Limited role for surveillance PET–CT scanning in patients with diffuse large B-cell lymphoma in complete metabolic remission following primary therapy

• Published in: British journal of cancer Vol. 109; no. 2; pp. 312 - 317
• Main Authors: Cheah, C Y, Hofman, M S, Dickinson, M, Wirth, A, Westerman, D, Harrison, S J, Burbury, K, Wolf, M, Januszewicz, H, Herbert, K, Prince, H M, Carney, D A, Ritchie, D S, Hicks, R J, Seymour, J F
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 23-07-2013; Nature Publishing Group
• Subjects: 692/699/67/1059; 692/699/67/1990/291/1621/1915; 692/699/67/2321; Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biomarkers, Tumor - metabolism; Biomedical and Life Sciences; Biomedicine; Cancer Research; Cancer therapies; Chemotherapy; Clinical Study; Data collection; Drug Resistance; Epidemiology; Female; Hematologic and hematopoietic diseases; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma; Lymphoma, Large B-Cell, Diffuse - diagnostic imaging; Lymphoma, Large B-Cell, Diffuse - metabolism; Lymphoma, Large B-Cell, Diffuse - therapy; Male; Medical imaging; Medical prognosis; Medical sciences; Metabolism; Middle Aged; Molecular Medicine; Monitoring, Physiologic - methods; Monitoring, Physiologic - utilization; Multimodal Imaging - methods; Multimodal Imaging - utilization; Neoadjuvant Therapy; Oncology; Positron-Emission Tomography; Predictive Value of Tests; Prognosis; Remission (Medicine); Remission Induction; Retrospective Studies; Stem cells; Surveillance; Tomography; Tomography, X-Ray Computed; Transplants & implants; Tumors; Young Adult; Australia; follow-up; non-Hodgkin lymphoma; diffuse large B-cell lymphoma; surveillance PET; PET–CT; surveillance imaging; Radionuclide study; PET-CT; Cancerology; Lymphoproliferative syndrome; Primary; Remission; Human; Radiodiagnosis; B cell neoplasm; Malignant hemopathy; Non Hodgkin lymphoma; Metabolism; Treatment; Surveillance; Follow up study; Medical imagery; Diffuse large B cell lymphoma; Computerized axial tomography; Positron emission tomography; Cancer; Emission tomography
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/bjc.2013.338

Background:
The usefulness of positron emission tomography with computed tomography (PET–CT) in the surveillance of patients with diffuse large B-cell lymphoma (DLBCL) in complete metabolic remission after primary therapy is not well studied.
Methods:
We performed a retrospective review of our database between 2002 and 2009 for patients with
de novo
DLBCL who underwent surveillance PET–CT after achieving complete metabolic response (CMR) following primary therapy.
Results:
Four-hundred and fifty scans were performed in 116 patients, with a median follow-up of 53 (range 8–133) months from completion of therapy. Thirteen patients (11%) relapsed: seven were suspected clinically and six were subclinical (all within first 18 months). The positive predictive value in patients with international prognostic index (IPI) <3 was 56% compared with 80% in patients with IPI⩾3. Including indeterminate scans, PET–CT retained high sensitivity 95% and specificity 97% for relapse.
Conclusion:
Positron emission tomography with computed tomography is not useful in patients for the majority of patients with diffuse large B-cell lymphoma in CMR after primary therapy, with the possible exception of patients with baseline IPI ⩾3 in the 18 months following completion of primary therapy. This issue could be addressed by a prospective clinical trial.