From the Guidelines
Monitoring progress of non-Hodgkin's B cell lymphoma requires a comprehensive approach combining clinical evaluation, imaging studies, and laboratory tests, with a focus on FDG-PET/CT scans for assessing treatment response, as recommended by the Lugano classification 1.
Key Components of Monitoring
- Regular physical examinations to assess lymph node size and detect new sites of disease
- Imaging studies, such as CT scans every 3-6 months during treatment and then every 6-12 months afterward, to objectively measure tumor response
- PET/CT scans, particularly at mid-treatment and end-of-treatment timepoints, to evaluate treatment response, as they are especially valuable for FDG-avid lymphomas 1
- Laboratory monitoring, including complete blood counts, comprehensive metabolic panels, and lactate dehydrogenase (LDH) levels, as elevated LDH often correlates with disease activity
Frequency of Monitoring
- The frequency of monitoring typically decreases over time if the patient remains in remission, transitioning from every 3-4 months during the first year to every 6 months for the next 2 years, and then annually thereafter, as suggested by the National Comprehensive Cancer Network guidelines 1
- Surveillance imaging, such as CT scans, should be performed up to 2 years post-completion of treatment, with no more than every 6 months, and then annually after 2 years, unless there are clinical indications for more frequent imaging 1
Special Considerations
- For certain lymphoma subtypes, specific tumor markers or molecular tests may be useful, such as monitoring minimal residual disease through flow cytometry or PCR-based techniques
- Bone marrow biopsies may be necessary in some cases to assess disease involvement, although they are no longer indicated for routine staging of most diffuse large B-cell lymphomas 1
- Functional imaging, such as FDG-PET, may help identify areas suspicious for transformation, but biopsy is still necessary to diagnose transformation 1
From the FDA Drug Label
Among 166 patients in NHL Study 1 (NCT000168740), circulating CD19-positive B cells were depleted within the first three weeks with sustained depletion for up to 6 to 9 months post treatment in 83% of patients
- Monitoring progress of non-Hodgkin’s B cell lymphoma can be done by tracking the depletion of circulating and tissue-based B cells, specifically CD19-positive B cells.
- Key markers to monitor include CD19 counts and IgM and IgG serum levels.
- Frequency of monitoring is not explicitly stated, but based on the study, it can be inferred that monitoring should be done within the first three weeks and at 6 to 9 months post treatment 2
From the Research
Monitoring Progress of Non-Hodgkin's B Cell Lymphoma
To monitor the progress of non-Hodgkin's B cell lymphoma, several methods can be employed, including:
- Positron emission tomography/computed tomography (PET/CT) scans 3, 4, 5
- Open lymph node biopsy for diagnosis 6
- Lugano classification system to stage lymphoma 6
- Gene-expression analyses to understand the molecular basis of chemotherapy resistance 7
Role of PET/CT in Monitoring Progress
PET/CT scans play a crucial role in monitoring the progress of non-Hodgkin's B cell lymphoma, particularly in:
- Initial staging of most lymphomas 5
- Detection of nodal involvement and extra-nodal disease 5
- Early therapeutic evaluation of Hodgkin's lymphoma through interim PET 5
- Post-treatment assessment of lymphomas with excellent negative predictive value (NPV) and superior diagnostic accuracy compared with CT 5
PET/CT Evaluation Criteria
The Deauville 5-score scale is used to evaluate PET/CT scans, with: