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Title: Routine blood investigations have limited utility in surveillance of aggressive lymphoma in asymptomatic patients in complete remission.
Austin Authors: Hawkes, Eliza A ;Loh, Zoe ;Estacio, Ortis;Chong, Geoffrey ;Ha, Francis J;Gilbertson, Michael;Grigg, Andrew P 
Affiliation: Department of Oncology and Clinical Haematology, Austin Health, Heidelberg, Victoria, Australia
Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
University of Melbourne, Parkville, Victoria, Australia
Department of Oncology and Clinical Haematology, Austin Hospital, Heidelberg, Victoria, Australia
Monash University, Clayton, Victoria, Australia
Department of Haematology, Monash Medical Center, Monash Health, Clayton, Victoria, Australia
Issue Date: 2018
Date: 2018-07-23
Publication information: British Journal of Cancer 2018; 119(5): 546-550
Abstract: Patients with aggressive lymphoma achieving complete remission (CR) after first-line combination chemotherapy undergo regular surveillance to detect relapse. Current international guidelines recommend routine follow-up blood tests in this context, but evidence supporting this practice is limited. We conducted a multi-centre retrospective analysis of all patients diagnosed with aggressive lymphoma treated with curative-intent chemotherapy who achieved CR for at least 3 months between 2000 and 2015. An abnormal blood test was defined as any new and unexplained abnormality for full blood examination, lactate dehydrogenase or erythrocyte sedimentation rate. Three hundred and forty-six patients attended a total of 3084 outpatient visits; blood tests were performed at 90% of these appointments. Fifty-six (16%) patients relapsed. Routine laboratory testing detected relapse in only three patients (5% of relapses); in the remaining patients, relapse was suspected clinically (80%) or detected by imaging (15%). The sensitivity of all blood tests was 42% and the positive predictive value was 9%. No significant difference in survival was shown in patients who underwent a routine blood test within 3 months prior to relapse versus those who did not (pā€‰=ā€‰0.88). Routine blood tests demonstrate unacceptably poor performance characteristics, have no impact on survival and thus have limited value in the detection of relapse in routine surveillance.
DOI: 10.1038/s41416-018-0183-x
ORCID: 0000-0003-3206-5725
Journal: British Journal of Cancer
PubMed URL: 30033446
Type: Journal Article
Appears in Collections:Journal articles

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