Value of Surveillance Studies for Patients With Stage I to II Diffuse Large B-Cell Lymphoma in the Rituximab Era.
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| Title: | Value of Surveillance Studies for Patients With Stage I to II Diffuse Large B-Cell Lymphoma in the Rituximab Era. |
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| Authors: | Hiniker, Susan M.1, Pollom, Erqi L.1, Khodadoust, Michael S.2, Kozak, Margaret M.1, Xu, Guofan3, Quon, Andrew3, Advani, Ranjana H.2, Hoppe, Richard T.1 rhoppe@stanford.edu |
| Source: | International Journal of Radiation Oncology, Biology, Physics. May2015, Vol. 92 Issue 1, p99-106. 8p. |
| Subjects: | B cell lymphoma, Rituximab, Computed tomography, Retrospective studies, Biomarkers, Patients |
| Abstract: | Background The role of surveillance studies in limited-stage diffuse large B-cell lymphoma (DLBCL) in the rituximab era has not been well defined. We sought to evaluate the use of imaging (computed tomography [CT] and positron emission tomography [PET]-CT) scans and lactate dehydrogenase (LDH) in surveillance of patients with stage I to II DLBCL. Methods A retrospective analysis was performed of patients who received definitive treatment between 2000 and 2013. Results One hundred sixty-two consecutive patients with stage I to II DLBCL were treated with chemotherapy +/− rituximab, radiation, or combined modality therapy. The 5-year rates of overall survival (OS) and freedom from progression (FFP) were 81.2% and 80.8%, respectively. Of the 162 patients, 124 (77%) were followed up with at least 1 surveillance PET scan beyond end-of-treatment scans; of those, 94 of 124 (76%) achieved a complete metabolic response on PET scan after completion of chemotherapy, and this was associated with superior FFP ( P =.01, HR=0.3) and OS ( P =.01, HR 0.3). Eighteen patients experienced relapse after initial response to therapy. Nine relapses were initially suspected by surveillance imaging studies (8 PET, 1 CT), and 9 were suspected clinically (5 by patient-reported symptoms and 4 by symptoms and physical examination). No relapses were detected by surveillance LDH. The median duration from initiation of treatment to relapse was 14.3 months among patients with relapses suspected by imaging, and 59.8 months among patients with relapses suspected clinically ( P =.077). There was no significant difference in OS from date of first therapy or OS after relapse between patients whose relapse was suspected by imaging versus clinically. Thirteen of 18 patients underwent successful salvage therapy after relapse. Conclusions A complete response on PET scan immediately after initial chemotherapy is associated with superior FFP and OS in stage I to II DLBCL. The use of PET scans as posttreatment surveillance is not associated with a survival advantage. LDH is not a sensitive marker for relapse. Our results argue for limiting the use of posttreatment surveillance in patients with limited-stage DLBCL. [ABSTRACT FROM AUTHOR] |
| Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | Engineering Source |
| FullText | Text: Availability: 0 |
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| Header | DbId: egs DbLabel: Engineering Source An: 102053856 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: Value of Surveillance Studies for Patients With Stage I to II Diffuse Large B-Cell Lymphoma in the Rituximab Era. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Hiniker%2C+Susan+M%2E%22">Hiniker, Susan M.</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Pollom%2C+Erqi+L%2E%22">Pollom, Erqi L.</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Khodadoust%2C+Michael+S%2E%22">Khodadoust, Michael S.</searchLink><relatesTo>2</relatesTo><br /><searchLink fieldCode="AR" term="%22Kozak%2C+Margaret+M%2E%22">Kozak, Margaret M.</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Xu%2C+Guofan%22">Xu, Guofan</searchLink><relatesTo>3</relatesTo><br /><searchLink fieldCode="AR" term="%22Quon%2C+Andrew%22">Quon, Andrew</searchLink><relatesTo>3</relatesTo><br /><searchLink fieldCode="AR" term="%22Advani%2C+Ranjana+H%2E%22">Advani, Ranjana H.</searchLink><relatesTo>2</relatesTo><br /><searchLink fieldCode="AR" term="%22Hoppe%2C+Richard+T%2E%22">Hoppe, Richard T.