Limited clinical relevance of imaging techniques in the follow-up of patients with advanced chronic lymphocytic leukemia: results of a meta-analysis

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BlankLimited clinical relevance of imaging techniques in the follow-up of

patients with advanced chronic lymphocytic leukemia: results of a meta-analysis.

BF Eichhorst, K Fischer, AM Fink, T Elter, CM Wendtner, V Goede, M Bergmann, S

Stilgenbauer, G Hopfinger, M Ritgen, J Bahlo, R Busch, and M Hallek

Blood, December 7, 2010; .

Department I of Internal Medicine, Centre of Integrated Oncology Koeln Bonn,

University of Cologne, Cologne, Germany;

The clinical value of imaging is well established for the follow-up of many

lymphoid malignancies but not for chronic lymphocytic leukemia (CLL). A

meta-analysis was performed using the dataset of three GCLLSG phase III trials

(CLL4, CLL5 and CLL8) including 1372 patients receiving first line therapy for

CLL. Response as well as progression during follow-up was reassessed according

to the NCI-WG 1996 criteria. 481 events were counted as progressive disease (PD)

during treatment or follow-up. Of these, 372 progressions (77%) were detected by

clinical symptoms or blood counts. CT scans or ultrasound were relevant in 44

and 29 cases (9% and 6%), respectively. The decision for relapse treatment was

based on CT scan or ultrasound results in only 2 out of 176 patients (1%). An

initial bulk (lymph node diameter > 5 cm) detected by imaging techniques had no

prognostic impact on progression free or overall survival. CT scan results had

an impact on the prognosis of patients in complete remission only after the

administration of conventional chemotherapy, but not after chemoimmunotherapy.

In conclusion physical examination and blood count remain the methods of choice

for staging and clinical follow-up of patients with CLL as recommended by the

IWCLL 2008 guidelines. The trials were registered at www.isrctn.org as #ISRCTN

75653261 and #ISRCTN 36294212 or at www.ClinicalTrials.gov as #NCT00281918.

PMID: 21139079