Detection of relapse in non-Hodgkin's lymphoma: role of routine follow-up studies.
Complete remission can be achieved in 60-80% of adults with diffuse aggressive non-Hodgkin's lymphoma. However, 20-40% of them will subsequently relapse. Nevertheless, formal follow-up guidelines for recurrence detection have never been advocated. We analyzed the pattern of relapse in 30 patients with intermediate- and high-grade non-Hodgkin's lymphoma and the value of intensive protocol for relapse detection. This protocol includes frequent follow-up visits, complete blood count, and serum LDH tests along with annual chest, abdominal, and pelvic CT scans. The median duration of complete remission was 12 months. Twenty-five relapses (83%) were suspected after an interim history and/or physical examination, whereas only 5 relapses (17%) were detected by routine radiographic or laboratory follow-up studies. The majority of relapses (19/30) were detected in sites that included the sites of prior disease. For the first 12 months of complete remission, the estimated cumulative save in charge for a follow-up strategy, based on regular visits in the hematology clinic and performing laboratory and radiologic studies as clinically indicated, is 44% of the cost of a routine intensive evaluation. A reliable and cost-effective follow-up method for non-Hodgkin's lymphoma patients in complete remission should include frequent history and physical examination. Complementary studies should be performed according to clinical indications.
Elis
Avishay
A
Departments of Medicine and Hematology, Meir Hospital, Kfar Saba and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Blickstein
Dorit
D
Klein
Osnat
O
Eliav-Ronen
Rivka
R
Manor
Yosef
Y
Lishner
Michael
M
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001772:Blood Cell Count; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis* / Q000191:economics / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011878:Radiotherapy; D012008:Recurrence; D012074:Remission Induction; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D007770:L-Lactate Dehydrogenase