Analysis of the Different Surveillance Strategies for Patients with Hodgkin Lymphoma in Clinical Remission after First-Line Treatment. a Study of the Geltamo Group (Spanish lymphoma and autologous transplant group)

Introduction

The best strategy for the follow-up of patients with Hodgkin Lymphoma (HL) in complete remission (CR) after the first line of treatment is not established. The NCCN guidelines recommend follow-up computed tomography scan (CT) at 6, 12 and 24 months after the end of treatment. Several clinical trials of relevance require the follow-up with quarterly CT during the first year after treatment, and every 6 months thereafter. However, these recommendations are based on expert opinion rather than evidence. The aim of our study is to evaluate the different follow-up strategies after 1st line of treatment in patients with diagnosis of LH who achieved CR, and to identify the best follow-up strategy.

Materials and methods

This is a multicenter, retrospective study. We analysed 604 patients from 11 GELTAMO group centers, diagnosed with HL between 2007 and 2016 that had positron emission tomography-computed tomography scan (PET-CT) for initial staging, and at the end of induction treatment. Patients were grouped according to the different follow-up strategies in: 1) only clinical (clinical history, blood test (BT) and physical examination), 2) CT 3) PET-CT. The study was approved by the ethics committee of the Gregorio Marañón hospital. Medians, ranges and percentages were used for the descriptive analysis and the X² test, Fisher's test and the Mann-Whitney U test for the comparison of variables.

Results:

Patients and disease characteristics and treatment information are included in Table 1. Table 2 shows the number of radiological images performed, the number of visits and the suspicion of relapse according to the used strategy. The median follow-up was 64 months (24-180). Of 90 suspicions, 59 relapses were confirmed. Relapse was identified in 64% of the patients by some clinical data that suggested it, 17% of patients had only symptoms, 25% had only abnormal physical examinations, 2% had only abnormal BT and 20% presented a combination of all the clinical variables. Regarding laboratory assessment at relapse time, 62% of the patients had a normal blood test at the time of relapse, 18% had elevated ESR, 8% elevated LDH and 9% abnormal blood count. Regardless of the strategy, 55% of relapses had at least one accessible lesion on physical examination. Comparing the used strategy, the median time to relapse was 19 months (p25-75 = 8-39) for the clinical follow-up, 18 months (p25-75 = 9-41) with CT follow-up and 13 months (p25-75 = 2-23) with PET-CT, with not statistical significance differences among them (p = 0.57) (Figure 1). Overall survival was not different using any of the strategies (Figure 2).

Conclusions:

In our study, the use of CT and PET-CT for the follow-up of patients with HL does not significantly reduce the time to identify the relapse and has no impact on survival. In addition, these strategies expose patients to radiation and have a high cost with not clear benefit. Our next step is to confirm this results with a prospective study.

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