Limited utility of routine surveillance imaging for classical Hodgkin lymphoma patients in first complete remission

Sai Ravi Pingali, Sarah W. Jewell, Luiza Havlat, Martin A. Bast, Jonathan R. Thompson, Daniel C. Eastwood, Nancy L. Bartlett, James O. Armitage, Nina Wagner-Johnston, Julie M. Vose, Timothy S. Fenske

Research output: Contribution to journalArticle

Abstract

BACKGROUND The objective of this study was to compare the outcomes of patients with classical Hodgkin lymphoma (cHL) who achieved complete remission with frontline therapy and then underwent either clinical surveillance or routine surveillance imaging. METHODS In total, 241 patients who were newly diagnosed with cHL between January 2000 and December 2010 at 3 participating tertiary care centers and achieved complete remission after first-line therapy were retrospectively analyzed. Of these, there were 174 patients in the routine surveillance imaging group and 67 patients in the clinical surveillance group, based on the intended mode of surveillance. In the routine surveillance imaging group, the intended plan of surveillance included computed tomography and/or positron emission tomography scans; whereas, in the clinical surveillance group, the intended plan of surveillance was clinical examination and laboratory studies, and scans were obtained only to evaluate concerning signs or symptoms. Baseline patient characteristics, prognostic features, treatment records, and outcomes were collected. The primary objective was to compare overall survival for patients in both groups. For secondary objectives, we compared the success of second-line therapy and estimated the costs of imaging for each group. RESULTS After 5 years of follow-up, the overall survival rate was 97% (95% confidence interval, 92%-99%) in the routine surveillance imaging group and 96% (95% confidence interval, 87%-99%) in the clinical surveillance group (P = .41). There were few relapses in each group, and all patients who relapsed in both groups achieved complete remission with second-line therapy. The charges associated with routine surveillance imaging were significantly higher than those for the clinical surveillance strategy, with no apparent clinical benefit. CONCLUSIONS Clinical surveillance was not inferior to routine surveillance imaging in patients with cHL who achieved complete remission with frontline therapy. Routine surveillance imaging was associated with significantly increased estimated imaging charges.

Original languageEnglish (US)
Pages (from-to)2122-2129
Number of pages8
JournalCancer
Volume120
Issue number14
DOIs
StatePublished - 2014
Externally publishedYes

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Hodgkin Disease
Confidence Intervals
Therapeutics
Tertiary Care Centers
Signs and Symptoms
Survival Rate
Costs and Cost Analysis
Recurrence
Survival

Keywords

  • first complete remission
  • Hodgkin lymphoma
  • Limited utility
  • routine surveillance imaging

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Pingali, S. R., Jewell, S. W., Havlat, L., Bast, M. A., Thompson, J. R., Eastwood, D. C., ... Fenske, T. S. (2014). Limited utility of routine surveillance imaging for classical Hodgkin lymphoma patients in first complete remission. Cancer, 120(14), 2122-2129. https://doi.org/10.1002/cncr.28698

Limited utility of routine surveillance imaging for classical Hodgkin lymphoma patients in first complete remission. / Pingali, Sai Ravi; Jewell, Sarah W.; Havlat, Luiza; Bast, Martin A.; Thompson, Jonathan R.; Eastwood, Daniel C.; Bartlett, Nancy L.; Armitage, James O.; Wagner-Johnston, Nina; Vose, Julie M.; Fenske, Timothy S.

In: Cancer, Vol. 120, No. 14, 2014, p. 2122-2129.

Research output: Contribution to journalArticle

Pingali, SR, Jewell, SW, Havlat, L, Bast, MA, Thompson, JR, Eastwood, DC, Bartlett, NL, Armitage, JO, Wagner-Johnston, N, Vose, JM & Fenske, TS 2014, 'Limited utility of routine surveillance imaging for classical Hodgkin lymphoma patients in first complete remission', Cancer, vol. 120, no. 14, pp. 2122-2129. https://doi.org/10.1002/cncr.28698
Pingali, Sai Ravi ; Jewell, Sarah W. ; Havlat, Luiza ; Bast, Martin A. ; Thompson, Jonathan R. ; Eastwood, Daniel C. ; Bartlett, Nancy L. ; Armitage, James O. ; Wagner-Johnston, Nina ; Vose, Julie M. ; Fenske, Timothy S. / Limited utility of routine surveillance imaging for classical Hodgkin lymphoma patients in first complete remission. In: Cancer. 2014 ; Vol. 120, No. 14. pp. 2122-2129.
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abstract = "BACKGROUND The objective of this study was to compare the outcomes of patients with classical Hodgkin lymphoma (cHL) who achieved complete remission with frontline therapy and then underwent either clinical surveillance or routine surveillance imaging. METHODS In total, 241 patients who were newly diagnosed with cHL between January 2000 and December 2010 at 3 participating tertiary care centers and achieved complete remission after first-line therapy were retrospectively analyzed. Of these, there were 174 patients in the routine surveillance imaging group and 67 patients in the clinical surveillance group, based on the intended mode of surveillance. In the routine surveillance imaging group, the intended plan of surveillance included computed tomography and/or positron emission tomography scans; whereas, in the clinical surveillance group, the intended plan of surveillance was clinical examination and laboratory studies, and scans were obtained only to evaluate concerning signs or symptoms. Baseline patient characteristics, prognostic features, treatment records, and outcomes were collected. The primary objective was to compare overall survival for patients in both groups. For secondary objectives, we compared the success of second-line therapy and estimated the costs of imaging for each group. RESULTS After 5 years of follow-up, the overall survival rate was 97{\%} (95{\%} confidence interval, 92{\%}-99{\%}) in the routine surveillance imaging group and 96{\%} (95{\%} confidence interval, 87{\%}-99{\%}) in the clinical surveillance group (P = .41). There were few relapses in each group, and all patients who relapsed in both groups achieved complete remission with second-line therapy. The charges associated with routine surveillance imaging were significantly higher than those for the clinical surveillance strategy, with no apparent clinical benefit. CONCLUSIONS Clinical surveillance was not inferior to routine surveillance imaging in patients with cHL who achieved complete remission with frontline therapy. Routine surveillance imaging was associated with significantly increased estimated imaging charges.",
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T1 - Limited utility of routine surveillance imaging for classical Hodgkin lymphoma patients in first complete remission

