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Tobin JWD, Hapgood G, Johnston A, Cheah CY, Lee ST, Trotman J, Inam S, Campbell BA, Norris D, MacManus M, Hertzberg M, Hawkes E. Diagnosis, management and follow-up of follicular lymphoma: a consensus practice statement from the Australasian Lymphoma Alliance. Intern Med J 2024; 54:1384-1395. [PMID: 39099075 DOI: 10.1111/imj.16454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 05/30/2024] [Indexed: 08/06/2024]
Abstract
Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma subtype, accounting for 15-20% of all lymphoma diagnoses. Although typically slow-growing and responsive to frontline therapies, advanced-stage FL remains incurable with current treatments and typically follows a chronic relapsing/remitting course with increasingly shorter responses to subsequent lines of therapy. Outcomes are highly variable; some patients experience prolonged first remissions that may approximate a 'functional cure'. By contrast, a significant minority of patients experience disease progression shortly after frontline treatment resulting in high rates of lymphoma-related mortality. Reflecting on the heterogeneous natural history of FL, clinical practice varies widely, particularly in controversial areas, including appropriate disease staging, selection of management strategies and duration of clinical follow-up. This position statement presents an evidence-based synthesis of the literature for application in Australasian practice.
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Affiliation(s)
- Joshua W D Tobin
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Greg Hapgood
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Anna Johnston
- The Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Chan Y Cheah
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - Sze T Lee
- Austin Health, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Judith Trotman
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | | | - Belinda A Campbell
- University of Melbourne, Melbourne, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Michael MacManus
- University of Melbourne, Melbourne, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Mark Hertzberg
- University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Eliza Hawkes
- Austin Health, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
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Mascaró-Pol M, Díez-Feijoo R, Rodriguez-Sevilla JJ, Fernández-Rodriguez C, García-Pallarols F, Flores S, Vazquez I, Rodriguez-Lopez S, Roman D, Gimeno E, Colomo L, Maiques J, Sánchez-González B, Salar A. Evaluation of routine CT scans in the follow-up of diffuse large B-cell lymphomas. ACTA ACUST UNITED AC 2021; 26:709-715. [PMID: 34547987 DOI: 10.1080/16078454.2021.1975957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Our aim was to retrospectively assess the role of routine CT scans within the first year of follow-up with a limited surveillance policy prior to Lugano recommendations in diffuse large B-cell lymphomas (DLBCL) achieving complete metabolic remission (CMR). We also evaluated the type of relapse detection and exposure to CT scans within the first five years. METHODS Patients diagnosed with DLBCL who achieved CMR after first-line immunochemotherapy were included. Imaging studies and medical records were thoroughly reviewed. RESULTS Among 101 DLBCL patients in the first CMR, a total of 19 relapses were identified in the study period (18.8% of DLBCL patients included). Nine patients relapsed within the first year (47.4% of all relapses) but only 3 of them were detected by the 202 surveillance CT scans performed during this first year of follow-up. CONCLUSIONS Our real-world data provide clinically applicable results which are in agreement with the Lugano recommendations based on trial data, highlighting the lack of utility of routine CTs in DLBCL patients achieving CMR.
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Affiliation(s)
| | | | | | - Concepción Fernández-Rodriguez
- Group of Applied Clinical Research in Hematology, Cancer Research Program-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Department of Pathology, Hospital del Mar-IMIM, Barcelona, Spain
| | | | - Solange Flores
- Department of Hematology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Ivonne Vazquez
- Department of Pathology, Hospital del Mar-IMIM, Barcelona, Spain
| | | | - David Roman
- Department of Hematology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Eva Gimeno
- Department of Hematology, Hospital del Mar-IMIM, Barcelona, Spain.,Group of Applied Clinical Research in Hematology, Cancer Research Program-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Luis Colomo
- Department of Pathology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Jose Maiques
- Department of Radiology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Blanca Sánchez-González
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Hematology, Hospital del Mar-IMIM, Barcelona, Spain.,Group of Applied Clinical Research in Hematology, Cancer Research Program-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Antonio Salar
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Hematology, Hospital del Mar-IMIM, Barcelona, Spain.,Group of Applied Clinical Research in Hematology, Cancer Research Program-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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