Skip to main content
SpringerLink
Log in

The role of routine imaging procedures in the detection of relapse of patients with Hodgkin lymphoma and aggressive non-Hodgkin lymphoma

  • Original Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

Despite improved initial therapies, a subgroup of patients with aggressive non-Hodgkin (A-NHL) and Hodgkin lymphomas (HL) will relapse after first remission. The optimal follow-up strategy for the detection of relapse has not been clarified and periodic imaging is not recommended in most written guidelines. We identified 125 patients with HL and A-NHL diagnosed between January 1993 and September 2008 who relapsed at least 1 month after the end of initial therapy. We assessed whether relapse was detected based on clinical signs or periodic computed tomography (CT), [18F] fluorodeoxyglucose positron emission tomography (PET), or combined PET/CT and whether the mode of detection influenced the pattern and outcome of relapsed disease. Overall, most relapses (62%) were diagnosed clinically especially in A-NHL and in patients with extranodal involvement at diagnosis (p < 0.05); however, relapses of HL occurring after 2001 when PET/CT became available were more commonly detected by routine imaging (p < 0.05). Imaging-detected relapse was not associated with improved survival. While clinical exam remains the most common mode of detecting relapse, our results suggest a potential role for routine PET/CT surveillance in HL patients; however, survival does not appear to be affected by mode of detection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Quddus F, Armitage JO (2009) Salvage therapy for Hodgkin's lymphoma. Cancer J 15:161–163

    Article  PubMed  Google Scholar 

  2. Seshadri T, Kuruvilla J, Crump M, Keating A (2008) Salvage therapy for relapsed/refractory diffuse large B cell lymphoma. Biol Blood Marrow Transplant 14:259–267

    Article  CAS  PubMed  Google Scholar 

  3. Josting A, Rudolph C, Mapara M, Glossmann JP, Sieniawski M, Sieber M, Kirchner HH, Dorken B, Hossfeld DK, Kisro J, Metzner B, Berdel WE, Diehl V, Engert A (2005) Cologne high-dose sequential chemotherapy in relapsed and refractory Hodgkin lymphoma: results of a large multicenter study of the German Hodgkin Lymphoma Study Group (GHSG). Ann Oncol 16:116–123

    Article  CAS  PubMed  Google Scholar 

  4. Philip T, Guglielmi C, Hagenbeek A, Somers R, Van der Lelie H, Bron D, Sonneveld P, Gisselbrecht C, Cahn JY, Harousseau JL et al (1995) Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin's lymphoma. N Engl J Med 333:1540–1545

    Article  CAS  PubMed  Google Scholar 

  5. Connors JM (2009) Clinical manifestations and natural history of Hodgkin's lymphoma. Cancer J 15:124–128

    Article  PubMed  Google Scholar 

  6. Hamlin PA, Zelenetz AD, Kewalramani T, Qin J, Satagopan JM, Verbel D, Noy A, Portlock CS, Straus DJ, Yahalom J, Nimer SD, Moskowitz CH (2003) Age-adjusted International Prognostic Index predicts autologous stem cell transplantation outcome for patients with relapsed or primary refractory diffuse large B-cell lymphoma. Blood 102:1989–1996

    Article  CAS  PubMed  Google Scholar 

  7. Josting A, Franklin J, May M, Koch P, Beykirch MK, Heinz J, Rudolph C, Diehl V, Engert A (2002) New prognostic score based on treatment outcome of patients with relapsed Hodgkin's lymphoma registered in the database of the German Hodgkin's lymphoma study group. J Clin Oncol 20:221–230

    Article  PubMed  Google Scholar 

  8. NCCN Practice Guidelines in Oncology, Hodgkin’s disease/Lymphoma and Non-Hodgkin’s lymphoma. 2009; V.2.2009

  9. Engert A, Eichenauer DA, Dreyling M (2009) Hodgkin's lymphoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 20(Suppl 4):108–109

    PubMed  Google Scholar 

  10. Tilly H, Dreyling M (2009) Diffuse large B-cell non-Hodgkin's lymphoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 20(Suppl 4):110–112

    PubMed  Google Scholar 

  11. Jerusalem G, Beguin Y, Fassotte MF, Najjar F, Paulus P, Rigo P, Fillet G (2001) Whole-body positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures for staging patients with Hodgkin's disease. Haematologica 86:266–273

