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

Autor: El-Galaly, T. C., Jakobsen, L. H., Hutchings, M., De Nully Brown, P., Nilsson-Ehle, H., Szekely, E., Hjalmar, V., Juul Mylam, Karen, Johnsen, H. E., Bøgsted, M., Jerkeman, M.
Jazyk: angličtina
Rok vydání: 2015
Předmět:
Zdroj: El-Galaly, T C, Jakobsen, L H, Hutchings, M, De Nully Brown, P, Nilsson-Ehle, H, Szekely, E, Hjalmar, V, Juul Mylam, K, Johnsen, H E, Bøgsted, M & Jerkeman, M 2015, ' Routine imaging for diffuse large B-cell lymphoma in first remission is not associated with better survival : A danish-Swedish population-based study ', Hematological Oncology
, vol. 33, no. S1, 086, pp. 146 . https://doi.org/10.1002/hon.2227
DOI: 10.1002/hon.2227
Popis: 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 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). The cumulative 2-year progression rate was 6% (95% CI 4-9) 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.
Databáze: OpenAIRE
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