Routine blood investigations have limited utility in surveillance of aggressive lymphoma in asymptomatic patients in complete remission.

Abstract

BACKGROUND:

Patients with aggressive lymphoma achieving complete remission (CR) after first-line combination chemotherapy undergo regular surveillance to detect relapse. Current international guidelines recommend routine follow-up blood tests in this context, but evidence supporting this practice is limited.

METHODS:

We conducted a multi-centre retrospective analysis of all patients diagnosed with aggressive lymphoma treated with curative-intent chemotherapy who achieved CR for at least 3 months between 2000 and 2015. An abnormal blood test was defined as any new and unexplained abnormality for full blood examination, lactate dehydrogenase or erythrocyte sedimentation rate.

RESULTS:

Three hundred and forty-six patients attended a total of 3084 outpatient visits; blood tests were performed at 90% of these appointments. Fifty-six (16%) patients relapsed. Routine laboratory testing detected relapse in only three patients (5% of relapses); in the remaining patients, relapse was suspected clinically (80%) or detected by imaging (15%). The sensitivity of all blood tests was 42% and the positive predictive value was 9%. No significant difference in survival was shown in patients who underwent a routine blood test within 3 months prior to relapse versus those who did not (p = 0.88).

CONCLUSIONS:

Routine blood tests demonstrate unacceptably poor performance characteristics, have no impact on survival and thus have limited value in the detection of relapse in routine surveillance.

• Authors: Eliza A Hawkes, Zoe Loh, Ortis Estacio, Geoff Chong, Francis J Ha, Michael Gilbertson, Andrew Grigg
• Journal: British journal of cancer (Br J Cancer) Vol. 119 Issue 5 Pg. 546-550 (08 2018) ISSN: 1532-1827 [Electronic] England
• PMID: 30033446 (Publication Type: Journal Article, Multicenter Study)

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Drug Therapy
• Female
• Humans
• Lymphoma (blood, diagnosis, drug therapy, pathology)
• Male
• Middle Aged
• Neoplasm Recurrence, Local (blood, diagnosis)
• Neoplasm Staging
• Population Surveillance
• Practice Guidelines as Topic
• Remission Induction
• Retrospective Studies
• Sensitivity and Specificity
• Young Adult