A 12-year retrospective analysis of surveillance strategy in young adults after complete remission from aggressive lymphomas

Abstract Background After complete remission from high-risk lymphomas, including classical Hodgkin's lymphoma (cHL), diffuse large B-cell lymphoma (DLBCL), primary mediastinal B-cell lymphoma (PMBCL), grey zone lymphoma (GZL), or Burkitt's lymphoma (BL), young adults enter a period of surveillance for recurrence. Both NCCN and ESMO guidelines have recommended against asymptomatic surveillance imaging and instead recommend imaging based on change in symptoms or clinical status . There have been multiple retrospective and one prospective studies which have failed to show benefit from routine surveillance imaging. In theory there could be benefit if a relapse could be detected earlier with imaging, as treatment could be initiated earlier. This study sought to determine whether a difference in disease-free progression or mortality could be identified in young adults, who would then be more likely to be eligible for intensive second-line therapies and thus more likely to benefit from early detection. Methods We conducted a single-center retrospective chart review of patients aged 18–39 at the time of diagnosis who achieved complete remission from classical Hodgkin lymphoma (cHL), diffuse large B-cell lymphoma (DLBCL), grey zone lymphoma (GZL), primary mediastinal B-cell lymphoma (PMBCL), or Burkitt lymphoma (BL). Medical records dated between January 1, 2010, and October 2, 2022, were included. Patients were excluded if their first post-remission scan did not show relapse or if the chart lacked sufficient information. Patients were categorized by surveillance strategy: either planned CT-based imaging or symptom-guided follow-up using history, laboratory studies, and clinical signs. For comparison across disease types, patients were also risk-stratified into low- and high-risk groups. A score of zero on the IPS, R-IPI, or BL-IPI was considered low-risk, while any non-zero score was classified as high-risk. Results Patients were initially screened using Epic Slicer Dicer, identifying 864 patients who met the age and diagnosis criteria. Of these, 108 patients met inclusion criteria. Five year mortality data was available for 81 patients. Among them, 16 patients (20.8%) were managed with observation alone, while 61 patients (79.2%) underwent scheduled imaging surveillance. There were a total of 9 relapses (11.1%). At time of relapse, 7 (77.0%) were symptomatic, while two relapses were detected primarily through imaging. Three patients (33.3%) had abnormal findings on physical examination, and no relapses were identified based on abnormal laboratory results. Among 17 patients classified as low-risk (risk score of 0), there were 2 relapses (11%). In contrast, 8 relapses (15%) occurred among 51 patients with elevated risk (non-zero scores based on the appropriate risk stratification tool), with a p-value of 1.00. Of the 77 patients with five-year outcome data , there were 5 deaths. One occurred in the observational cohort, and four deaths were in the scheduled imaging cohort. Conclusion In this cohort, scheduled surveillance imaging did not improve mortality or progression-free survival. Most relapses were detected by symptoms. These findings continue to support the growing support for foregoing scheduled CT surveillance imaging in the absence of clinical suspicion for progression.