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Title: | Routine blood investigations have limited utility in surveillance of aggressive lymphoma in asymptomatic patients in complete remission. | Authors: | Estacio O.;Gilbertson M. ;Loh Z.;Chong G.;Grigg A.;Ha F.J.;Hawkes E.A. | Institution: | (Hawkes, Loh, Chong, Grigg) Department of Oncology and Clinical Haematology, Austin Hospital, Heidelberg, VIC, Australia (Hawkes, Chong, Grigg) Olivia Newton-John Cancer Wellness and Research Centre, Austin Hospital, Heidelberg, VIC, Australia (Hawkes) Eastern Health, Box Hill, VIC, Australia (Loh, Estacio, Grigg) University of Melbourne, Parkville, VIC, Australia (Ha) Monash University, Clayton, VIC, Australia (Gilbertson) Department of Haematology, Monash Medical Center, Monash Health, Clayton, VIC, Australia | Issue Date: | 12-Oct-2018 | Copyright year: | 2018 | Publisher: | Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS, United Kingdom) | Place of publication: | United Kingdom | Publication information: | British Journal of Cancer. 119 (5) (pp 546-550), 2018. Date of Publication: 28 Aug 2018. | Journal: | British Journal of Cancer | Abstract: | Background: 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. Method(s): 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. Result(s): 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 (p = 0.88). Conclusion(s): 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.Copyright © 2018, Cancer Research UK. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1038/s41416-018-0183-x | Link to associated publication: | Click here for full text options | PubMed URL: | 30033446 [http://www.ncbi.nlm.nih.gov/pubmed/?term=30033446] | ISSN: | 0007-0920 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/36887 | Type: | Article | Subjects: | human tissue adolescent adult aged article *asymptomatic disease/di [Diagnosis] *asymptomatic disease/dt [Drug Therapy] *blood examination cancer chemotherapy cancer patient cancer recurrence controlled study disease surveillance erythrocyte sedimentation rate female human intention to treat analysis lactate dehydrogenase blood level *lymphoma/di [Diagnosis] *lymphoma/dt [Drug Therapy] major clinical study male *medical examination multicenter study outpatient care predictive value priority journal relapse/di [Diagnosis] retrospective study sensitivity and specificity *tumor regression very elderly antineoplastic agent/dt [Drug Therapy] lactate dehydrogenase/ec [Endogenous Compound] cancer recurrence controlled study disease surveillance erythrocyte sedimentation rate female human human tissue intention to treat analysis lactate dehydrogenase blood level *lymphoma / *diagnosis / *drug therapy major clinical study male *medical examination multicenter study outpatient care predictive value relapse / diagnosis retrospective study sensitivity and specificity *tumor regression very elderly priority journal adolescent adult aged Article *asymptomatic disease / *diagnosis / *drug therapy *blood examination cancer chemotherapy cancer patient |
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