title: Routine Imaging for Diffuse Large B-Cell Lymphoma in First Complete Remission Does Not Improve Post-Treatment Survival: A Danish-Swedish Population-Based Study.
abstract: OBJECTIVE
  Routine imaging for diffuse large B-cell lymphoma (DLBCL) in first complete remission (CR) is controversial and plays a limited role in detecting relapse. This population-based study compared the survival of Danish and Swedish patients with DLBCL for whom traditions for routine imaging have been different.
  
  
  METHODS
  Patients from the Danish and Swedish lymphoma registries were included according to the following criteria: newly diagnosed DLBCL from 2007 to 2012, age 18 to 65 years, and CR after R-CHOP/CHOEP. Follow-up for Swedish patients included symptom assessment, clinical examinations, and blood tests at 3- to 4-month intervals for 2 years, with longer intervals later in follow-up. Imaging was only recommended when relapse was clinically suspected. Follow-up for Danish patients was similar but included routine imaging (usually computed tomography every 6 months for 2 years).
  
  
  RESULTS
  Danish (n = 525) and Swedish (n = 696) patients with DLBCL had comparable baseline characteristics. Cumulative 2-year progression rate after CR was 6% (95% CI, 4 to 9) for International Prognostic Index (IPI) ≤ 2 versus 21% (95% CI, 13 to 28) for IPI > 2. Age > 60 years (hazard ratio [HR], 2.3; 95% CI, 1.6 to 3.4), elevated lactate dehydrogenase (HR, 2.3; 95% CI, 1.4 to 3.8), B symptoms (HR, 1.7; 95% CI, 1.1 to 2.5), and Eastern Cooperative Oncology Group performance status ≥ 2 (HR, 1.8; 95% CI, 1.0 to 3.0) were associated with worse post-CR survival. Imaging-based follow-up strategy had no impact on survival, neither for all patients nor for IPI-specific subgroups.
  
