Are we Choosing Wisely in lymphoma? Excessive use of surveillance CT imaging in patients with diffuse large B-cell lymphoma (DLBCL) in long-term remission
The use of surveillance computed tomography (CT) imaging in patients with diffuse large B-cell lymphoma (DLBCL) in remission is neither effective nor cost-effective. The American Society of Hematology (ASH) Choosing Wisely (CW) campaign, in particular, emphasizes the lack of benefit beyond 2-years of completion of therapy. We sought to describe the real-world practice of surveillance imaging.
We present a case of a patient with well-controlled human immunodeficiency virus (HIV) infection and refractory classical Hodgkin lymphoma (HL) treated with nivolumab as fifth-line treatment, who achieved complete response (CR) by positron emission tomography –computed tomography (PET/CT). To our knowledge, this is the second case report of a patient exhibiting nivolumab’s response, and first reported CR in the setting of HIV-associated HL (HIV-HL).
The role of consolidation radiation therapy (RT) in advanced Hodgkin lymphoma is controversial, especially if a complete response (CR) is achieved according to positron emission tomography-computed tomography imaging after chemotherapy. In this series, low-dose (approximately 20 Gy) RT to all sites of original disease improved progression-free survival, even in the setting of a CR after ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine). Long-term toxicity was similar between chemotherapy and combined modality therapy.
Conclusion During a timeframe in which surveillance imaging is deemed unnecessary by the CW campaign, the practice remains excessive. Regional variations in CT scanning suggest that local practice patterns can be targeted to reduce imaging. A recent decline in scanning may reflect a broadening appreciation for the evidence against surveillance or uptake of the CW campaign.
Conclusion To the best of our knowledge, ours is the first report to analyze the bone density and stability in patients with multiple myeloma after RT using a validated scoring system and computed tomography imaging. Palliative RT is an effective method resulting in a significant increase in bone density for local response and stability without severe RT-related toxicity. Furthermore, recalcification could already be detected at 3 months after treatment. Micro-Abstract This retrospective analysis evaluated the response regarding bone density and stability of patients with osteolytic spinal bone lesions due to multiple myel...
Conclusions This is the first report to analyze bone density and stability in patients with multiple myeloma after irradiation using a validated scoring system on the basis of CT imaging. Palliative radiotherapy is an effective treatment with a significant increase in bone density for local response and stability without severe radiotherapy-related toxicity. Furthermore, re-calcification can be already detected at 3 months after treatment.
Early stage classical Hodgkin lymphoma (cHL) has a high rate of cure for patients for are interim PET/CT-2 or 3 negative (1, 2) Thus, given this there is an increased focus on treatment de-escalation for patients with a negative interim PET/CT scan including decreasing number of cycles of chemotherapy, adding in biologic therapies, and decreasing radiation ranging from decreasing radiation doses and field sizes to eliminating radiation. However, for patients who have residual disease activity on interim PET/CT (1, 2) the outcomes remain challenging in that often ultimately these patients develop refractory disease th...
Remission assessment in multiple myeloma (MM) after treatment is performed by measurement of monoclonal paraprotein (MP) in serum and urine, detection of persisting extramedullary components by computed tomography (CT). Deep response (absence of minimal residual disease – MRD) could be evaluated by methods with high sensitivity such as multicolor flow cytometry (MFC), allele-specific PCR. Visualizing systems (MRI and PET-CT) are used to assess heterogeneous pathological involvement of bone marrow (BM) and tissue.
In Hodgkin ’s lymphoma, Pet-CT scan has established itself as the functional imaging modality of choice when it comes to evaluation and guiding treatment decisions. However, it remains an expensive imaging technique and therefore the number of PET CTs is limited for each patient. Recent studies show that Int erim Pet-CT scan is gaining an important role as a predictor of survival and an influencer for treatment modifications.
Conclusion Functional imaging techniques are increasing in popularity compared with anatomic imaging. The usage of PET-CT has emerged as a highly valuable staging and follow-up method in the treatment of HL 8 years after the introduction of PET in Lebanon. PET was used first to improve the staging, then to evaluate the treatment response, and, recently, to tailor therapy according to the response. Micro-Abstract Hodgkin lymphoma (HL) is a highly curable disease. We analyzed the data regarding the usage of PET-CT at diagnosis, during treatment (interim PET), and at the end of treatment. The first PET-CT system was introduce...
Conclusions In patients with newly diagnosed DLBCL, PET-CT is accurate in detecting BMI by DLBCL. Although PET-CT has a very high negative predictive value for BMI, it overestimates the number of cases with marrow involvement by DLBCL. In clinical practice, routine BMAB may no longer be necessary for all patients with DLBCL who are staged by PET-CT, unless the results would change both staging and therapy. The prognostic implication of BMI identified by PET-CT compared to BMAB remains unknown. Whether a PET-CT precludes the need for a BMAB in patients with DLBCL remains to be evaluated in a prospective study.