</searchLink><relatesTo>1</relatesTo><i> rhoppe@stanford.edu</i> – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22International+Journal+of+Radiation+Oncology%2C+Biology%2C+Physics%22">International Journal of Radiation Oncology, Biology, Physics</searchLink>. May2015, Vol. 92 Issue 1, p99-106. 8p. – Name: Subject Label: Subjects Group: Su Data: <searchLink fieldCode="DE" term="%22B+cell+lymphoma%22">B cell lymphoma</searchLink><br /><searchLink fieldCode="DE" term="%22Rituximab%22">Rituximab</searchLink><br /><searchLink fieldCode="DE" term="%22Computed+tomography%22">Computed tomography</searchLink><br /><searchLink fieldCode="DE" term="%22Retrospective+studies%22">Retrospective studies</searchLink><br /><searchLink fieldCode="DE" term="%22Biomarkers%22">Biomarkers</searchLink><br /><searchLink fieldCode="DE" term="%22Patients%22">Patients</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Background The role of surveillance studies in limited-stage diffuse large B-cell lymphoma (DLBCL) in the rituximab era has not been well defined. We sought to evaluate the use of imaging (computed tomography [CT] and positron emission tomography [PET]-CT) scans and lactate dehydrogenase (LDH) in surveillance of patients with stage I to II DLBCL. Methods A retrospective analysis was performed of patients who received definitive treatment between 2000 and 2013. Results One hundred sixty-two consecutive patients with stage I to II DLBCL were treated with chemotherapy +/− rituximab, radiation, or combined modality therapy. The 5-year rates of overall survival (OS) and freedom from progression (FFP) were 81.2% and 80.8%, respectively. Of the 162 patients, 124 (77%) were followed up with at least 1 surveillance PET scan beyond end-of-treatment scans; of those, 94 of 124 (76%) achieved a complete metabolic response on PET scan after completion of chemotherapy, and this was associated with superior FFP ( P =.01, HR=0.3) and OS ( P =.01, HR 0.3). Eighteen patients experienced relapse after initial response to therapy. Nine relapses were initially suspected by surveillance imaging studies (8 PET, 1 CT), and 9 were suspected clinically (5 by patient-reported symptoms and 4 by symptoms and physical examination). No relapses were detected by surveillance LDH. The median duration from initiation of treatment to relapse was 14.3 months among patients with relapses suspected by imaging, and 59.8 months among patients with relapses suspected clinically ( P =.077). There was no significant difference in OS from date of first therapy or OS after relapse between patients whose relapse was suspected by imaging versus clinically. Thirteen of 18 patients underwent successful salvage therapy after relapse. Conclusions A complete response on PET scan immediately after initial chemotherapy is associated with superior FFP and OS in stage I to II DLBCL. The use of PET scans as posttreatment surveillance is not associated with a survival advantage. LDH is not a sensitive marker for relapse. Our results argue for limiting the use of posttreatment surveillance in patients with limited-stage DLBCL. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1016/j.ijrobp.2015.01.039 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 8 StartPage: 99 Subjects: – SubjectFull: B cell lymphoma Type: general – SubjectFull: Rituximab Type: general – SubjectFull: Computed tomography Type: general – SubjectFull: Retrospective studies Type: general – SubjectFull: Biomarkers Type: general – SubjectFull: Patients Type: general Titles: – TitleFull: Value of Surveillance Studies for Patients With Stage I to II Diffuse Large B-Cell Lymphoma in the Rituximab Era. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Hiniker, Susan M. – PersonEntity: Name: NameFull: Pollom, Erqi L. – PersonEntity: Name: NameFull: Khodadoust, Michael S. – PersonEntity: Name: NameFull: Kozak, Margaret M. – PersonEntity: Name: NameFull: Xu, Guofan – PersonEntity: Name: NameFull: Quon, Andrew – PersonEntity: Name: NameFull: Advani, Ranjana H. – PersonEntity: Name: NameFull: Hoppe, Richard T. IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 05 Text: May2015 Type: published Y: 2015 Identifiers: – Type: issn-print Value: 03603016 Numbering: – Type: volume Value: 92 – Type: issue Value: 1 Titles: – TitleFull: International Journal of Radiation Oncology, Biology, Physics Type: main |
| ResultId | 1 |
