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Utility of surveillance imaging in patients with non-Hodgkin lymphoma.
Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy are designated with a caret symbol (^).
Background: The optimal surveillance imaging in the management of patients (pts) with non-Hodgkins lymphoma (NHL) remains undefined. Unnecessary scans increase health care costs and radiation related health hazards. A recent report (Thompson, C.A. et.al; ASCO 2013) suggests that routine surveillance scans did not add much value to follow up of pts treated for NHL. We reviewed our hospital’s patient charts to further explore the effectiveness and cost of surveillance imaging. Methods: We retrospectively studied the records of 218 pts (118 male, 100 female) with NHL managed at our institution from 2008 to 2012. Pts with high-grade (HG) NHL treated to complete remission, and pts managed for low-grade (LG) NHL were included. Patients with HIV-related NHL were analyzed separately. Primary CNS lymphoma was excluded. Data were analyzed to determine if re-treatment decisions at relapse, as well as decisions to initiate therapy in pts with LG NHL, were based on clinical features (physical exam, laboratory abnormalities) or findings noted on scans. Results: Of 218 pts, 115 (53 %) pts had HG NHL, and 103 (47 %) had LG NHL. Patients were managed with observation, radiation therapy, rituximab, and/or immunochemotherapy as appropriate. Median age was 60 years (Range: 24 - 97) and median follow-up was 31 months. Median overall survival was not reached. Forty -six pts had disease relapse or progression warranting treatment initiation: 38 were detected by symptoms and 8 were diagnosed by imaging alone. A total of 834 surveillance scans were done including 373 PET/CT scans with an estimated total cost of over USD 750,000. (Medicare reimbursement prices 2014). Of the 218 pts, 32 (15 %) had HIV-related NHL. Eleven of these patients had disease relapse, all detected by symptoms. HIV patients averaged 2.9 scans/pt compared to 3.9 scans/pt in non-HIV pts (p: 0.156). HIV-NHL pts had a higher relapse rate compared to non-HIV pts, which did not reach statistical significance. (34% vs 19% (p: 0.059). Conclusions: Disease relapses were mostly diagnosed due to a change in patient’s clinical status. Only 8 of the 46 cases of relapse were detected by surveillance imaging alone. We plan to further explore whether the outcomes were different for patients with relapse detected by imaging.