  
  CONCLUSIONS
  DLBCL relapse after first CR is infrequent, and the widespread use of routine imaging in Denmark did not translate into better survival. This favors follow-up without routine imaging and, more generally, a shift of focus from relapse detection to improved survivorship.
authors.affiliation: Tarec Christoffer El-Galaly, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University Hospital; Tarec Christoffer El-Galaly, Lasse Hjort Jakobsen, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University, Aalborg; Martin Hutchings and Peter de Nully Brown, Rigshospitalet, Copenhagen University Hospital, Copenhagen; Karen Juul Mylam, Odense University Hospital, Odense, Denmark; Herman Nilsson-Ehle, Sahlgrenska University Hospital, Gothenburg; Elisabeth Székely and Mats Jerkeman, Lund University Hospital, Lund; and Viktoria Hjalmar, Karolinska Institutet, Stockholm University Hospital, Stockholm, Sweden. tarec.galaly@gmail.com.
authors.forename: Tarec Christoffer
authors.initials: TC
authors.lastname: El-Galaly
authors.affiliation: Tarec Christoffer El-Galaly, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University Hospital; Tarec Christoffer El-Galaly, Lasse Hjort Jakobsen, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University, Aalborg; Martin Hutchings and Peter de Nully Brown, Rigshospitalet, Copenhagen University Hospital, Copenhagen; Karen Juul Mylam, Odense University Hospital, Odense, Denmark; Herman Nilsson-Ehle, Sahlgrenska University Hospital, Gothenburg; Elisabeth Székely and Mats Jerkeman, Lund University Hospital, Lund; and Viktoria Hjalmar, Karolinska Institutet, Stockholm University Hospital, Stockholm, Sweden.
authors.forename: Lasse Hjort
authors.initials: LH
authors.lastname: Jakobsen
authors.affiliation: Tarec Christoffer El-Galaly, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University Hospital; Tarec Christoffer El-Galaly, Lasse Hjort Jakobsen, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University, Aalborg; Martin Hutchings and Peter de Nully Brown, Rigshospitalet, Copenhagen University Hospital, Copenhagen; Karen Juul Mylam, Odense University Hospital, Odense, Denmark; Herman Nilsson-Ehle, Sahlgrenska University Hospital, Gothenburg; Elisabeth Székely and Mats Jerkeman, Lund University Hospital, Lund; and Viktoria Hjalmar, Karolinska Institutet, Stockholm University Hospital, Stockholm, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Hutchings
authors.affiliation: Tarec Christoffer El-Galaly, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University Hospital; Tarec Christoffer El-Galaly, Lasse Hjort Jakobsen, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University, Aalborg; Martin Hutchings and Peter de Nully Brown, Rigshospitalet, Copenhagen University Hospital, Copenhagen; Karen Juul Mylam, Odense University Hospital, Odense, Denmark; Herman Nilsson-Ehle, Sahlgrenska University Hospital, Gothenburg; Elisabeth Székely and Mats Jerkeman, Lund University Hospital, Lund; and Viktoria Hjalmar, Karolinska Institutet, Stockholm University Hospital, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: de Nully Brown
authors.affiliation: Tarec Christoffer El-Galaly, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University Hospital; Tarec Christoffer El-Galaly, Lasse Hjort Jakobsen, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University, Aalborg; Martin Hutchings and Peter de Nully Brown, Rigshospitalet, Copenhagen University Hospital, Copenhagen; Karen Juul Mylam, Odense University Hospital, Odense, Denmark; Herman Nilsson-Ehle, Sahlgrenska University Hospital, Gothenburg; Elisabeth Székely and Mats Jerkeman, Lund University Hospital, Lund; and Viktoria Hjalmar, Karolinska Institutet, Stockholm University Hospital, Stockholm, Sweden.
authors.forename: Herman
authors.initials: H
authors.lastname: Nilsson-Ehle
authors.affiliation: Tarec Christoffer El-Galaly, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University Hospital; Tarec Christoffer El-Galaly, Lasse Hjort Jakobsen, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University, Aalborg; Martin Hutchings and Peter de Nully Brown, Rigshospitalet, Copenhagen University Hospital, Copenhagen; Karen Juul Mylam, Odense University Hospital, Odense, Denmark; Herman Nilsson-Ehle, Sahlgrenska University Hospital, Gothenburg; Elisabeth Székely and Mats Jerkeman, Lund University Hospital, Lund; and Viktoria Hjalmar, Karolinska Institutet, Stockholm University Hospital, Stockholm, Sweden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Székely
authors.affiliation: Tarec Christoffer El-Galaly, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University Hospital; Tarec Christoffer El-Galaly, Lasse Hjort Jakobsen, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University, Aalborg; Martin Hutchings and Peter de Nully Brown, Rigshospitalet, Copenhagen University Hospital, Copenhagen; Karen Juul Mylam, Odense University Hospital, Odense, Denmark; Herman Nilsson-Ehle, Sahlgrenska University Hospital, Gothenburg; Elisabeth Székely and Mats Jerkeman, Lund University Hospital, Lund; and Viktoria Hjalmar, Karolinska Institutet, Stockholm University Hospital, Stockholm, Sweden.
authors.forename: Karen Juul
authors.initials: KJ
authors.lastname: Mylam
authors.affiliation: Tarec Christoffer El-Galaly, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University Hospital; Tarec Christoffer El-Galaly, Lasse Hjort Jakobsen, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University, Aalborg; Martin Hutchings and Peter de Nully Brown, Rigshospitalet, Copenhagen University Hospital, Copenhagen; Karen Juul Mylam, Odense University Hospital, Odense, Denmark; Herman Nilsson-Ehle, Sahlgrenska University Hospital, Gothenburg; Elisabeth Székely and Mats Jerkeman, Lund University Hospital, Lund; and Viktoria Hjalmar, Karolinska Institutet, Stockholm University Hospital, Stockholm, Sweden.
authors.forename: Viktoria
authors.initials: V
authors.lastname: Hjalmar
authors.affiliation: Tarec Christoffer El-Galaly, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University Hospital; Tarec Christoffer El-Galaly, Lasse Hjort Jakobsen, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University, Aalborg; Martin Hutchings and Peter de Nully Brown, Rigshospitalet, Copenhagen University Hospital, Copenhagen; Karen Juul Mylam, Odense University Hospital, Odense, Denmark; Herman Nilsson-Ehle, Sahlgrenska University Hospital, Gothenburg; Elisabeth Székely and Mats Jerkeman, Lund University Hospital, Lund; and Viktoria Hjalmar, Karolinska Institutet, Stockholm University Hospital, Stockholm, Sweden.
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Johnsen
authors.affiliation: Tarec Christoffer El-Galaly, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University Hospital; Tarec Christoffer El-Galaly, Lasse Hjort Jakobsen, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University, Aalborg; Martin Hutchings and Peter de Nully Brown, Rigshospitalet, Copenhagen University Hospital, Copenhagen; Karen Juul Mylam, Odense University Hospital, Odense, Denmark; Herman Nilsson-Ehle, Sahlgrenska University Hospital, Gothenburg; Elisabeth Székely and Mats Jerkeman, Lund University Hospital, Lund; and Viktoria Hjalmar, Karolinska Institutet, Stockholm University Hospital, Stockholm, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Bøgsted
authors.affiliation: Tarec Christoffer El-Galaly, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University Hospital; Tarec Christoffer El-Galaly, Lasse Hjort Jakobsen, Hans Erik Johnsen, and Martin Bøgsted, Aalborg University, Aalborg; Martin Hutchings and Peter de Nully Brown, Rigshospitalet, Copenhagen University Hospital, Copenhagen; Karen Juul Mylam, Odense University Hospital, Odense, Denmark; Herman Nilsson-Ehle, Sahlgrenska University Hospital, Gothenburg; Elisabeth Székely and Mats Jerkeman, Lund University Hospital, Lund; and Viktoria Hjalmar, Karolinska Institutet, Stockholm University Hospital, Stockholm, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Jerkeman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012074:Remission Induction; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult