From the Guidelines
Imaging frequency in mantle cell lymphoma (MCL) should be individualized, but typically follows a schedule of every 3-6 months for the first 2 years after diagnosis or treatment, then every 6-12 months for the next 3 years, and annually thereafter if the patient remains in remission, as suggested by recent guidelines and studies 1. The imaging schedule should be based on the patient's risk factors, treatment regimen, and clinical status.
- For patients with minimal residual disease monitoring capabilities, imaging frequency may be reduced.
- During active treatment, imaging is often performed after 2-3 cycles of therapy to assess response, and then at the completion of therapy.
- More frequent imaging may be warranted for patients with aggressive disease features, while those with indolent disease may require less frequent monitoring.
- CT scans with contrast of the neck, chest, abdomen, and pelvis are the standard imaging modality, though PET/CT is preferred for initial staging and assessment of treatment response, as noted in studies on lymphoma management 1. This surveillance approach allows for early detection of relapse while minimizing radiation exposure and healthcare costs.
- The choice of imaging modality and frequency should be guided by the patient's specific clinical situation and the potential benefits and risks of imaging, as there is no definitive evidence that routine imaging in patients in complete remission provides any outcome advantage 1.
- However, high-risk patients with curative options may potentially mandate more frequent controls, and the imaging schedule should be adjusted accordingly 1.
From the Research
Imaging Frequency in Mantle Cell Lymphoma
The recommended frequency for imaging in mantle cell lymphoma (MCL) is not well-established, but several studies provide insights into the utility of surveillance imaging in this context.
- A study published in 2018 2 found that relapse detection by surveillance imaging was not associated with improved survival and lacked clinical benefit.
- Another study from 2011 3 reported that surveillance PET scans had a high false positive rate (35%) and low positive predictive value (8%), and contributed to an earlier diagnosis of relapse in only 11% of patients who relapsed.
- The 2018 study 2 also found that PET/CT had a positive predictive value (PPV) of 24% and number needed-to-scan/treat (NNT) of 51 to detect one relapse, and CT had a PPV of 49% and NNT of 24.
Key Findings
- The use of surveillance imaging in MCL is not supported by strong evidence, and its clinical utility is limited.
- The choice of imaging modality (e.g., PET/CT or CT) does not significantly impact the detection of relapse or overall survival.
- Other studies, such as those focusing on treatment strategies 4, 5, 6, do not provide direct guidance on the recommended frequency for imaging in MCL.