Followup

Very few studies have formally addressed the optimal follow-up schedule and optimal follow-up procedures for patients with NHL. Although routine imaging techniques such as CT scanning and FDG-PET are now commonly used for the early detection of relapse, there are no published studies evaluating the utility of PET in this context, and studies of CTscanning and other imaging modalities have failed to show a high rate of early detection of relapse (although most studies were reported in the early 1990s with inferior scanning technology to that now available).43

Although molecular techniques such as quantitative PCR may help detect early, subclinical relapse in some subtypes of NHL, especially FL, there is no evidence at present to suggest that early treatment intervention in this context improves survival compared with the treatment of clinically detected relapse, although this may change with the increased used of monoclonal antibodies in this disease.

The International Workshop defined a recommended follow-up schedule and investigations for patients with NHL on clinical trials to establish consistency across different studies. Their recommendations were that patients should be evaluated a minimum of every 3 months after completion of treatment for 2 years, then every 6 months for 3 years, and then annually for at least a further 5 years. For patients with aggressive lymphoma, few recurrences occur beyond 10 years, although the group acknowledged that for low-grade FL, longer follow-up would be required, not only for the detection of relapse but also to monitor for late side effects of therapy such as secondary myelodysplastic syndrome or acute myeloid leukemia which have been reported with increasing frequency in the FL population.

Minimum testing recommended at each follow-up visit was for a history, full physical examination, complete blood count, and LDH. No recommendations

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