AU - Pingali, Sai Ravi

AU - Jewell, Sarah W.

AU - Havlat, Luiza

AU - Bast, Martin A.

AU - Thompson, Jonathan R.

AU - Eastwood, Daniel C.

AU - Bartlett, Nancy L.

AU - Armitage, James O.

AU - Wagner-Johnston, Nina

AU - Vose, Julie M.

AU - Fenske, Timothy S.

PY - 2014

Y1 - 2014

N2 - BACKGROUND The objective of this study was to compare the outcomes of patients with classical Hodgkin lymphoma (cHL) who achieved complete remission with frontline therapy and then underwent either clinical surveillance or routine surveillance imaging. METHODS In total, 241 patients who were newly diagnosed with cHL between January 2000 and December 2010 at 3 participating tertiary care centers and achieved complete remission after first-line therapy were retrospectively analyzed. Of these, there were 174 patients in the routine surveillance imaging group and 67 patients in the clinical surveillance group, based on the intended mode of surveillance. In the routine surveillance imaging group, the intended plan of surveillance included computed tomography and/or positron emission tomography scans; whereas, in the clinical surveillance group, the intended plan of surveillance was clinical examination and laboratory studies, and scans were obtained only to evaluate concerning signs or symptoms. Baseline patient characteristics, prognostic features, treatment records, and outcomes were collected. The primary objective was to compare overall survival for patients in both groups. For secondary objectives, we compared the success of second-line therapy and estimated the costs of imaging for each group. RESULTS After 5 years of follow-up, the overall survival rate was 97% (95% confidence interval, 92%-99%) in the routine surveillance imaging group and 96% (95% confidence interval, 87%-99%) in the clinical surveillance group (P = .41). There were few relapses in each group, and all patients who relapsed in both groups achieved complete remission with second-line therapy. The charges associated with routine surveillance imaging were significantly higher than those for the clinical surveillance strategy, with no apparent clinical benefit. CONCLUSIONS Clinical surveillance was not inferior to routine surveillance imaging in patients with cHL who achieved complete remission with frontline therapy. Routine surveillance imaging was associated with significantly increased estimated imaging charges.

AB - BACKGROUND The objective of this study was to compare the outcomes of patients with classical Hodgkin lymphoma (cHL) who achieved complete remission with frontline therapy and then underwent either clinical surveillance or routine surveillance imaging. METHODS In total, 241 patients who were newly diagnosed with cHL between January 2000 and December 2010 at 3 participating tertiary care centers and achieved complete remission after first-line therapy were retrospectively analyzed. Of these, there were 174 patients in the routine surveillance imaging group and 67 patients in the clinical surveillance group, based on the intended mode of surveillance. In the routine surveillance imaging group, the intended plan of surveillance included computed tomography and/or positron emission tomography scans; whereas, in the clinical surveillance group, the intended plan of surveillance was clinical examination and laboratory studies, and scans were obtained only to evaluate concerning signs or symptoms. Baseline patient characteristics, prognostic features, treatment records, and outcomes were collected. The primary objective was to compare overall survival for patients in both groups. For secondary objectives, we compared the success of second-line therapy and estimated the costs of imaging for each group. RESULTS After 5 years of follow-up, the overall survival rate was 97% (95% confidence interval, 92%-99%) in the routine surveillance imaging group and 96% (95% confidence interval, 87%-99%) in the clinical surveillance group (P = .41). There were few relapses in each group, and all patients who relapsed in both groups achieved complete remission with second-line therapy. The charges associated with routine surveillance imaging were significantly higher than those for the clinical surveillance strategy, with no apparent clinical benefit. CONCLUSIONS Clinical surveillance was not inferior to routine surveillance imaging in patients with cHL who achieved complete remission with frontline therapy. Routine surveillance imaging was associated with significantly increased estimated imaging charges.

KW - first complete remission

KW - Hodgkin lymphoma

KW - Limited utility

KW - routine surveillance imaging

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