Study: CT adds little value for many CLL patients

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BlankStudy: CT adds little value for many CLL patients

CT imaging provided minimal utility in the follow-up of patients diagnosed

with chronic lymphocytic leukemia (CLL), according to a study published in the

January issue of Blood.

Most recent response criteria suggest a clear role for CT imaging in most

lymphoid malignancies. However, CT imaging criteria for CLL are unclear with the

National Cancer Institute Working Group criteria recommending CT imaging “when

clinically indicated,” offered Barbara F. Eichhorst, MD, of the Center for

Integrated Oncology at the University of Cologne in Germany, and colleagues.

The recent Institute Working Group CLL criteria aimed to curb CT use in

CLL by limiting imaging to pre-and post-treatment scans, two CT studies, in

clinical trials. The researchers noted that this recommendation has not yet been

substantiated.

Eichhorst and colleagues undertook a meta-analysis of 1,372 CLL patients

in three clinical trials between 1999 and 2006 to better determine the role of

CT and reassessed response and progression during follow-up.

CT studies were performed in 52 percent of patients, ultrasound exams in

85 percent and chest x-rays in 55 percent. Researchers compared clinical

parameters and treatment outcome of patients undergoing imaging with those

without imaging.

When the researchers evaluated disease progression (PD), they found 481

cases of PD in treatment or follow-up. Of this group, physical exam and/or blood

work detected progression in 77 percent and imaging detected progression in 15

percent, with CT responsible for 9 percent and ultrasound for 6 percent.

The authors noted minimal impact of CT on relapse treatment. Among the 176

patients undergoing relapse treatment, two patients were retreated based on

imaging data.

Although pretreatment CT and ultrasound studies were employed to detect

bulky disease in 91 percent of patients, the response rates, progression free

survival and overall survival did not differ among patients with and without

bulky disease.

Eichhorst and colleagues did observe that CT had an impact on prognosis of

complete remissions when they compared patient groups with differently defined

complete remissions. In the first group, complete remission was based on a

normal physical exam, normal peripheral blood count and bone marrow biopsy. In

the second group, additional CT imaging was used to confirm complete remission.

“[P]rogression free survival at 75 percentile was 36 months in the group

of patients with complete remissions by clinical examination and bone marrow

biopsy versus 49 months in the group of patients with additionally negative CT

scans,” wrote Eichhorst.

“The majority of events defined as disease progression was detected by

physical exam and/or blood count. Moreover, and more importantly, the results of

the imaging methods rarely influenced the decision to initiate relapse treatment

after first line therapy,” the authors said.

They further suggested that the findings might prevent unnecessary

radiation exposure and reduce healthcare costs. Finally, Eichhorst and

colleagues pointed out that novel biological markers, including fluorescence in

situ hybridization, IgHV mutational status, ZAP 70, CD 38 and the serum markers

beta2-microglobulin and serum thymidine kinase, may provide a method for

detailed evaluation of individual prognosis.