Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA.
Fred Hutchinson Cancer Research Center, Seattle, WA.
JCO Oncol Pract. 2020 Sep;16(9):e902-e911. doi: 10.1200/JOP.19.00733. Epub 2020 May 5.
Classic Hodgkin lymphoma is highly curable with contemporary therapy. Although the limited role of surveillance imaging to detect early relapse for patients in complete remission at the end of therapy is well established, there is a paucity of data regarding role of laboratory testing in this setting.
Patients with newly diagnosed classic Hodgkin lymphoma uniformly treated with the Stanford V regimen from 1998-2014 and in complete remission for at least 3 months were identified in a single-center institutional database. Laboratory tests categorized by Common Terminology Criteria for Adverse Events v4.03 as grade 2 or higher were considered abnormal. Primary analysis included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of surveillance laboratory tests for predicting relapse in the first 3 years after end of treatment.
Among 235 eligible patients, 24 (10.2%) patients ultimately relapsed. In the first 3 years after end of therapy, the mean number of surveillance blood draws per patient was 7.1, (range, 1-13). These 1,661 surveillance blood draws included 4,684 individual laboratory tests, comprising 1,609 CBCs, 1,578 metabolic panels, and 1,497 erythrocyte sedimentation rates. None of the biopsies confirming relapses were prompted by any abnormal laboratory finding. The sensitivity of any surveillance laboratory test for detecting relapse within 3 years of end of treatment was 72.7% (95% CI, 49.8% to 89.3%), specificity 22.6% (95% CI, 17.2% to 28.9%), yielding a PPV of 8.9% (95% CI, 7.0% to 11.3%) and NPV of 88.9% (95% CI, 79% to 94%).
Our study found limited clinically meaningful utility for routine surveillance laboratory testing in detecting relapse in patients with complete remission at end of treatment. Our results warrant consideration of modifications to current practice guidelines.
采用当代疗法，经典霍奇金淋巴瘤的治愈率很高。虽然在治疗结束时完全缓解的患者中，监测影像学在检测早期复发方面的作用有限已得到充分证实，但关于该情况下实验室检测作用的数据却很少。
在一个单中心机构数据库中，鉴定了 1998 年至 2014 年间采用斯坦福 V 方案治疗的新发经典霍奇金淋巴瘤且至少缓解 3 个月的患者。根据不良事件通用术语标准第 4.03 版将实验室检查分为 2 级或更高级别，认为这些实验室检查异常。主要分析包括在治疗结束后 3 年内，监测实验室检查对预测复发的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
在 235 名合格患者中，最终有 24 名（10.2%）患者复发。在治疗结束后的前 3 年内，每位患者的平均监测血样数为 7.1 次（范围 1-13 次）。这些 1661 次监测血样包括 4684 项单独的实验室检查，包括 1609 次全血细胞计数、1578 次代谢组学和 1497 次红细胞沉降率。无一例活检确认的复发是由任何异常实验室发现引发的。在治疗结束后 3 年内，任何监测实验室检查对检测复发的敏感性为 72.7%（95%CI，49.8%至 89.3%），特异性为 22.6%（95%CI，17.2%至 28.9%），PPV 为 8.9%（95%CI，7.0%至 11.3%），NPV 为 88.9%（95%CI，79%至 94%）。
我们的研究发现，在治疗结束时完全缓解的患者中，常规监测实验室检查在检测复发方面的临床意义有限。我们的研究结果证明有必要修改当前的实践指南。
