Rethinking Surveillance Imaging For DLBCL Patients in First Remission

Are there benefits to asymptomatic patients with diffuse large b-cell lymphoma in first remisssion to undergoing surveillance imaging such as CT or PET/CT? A new study says no.

Researchers compared three strategies in these older DLBCL patients:

• Routine clinical follow-up without serial imaging
• Routine follow-up with biannual computed tomography (CT) scans for 2 years.
• Routine follow-up with biannual PET/CT for 2 years.

Whether these patients actually get any benefit from undergoing imaging, and whether it's at all cost-effective, were examined using lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) .

Surveillance strategies utilizing 2 years of routine CT or PET/CT scans were associated with minimal survival benefit when compared with clinical follow-up without routine imaging. They further found that the benefit of imaging-based follow-up remained small after quality-of-life adjustments. And finally, costs associated with imaging-based surveillance strategies are considerable, especially when compared with simple clinical follow-up.

The team concluded that "Our cost-effectiveness analysis suggests surveillance imaging of asymptomatic DLBCL patients in remission offers little clinical benefit at substantial economic costs."

Source: JCO