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Evidence-based follow-up in patients with Hodgkin’s lymphoma and aggressive B-cell non-Hodgkin’s lymphoma

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Summary

In both Hodgkin’s Lymphoma and aggressive Non-Hodgkin’s-Lymphoma, complete remissions and long term survival can be achieved in a high number of patients, especially in those young and fit for intensive chemotherapy. The purpose of this review is to summarize the evidence and recommended follow-up procedures following curative therapy for these entities. After completion of treatment, a tight follow-up schedule is recommended, with history and physical examination being the mainstay of follow-up. There is no convincing evidence of the value of routine imaging for follow-up of lymphoma.

After several years, the risk of recurrence decreases drastically, and the focus shifts to the detection and management of late treatment effects. One of the most significant late toxicities of lymphoma treatment is cardiac toxicity, both due to mediastinal/chest radiotherapy and cardiotoxic chemotherapy. Patients have to be watched closely, and other cardiac risk factors should be managed aggressively. While there is no randomized trial proving benefit, serial echocardiograms seem a reasonable approach to approach this high-risk population.

Secondary neoplasms after treatment are another focus of follow-up. Chemotherapy and radiotherapy have strong potential to lead to both leukemia and secondary lymphoma, as well as solid tumors such as lung cancer and gastrointestinal tumors. Radiation therapy greatly increases the risk for breast cancer. Young (<40 years) women receiving radiotherapy should, in follow-up after treatment, be screened for breast cancer. Other than this, there is currently no sufficient rationale for any deviation from the cancer screening recommendations for the general population.

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  1. Department of Oncology, Hematology and Palliative Care, Wilhelminen Hospital, Montleartstraße 37, 1160, Vienna, Austria

    Thomas Spanberger

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Spanberger, T. Evidence-based follow-up in patients with Hodgkin’s lymphoma and aggressive B-cell non-Hodgkin’s lymphoma. memo 13, 55–59 (2020). https://doi.org/10.1007/s12254-020-00570-8

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