Evaluation of routine CT scans in the follow-up of diffuse large B-cell lymphomas

Figures & data

Figure 1. Flowchart detailing causes of exclusion, number of patients included and number of relapses.

Figure 2. Overall survival (A) and progression-free survival (B) in diffuse large B-cell lymphoma.

Table 1. Patient characteristics at diagnosis and treatment.

	DLBCL (n = 101)
	N (%)
Age years, median (range)	67 (25–85)
Age > 60 years	43 (42.6)
Gender
Male	58 (57.4)
Female	43 (42.6)
ECOG PS
0–1	77 (76.2)
2–4	37 (23.7)
Lymphadenopathies	51 (51.5)
Splenomegaly	13 (13.1)
B symptoms	35 (34.7)
Pruritus	4 (4.1)
Other findings	36 (36.4)
LDH ULN	50 (49.5)
Bulky ( > 10 cm)	27 (26.7)
≥2 extranodal sites	27 (26.7)
Bone marrow involvement	11 (10.9)
Ann Arbor stage
I–II	37 (36.6)
III–IV	64 (63.4)
IPI
Low risk	32 (31.7)
Intermediate risk	51 (50.5)
High risk	18 (17.8)
Chemo-immunotherapy
R-CHOP	78 (77.2)
R-MegaCHOP	5 (5)
R-EPOCH	10 (9.9)
Other regimens	8 (7.9)
Deaths	15 (14.9)
Follow-up duration median, months (range)	59 (143–144)

Notes: DLBCL: Diffuse large B-cell lymphoma. ECOG PS: Eastern Cooperative Oncology Group Performance Status. IPI: International Prognostic Index LDH: Lactate dehydrogenase. ULN: upper limit of normal. Other regimens: R-CHOP14 (3), R-CMyOP (4), R-GEMOX (1).

Table 2. Patient characteristics at relapse.

	DLBCL (n = 19)
	N (%)
Age years, median (range)	68 (40–86)
Gender
Male	13 (68.4)
Female	6 (31.6)
ECOG PS
0–1	15 (78.9)
2–4	4 (21.1)
Lymphadenopathies	7 (36.8)
Splenomegaly	2 (10.5)
B symptoms	2 (10.5)
Pruritus	0 (0)
Other findings^a	8 (42.1)
LDH ULN	8 (42.1)
Bulky(>10cm)	2 (11.1)
Ann Arbor stage
I–II	9 (47.4)
III–IV	10 (52.6)
IPI
Low risk	9 (47.4)
Intermediate risk	7 (36.8)
High risk	3 (15.8)
Median survival from relapse, months (range)	26 (1–134)

Notes: DLBCL: Diffuse large B-cell lymphoma. ECOG PS: Eastern Cooperative Oncology Group Performance Status. IPI: International Prognostic Index LDH: Lactate dehydrogenase. ULN: upper limit of normal.

^a Other findings: neurological manifestations (4), orbital mass, pleuritic chest pain, unilateral lower limb swelling, abdominal mass; non-productive cough, painful pectoral region mass, submandibular gland involvement, parotid gland involvement.

Table 3. Type of suspicion of relapse within the first year and from the second year.

Detection of relapse	DLBCL (n = 19)
	12 months or less	More than 12 months
Physical examination	4	5
Surveillance CT scan	3	3
P.E. + CT scan	0	1
P.E. + Blood test	1	0
Unscheduled CT scan	0	1
Upper GI endoscopy	1	0
All types of detection	9	10

Notes: CT: computed tomography. DLBCL: Diffuse large B-cell lymphoma. GI: gastrointestinal. P.E.: physical examination.

Table 4. CT scans exposure up to five years of follow-up.

	DLBCL (n = 101)
	N (%)
CT scans, total	432
CT scans, median (range)	3 (0–16)
CT scans, global exposure
0–2	33 (32.7)
3–5	46 (45.5)
6–10	12 (11.9)
>10	10 (9.9)
CT scans from the second year, median (range)	1 (0–13)
Diagnostic yield from the second year^a	3/230 (1.3)

Notes: CT: computed tomography. DLBCL: Diffuse large B-cell lymphoma.

^a Ratio of biopsy-proved relapses identified by CT scan among the total number of CT scans performed from the second to the fifth year.