (HR 2.3, P <0.01), B-symptoms (HR 1.6, P = 0.02), and ECOG performance >2 (HR 1.8, P = 0.04) at diagnosis were associated with inferior post-remission OS in multivariate Cox analysis, whereas an imaging-based FU strategy (country of FU) was not prognostic. An imaging-based FU strategy also had no impact on the post-remission OS for patients grouped according to the IPI scores (P = 0.2 for IPI <2 and P = 0.8 for IPI > 2). The cumulative 2-year progression rate was 6% (95% CI 4-9) for patients with IPI <2 versus 21% (95% CI 13-28) for patients with IPI > 2. Conclusions: The vast majority of young DLBCL patients in CR stay in remission, and only a small minority will benefit from a relapse-oriented FU program. More importantly, the post-remission survival rates were completely identical for Danish and Swedish patients despite the widespread use of routine imaging in Denmark, favouring a non-imaging-based FU strategy for DLBCL in 1st CR.
Original languageEnglish
Article number086
JournalHematological Oncology (Print)
Volume33
Issue numberS1
Pages (from-to)146
Number of pages1
ISSN0278-0232
DOIs
Publication statusPublished - 2015
Event13th International Conference on Malignant Lymphoma - Lugano, Switzerland
Duration: 17. Jun 201520. Jun 2015

Conference

Conference13th International Conference on Malignant Lymphoma
Country/TerritorySwitzerland
CityLugano
Period17/06/201520/06/2015

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