    CAS  PubMed  Google Scholar 

  12. Sasaki M, Kuwabara Y, Koga H, Nakagawa M, Chen T, Kaneko K, Hayashi K, Nakamura K, Masuda K (2002) Clinical impact of whole body FDG-PET on the staging and therapeutic decision making for malignant lymphoma. Ann Nucl Med 16:337–345

    Article  PubMed  Google Scholar 

  13. Hutchings M, Loft A, Hansen M, Pedersen LM, Berthelsen AK, Keiding S, D’Amore F, Boesen AM, Roemer L, Specht L (2006) Position emission tomography with or without computed tomography in the primary staging of Hodgkin's lymphoma. Haematologica 91:482–489

    PubMed  Google Scholar 

  14. Isasi CR, Lu P, Blaufox MD (2005) A metaanalysis of 18F-2-deoxy-2-fluoro-D-glucose positron emission tomography in the staging and restaging of patients with lymphoma. Cancer 104:1066–1074

    Article  PubMed  Google Scholar 

  15. Gallamini A, Hutchings M, Rigacci L, Specht L, Merli F, Hansen M, Patti C, Loft A, Di Raimondo F, D’Amore F, Biggi A, Vitolo U, Stelitano C, Sancetta R, Trentin L, Luminari S, Iannitto E, Viviani S, Pierri I, Levis A (2007) Early interim 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography is prognostically superior to international prognostic score in advanced-stage Hodgkin’s lymphoma: a report from a joint Italian-Danish study. J Clin Oncol 25:3746–3752

    Article  CAS  PubMed  Google Scholar 

  16. Schot BW, Zijlstra JM, Sluiter WJ, van Imhoff GW, Pruim J, Vaalburg W, Vellenga E (2007) Early FDG-PET assessment in combination with clinical risk scores determines prognosis in recurring lymphoma. Blood 109:486–491

    Article  CAS  PubMed  Google Scholar 

  17. Cheson B (2009) The case against heavy PETing. J Clin Oncol 27:1742–1743

    Article  PubMed  Google Scholar 

  18. Liedtke M, Hamlin PA, Moskowitz CH, Zelenetz AD (2006) Surveillance imaging during remission identifies a group of patients with more favorable aggressive NHL at time of relapse: a retrospective analysis of a uniformly-treated patient population. Ann Oncol 17:909–913

    Article  CAS  PubMed  Google Scholar 

  19. Dryver ET, Jernstrom H, Tompkins K, Buckstein R, Imrie KR (2003) Follow-up of patients with Hodgkin's disease following curative treatment: the routine CT scan is of little value. Br J Cancer 89:482–486

    Article  CAS  PubMed  Google Scholar 

  20. Elis A, Blickstein D, Klein O, Eliav-Ronen R, Manor Y, Lishner M (2002) Detection of relapse in non-Hodgkin's lymphoma: role of routine follow-up studies. Am J Hematol 69:41–44

    Article  PubMed  Google Scholar 

  21. (1993) A predictive model for aggressive non-Hodgkin's lymphoma. The International Non-Hodgkin's Lymphoma Prognostic Factors Project. N Engl J Med 329:987–994

  22. Noordijk EM, Carde P, Mandard AM, Mellink WA, Monconduit M, Eghbali H, Tirelli U, Thomas J, Somers R, Dupouy N et al (1994) Preliminary results of the EORTC-GPMC controlled clinical trial H7 in early-stage Hodgkin's disease. EORTC Lymphoma Cooperative Group. Groupe Pierre-et-Marie-Curie. Ann Oncol 5(Suppl 2):107–112

    PubMed  Google Scholar 

  23. Hasenclever D, Diehl V (1998) A prognostic score for advanced Hodgkin's disease. International Prognostic Factors Project on Advanced Hodgkin's Disease. N Engl J Med 339:1506–1514

    Article  CAS  PubMed  Google Scholar 

  24. Guppy AE, Tebbutt NC, Norman A, Cunningham D (2003) The role of surveillance CT scans in patients with diffuse large B-cell non-Hodgkin's lymphoma. Leuk Lymphoma 44:123–125

    Article  CAS  PubMed  Google Scholar 

  25. Nakamura K, Sasaki M, Kunitake N, Kimura M, Watanabe T, Sasaki T, Terashima H, Kuwabara Y, Sakai S, Masuda K (2001) Relapse patterns of localized non-Hodgkin's lymphoma of the head and neck after clinical remission: results of a strict follow-up procedure. Int J Clin Oncol 6:302–305

