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Limited utility of routine surveillance imaging for classical Hodgkin lymphoma patients in first complete remission.
[hodgkin lymphoma, classical]
The
objective
of
this
study
was
to
compare
the
outcomes
of
patients
with
classical
Hodgkin
lymphoma
(
cHL
)
who
achieved
complete
remission
with
frontline
therapy
and
then
underwent
either
clinical
surveillance
or
routine
surveillance
imaging
.
In
total
,
241
patients
who
were
newly
diagnosed
with
cHL
between
January
2000
and
December
2010
at
3
participating
tertiary
care
centers
and
achieved
complete
remission
after
first
-line
therapy
were
retrospectively
analyzed
.
Of
these
,
there
were
174
patients
in
the
routine
surveillance
imaging
group
and
67
patients
in
the
clinical
surveillance
group
,
based
on
the
intended
mode
of
surveillance
.
In
the
routine
surveillance
imaging
group
,
the
intended
plan
of
surveillance
included
computed
tomography
and
/
or
positron
emission
tomography
scans
;
whereas
,
in
the
clinical
surveillance
group
,
the
intended
plan
of
surveillance
was
clinical
examination
and
laboratory
studies
,
and
scans
were
obtained
only
to
evaluate
concerning
signs
or
symptoms
.
Baseline
patient
characteristics
,
prognostic
features
,
treatment
records
,
and
outcomes
were
collected
.
The
primary
objective
was
to
compare
overall
survival
for
patients
in
both
groups
.
For
secondary
objectives
,
we
compared
the
success
of
second
-line
therapy
and
estimated
the
costs
of
imaging
for
each
group
.
After
5
years
of
follow-up
,
the
overall
survival
rate
was
97
%
(
95
%
confidence
interval
,
92
%
-
99
%
)
in
the
routine
surveillance
imaging
group
and
96
%
(
95
%
confidence
interval
,
87
%
-
99
%
)
in
the
clinical
surveillance
group
(
P
=
.
41
)
.
There
were
few
relapses
in
each
group
,
and
all
patients
who
relapsed
in
both
groups
achieved
complete
remission
with
second
-line
therapy
.
The
charges
associated
with
routine
surveillance
imaging
were
significantly
higher
than
those
for
the
clinical
surveillance
strategy
,
with
no
apparent
clinical
benefit
.
Clinical
surveillance
was
not
inferior
to
routine
surveillance
imaging
in
patients
with
cHL
who
achieved
complete
remission
with
frontline
therapy
.
Routine
surveillance
imaging
was
associated
with
significantly
increased
estimated
imaging
charges
.
Diseases
Validation
Diseases presenting
"secondary objectives"
symptom
congenital adrenal hyperplasia
hodgkin lymphoma, classical
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