Relapse of diffuse large B-cell lymphoma not detected by imaging scans

Imaging scans following treatment for diffuse large B-cell lymphoma do little to help detect a relapse, according to a new study.  The overwhelming majority of patients with this aggressive lymphoma already have symptoms, an abnormal physical examination or an abnormal blood test at the time of relapse, researchers say. Results of a study supporting these findings will be presented at the 2013 annual meeting of the American Society of Clinical Oncology, held in Chicago, Illinois from May 31 to June 4.

"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 Thompson, MD, a hematologist at the Mayo Clinic in Rochester, Minnesota. "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. The cancer will come back in 20% to 30% of cases, and the best strategy for detecting that relapse early is unclear. In this study, Thompson and her colleagues looked at patients in remission to identify how relapses were detected.

Researchers followed 537 patients treated with anthracycline-based immunochemotherapy and enrolled in the Mayo Clinic/University of Iowa Special Program of Research Excellence (SPORE) Molecular Epidemiology Resource. Of the 109 patients who relapsed, 62% went to the doctor earlier than a planned follow-up visit due to the reemergence of symptoms such as enlarged lymph nodes, fever, night sweats, pain or weight loss. At the time of relapse, 68% had symptoms, 42% had abnormal physical examination findings, and 55% had abnormal blood test results. Performing surveillance scans detected relapse in only 8[WU2]  patients whose symptoms had not yet started to reappear.
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