    Article  CAS  PubMed  Google Scholar 

  26. Radford JA, Eardley A, Woodman C, Crowther D (1997) Follow up policy after treatment for Hodgkin's disease: too many clinic visits and routine tests? A review of hospital records. Bmj 314:343–346

    CAS  PubMed  Google Scholar 

  27. Crocchiolo R, Fallanca F, Giovacchini G, Ferreri AJ, Assanelli A, Verona C, Pescarollo A, Bregni M, Ponzoni M, Gianolli L, Fazio F, Ciceri F (2009) Role of 18FDG-PET/CT in detecting relapse during follow-up of patients with Hodgkin's lymphoma. Ann Hematol 88:1229–1236

    Article  CAS  PubMed  Google Scholar 

  28. Zinzani PL, Stefoni V, Tani M, Fanti S, Musuraca G, Castellucci P, Marchi E, Fina M, Ambrosini V, Pellegrini C, Alinari L, Derenzini E, Montini G, Broccoli A, Bacci F, Pileri S, Baccarani M (2009) Role of [18F]fluorodeoxyglucose positron emission tomography scan in the follow-up of lymphoma. J Clin Oncol 27:1781–1787

    Article  PubMed  Google Scholar 

  29. Jerusalem G, Beguin Y, Fassotte MF, Belhocine T, Hustinx R, Rigo P, Fillet G (2003) Early detection of relapse by whole-body positron emission tomography in the follow-up of patients with Hodgkin's disease. Ann Oncol 14:123–130

    Article  CAS  PubMed  Google Scholar 

  30. Gisselbrecht C, Glass B, Mounier N, Gill D, Linch D, Trneny M, Bosly A, Shpilberg O, Ketterer N, Moskowitz C, Schmitz N (2009) R-ICE versus R-DHAP in relapsed patients with CD20 diffuse large B-cell lymphoma (DLBCL) followed by autologous stem cell transplantation: CORAL study. J Clin Oncol 27:8509

    Google Scholar 

  31. Sehn LH, Donaldson J, Chhanabhai M, Fitzgerald C, Gill K, Klasa R, MacPherson N, O’Reilly S, Spinelli JJ, Sutherland J, Wilson KS, Gascoyne RD, Connors JM (2005) Introduction of combined CHOP plus rituximab therapy dramatically improved outcome of diffuse large B-cell lymphoma in British Columbia. J Clin Oncol 23:5027–5033

    Article  CAS  PubMed  Google Scholar 

  32. Levine JM, Weiner M, Kelly KM (2006) Routine use of PET scans after completion of therapy in pediatric Hodgkin disease results in a high false positive rate. J Pediatr Hematol Oncol 28:711–714

    Article  PubMed  Google Scholar 

  33. Juweid ME, Vose JM (2010) Imaging in early-stage Hodgkin's lymphoma. N Engl J Med 362:962

    Article  CAS  PubMed  Google Scholar 

  34. Guadagnolo BA, Punglia RS, Kuntz KM, Mauch PM, Ng AK (2006) Cost-effectiveness analysis of computerized tomography in the routine follow-up of patients after primary treatment for Hodgkin's disease. J Clin Oncol 24:4116–4122

    Article  PubMed  Google Scholar 

Download references

Disclosures

None

Author information

Authors and Affiliations

  1. Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Neta Goldschmidt, Omer Or & Ora Paltiel

  2. Department of Biophysics and Nuclear Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Martine Klein

  3. School of Public Health, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Bella Savitsky & Ora Paltiel

  4. Department of Hematology, Kyriat Hadassah, P.O. Box 12000, Jerusalem, 91120, Israel

    Neta Goldschmidt

Authors
  1. Neta Goldschmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Omer Or
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martine Klein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bella Savitsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ora Paltiel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Neta Goldschmidt.

Additional information

Neta Goldschmidt and Omer Or authors have equal contribution.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goldschmidt, N., Or, O., Klein, M. et al. The role of routine imaging procedures in the detection of relapse of patients with Hodgkin lymphoma and aggressive non-Hodgkin lymphoma. Ann Hematol 90, 165–171 (2011). https://doi.org/10.1007/s00277-010-1044-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-010-1044-8

Keywords

Search

Navigation