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Limited clinical benefit for surveillance PET-CT scanning in patients with histologically transformed lymphoma in complete metabolic remission following primary therapy

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Abstract

The optimum follow-up of patients with transformed indolent lymphoma (TrIL) is not well defined. We sought to determine the utility of surveillance positron emission tomography-computed tomography (PET-CT) in patients with TrIL achieving complete metabolic remission (CMR) after primary therapy. We performed a retrospective analysis of patients with TrIL treated at Peter MacCallum Cancer Centre between 2002 and 2012 who achieved CMR after primary therapy who had ≥1 subsequent surveillance PET-CT. Of 55 patients with TrIL, 37 (67 %) received autologous stem cell transplantation as consolidation following chemoimmunotherapy. After a median follow-up of 34 (range 3–101) months, the actuarial 3-year progression-free (PFS) and overall survival (OS) were 77 % (95 %CI 62–86 %) and 88 % (75–94 %), respectively. Of 180 surveillance PET-CT scans, there were 153 true negatives, 4 false positives, 1 false negative, 7 indeterminate and 15 true positives. Considering indeterminate scans as false positives, the specificity of PET-CT for detecting relapse was 94 %, sensitivity was 83 %, positive predictive value was 63 % and negative predictive value was 98 %. All seven subclinical (PET detected) relapses were of low-grade histology; in contrast, all nine relapses with diffuse large B cell lymphoma (DLBCL) were symptomatic. In our cohort of patients with TrIL achieving CMR, PET-CT detected subclinical low-grade relapses but all DLBCL relapses were accompanied by clinical symptoms. Thus, surveillance imaging of patients with TrIL achieving CMR is of limited clinical benefit. PET-CT should be reserved for evaluation of clinically suspected relapse.

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Acknowledgments

CYC is funded by the Victorian Cancer Agency (grant number CTCB11_18) and the Haematology Society of Australia and New Zealand (New Investigator Scholarship).

Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Haematology, Peter MacCallum Cancer Centre, Locked Bag 1, A’Beckett St, East Melbourne, 8006, Victoria, Australia

    Chan Y. Cheah, Michael Dickinson, Anupkumar George, David S. Ritchie, H. Miles Prince, David Westerman, Simon J. Harrison, Kate Burbury, Max Wolf, Henry Januszewicz, Kirsten E. Herbert, Dennis A. Carney, Constantine Tam & John F. Seymour

  2. Centre for Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia

    Michael S. Hofman

  3. Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia

    Chan Y. Cheah, Michael Dickinson, Michael S. Hofman, David S. Ritchie, H. Miles Prince, Simon J. Harrison, Max Wolf, Dennis A. Carney, Constantine Tam & John F. Seymour

  4. Cabrini Medical Centre, Melbourne, Australia

    H. Miles Prince & Kirsten E. Herbert

  5. Monash University, Melbourne, Australia

    H. Miles Prince

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  1. Chan Y. Cheah
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Correspondence to John F. Seymour.

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Cheah, C.Y., Dickinson, M., Hofman, M.S. et al. Limited clinical benefit for surveillance PET-CT scanning in patients with histologically transformed lymphoma in complete metabolic remission following primary therapy. Ann Hematol 93, 1193–1200 (2014). https://doi.org/10.1007/s00277-014-2040-1

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