P1177: routine clinical follow-up for relapse detection in patients with large b-cell lymphoma after first-line treatment – does not meet the aims. a retrospective danish multicenter study

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: There is no consensus on the optimal organization of post first-line treatment follow-up (FU) of patients with Large B-cell Lymphoma (LBCL). Most patients with LBCL are cured after primary treatment with immunochemotherapy, but 20-30% will relapse during FU. In Denmark patients are offered routine clinical consultations at a specialist in hematology and routine blood tests scheduled every 3-6 month for up to 5 years after treatment. However, increasing evidence suggests that routine clinical FU programs are ineffective when it comes to early detection of cancer relapses, and the majority of relapses are probably identified in between the scheduled FU consultations. Lack of evidence in the literature supporting use of routine scans in FU of LBCL, have led to updates in several international guidelines, discouraging their routine use. Currently the ability to meet the objectives of FU after primary cancer treatment are being debated and we wished to explore patterns of relapse detection in LBCL following first-line treatment. Aims: To determine the frequency of relapses after first-line treatment detected at routine vs. non-routine FU consultations. To investigate if relapses are symptomatic and what symptoms and clinical findings that are associated with detection of a relapse. Methods: A retrospective, multicenter study. Patients diagnosed with LBCL from 2010 – 2018 in 2/5 regions of Denmark were identified through The Danish National Lymphoma Registry (LYFO), which has a coverage of 95% of all Danish patients with lymphoma. Patients registered as having a relapse were reviewed for eligibility in a medical journal review. Patients in complete remission after first-line R-CHOP like treatment with at least one FU consultation after end-of-treatment evaluation were included. We excluded lymphomas in the central nervous system, palliative treated patients, or refractory patients. Non-routine consultations were defined as any consultation occurring earlier than the next scheduled consultation and initiated by the patient because of any abnormal symptom or physical finding. Symptomatic was defined as any new symptom within the last 4 weeks. Results: From preliminary data of 72 LBCL relapse patients we found that in 32 % and 68 % of patients, relapse was detected at routine FU consultations and non-routine consultations respectively. All non-routine consultations were prompted by the symptoms reported by the patient except for one patient with a random elevated LDH finding. 89% of all relapses were symptomatic at the time of relapse detection. 39% of patients had B symptoms (fatigue, night sweats, weight loss or fewer) by the time of relapse detection. 21 % had enlarged lymph nodes. Final data from the entire cohort (n=100) will be presented at the congress. Summary/Conclusion: To our knowledge this is the largest retrospective study to date about patterns of relapse detection in LBCL following first-line treatment. Since the vast majority of DLBCL relapses are symptomatic and often identified outside routine consultations in the outpatient setting, the benefit of routine clinical FU consultations for detecting relapse is limited. More personalized FU strategies including patient reported outcome measures should be considered. Keywords: Follow-up, Diffuse large B cell lymphoma, DLBCL, Lymphoma