Surveillance investigations after high-dose therapy with stem cell rescue for recurrent follicular lymphoma have no impact on management

Gerlinger, Marco, Rohatiner, Ama Z.S., Matthews, Janet, Davies, Andrew, Lister, T. Andrew and Montoto, Silvia (2010) Surveillance investigations after high-dose therapy with stem cell rescue for recurrent follicular lymphoma have no impact on management. Haematologica, 95 (7), 1130-1135. (doi:10.3324/haematol.2009.020115).

Abstract

Background: The impact of active surveillance, comprising an annual CT scan and bone marrow biopsies, in the follow-up of patients after high-dose therapy (HDT) with autologous stem cell rescue for recurrent follicular lymphoma was analyzed.

Design and Methods: Seventy-one of 99 patients who received HDT commenced on the surveillance program. Response duration, time-to-next-treatment and overall survival (OS) were compared, according to whether disease progression had been diagnosed on the basis of surveillance investigations or clinical grounds.

Results: After a median follow-up of 16 years, progression was documented by surveillance in 16 patients and clinically in 18, the median response duration being 2.4 and 2.3 years, respectively (p=NS). Ten patients with a clinical relapse started treatment immediately contrasting with one patient who had a surveillance relapse. Five patients with relapses on surveillance investigations have not required treatment after a median follow-up of 18 years, whereas all but 2 patients with a clinical relapse have been treated. The median time-to-next-treatment was 7 years for patients with a surveillance relapse and 4 years for those with a clinical relapse (p=0.03). OS was not significantly different.

Conclusions: Surveillance investigations have no impact on management and do not improve the outcome of this population.

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Contributors

Author: Andrew Davies

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