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Routine Radiographic Screening for Lymphoma before Autologous Stem Cell Transplantation (auto-SCT) Does Not Improve Relapse-Free Survival after Auto-SCT
The role of radiological surveillance with Positron Emission Tomography (PET) or Computed Tomography (CT) after completion of chemotherapy in patients with lymphoma is controversial. Prior studies have shown conflicting results in regards to the benefit of screening for patients with lymphoma using CT or PET versus clinical detection of relapse. What is not known is whether radiographic diagnosis of relapse is early enough to confer advantage over relapse diagnosed by clinical means in patients with relapsed lymphoma undergoing subsequent auto-SCT.
Methods
In an attempt to answer the above question, we grouped all the patients with relapsed lymphoma (Hodgkin and non-Hodgkin’s lymphoma) who were referred to our center for auto-SCT between January 1, 2007 till December 31, 2012 in Cohort A (Relapse diagnosed by radiological surveillance) and Cohort B (Relapse diagnosed by clinical means based on new symptoms and examination findings). All patients had biopsy proof of relapse prior to salvage chemotherapy.
The primary objectives were post-transplant relapse and disease-free survival. Kaplan-Meier and the Log-rank test were used for analysis.
Results
A total of 133 patients were included in the analysis, with 74 patients in the radiographic screening Cohort A and 59 patients in the symptomatic/clinical relapse Cohort B. Clinically important patient characteristics were similar between the two cohorts. The clinical stage at relapse leading to transplant, salvage chemotherapy regimens and number of cycles used prior to transplant, response to salvage chemotherapy, time to transplant, and 100-day post-transplant outcomes were not statistically different between the two groups. Nine patients died in cohort A, 5 of whom were due to disease relapse. Thirteen patients died in cohort B, 7 due to disease relapse. The 3-year relapse-free survival was 54% in Cohort A and 46% in Cohort B. There was no statistically significant difference in the relapse-free-survival between the two cohorts (p=0.26). The median duration of follow-up for Cohort A was 23.7 months (range 0.61-73.11) and for Cohort B was 13.57 months (range 0.36-57.0). When the same analysis was conducted in patients with non-Hodgkin’s lymphoma (excluding data for Hodgkin’s disease), the results were similar. Median duration of survival was not reached, so no attempt was made to comment on overall survival in this small cohort with few events to analyze.
Conclusions
In this single center study, we showed that routine radiological surveillance after completion of chemotherapy did not improve relapse-free-survival in patients with lymphoma undergoing subsequent auto-SCT. We plan to start a prospective study exploring the role of routine radiological surveillance after auto-SCT in patients with lymphoma to answer another important question.