Original article
ACR Appropriateness Criteria Follow-up of Hodgkin Lymphoma

https://doi.org/10.1016/j.jacr.2014.07.038Get rights and content

The main objectives of follow-up studies after completion of treatment for Hodgkin lymphoma are detection of recurrence for salvage therapy and monitoring for sequelae of treatment. The focus of the follow-up shifts, with time after treatment, from detection of recurrence to long-term sequelae. A majority of recurrence is detected by history and physical examination. The yield for routine imaging studies and blood tests is low. Although routine surveillance CT scan can detect recurrence not detected by history and physical examination, its benefit in ultimate survival and cost-effectiveness is not well defined. Although PET scan is a useful tool in assessing response to treatment, its routine use for follow-up is not recommended. Long-term sequelae of treatment include secondary malignancy, cardiovascular disease, pneumonitis, reproductive dysfunction, and hypothyroidism. Follow-up strategies for these sequelae need to be individualized, as their risks in general depend on the dose and volume of radiation to these organs, chemotherapy, age at treatment, and predisposing factors for each sequela.

The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is either lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Section snippets

Introduction/Background

Routine follow-up evaluation of patients after treatment for Hodgkin lymphoma serves several functions. Detection of relapse is most important in the first 5 years after treatment. Beyond 5 years, the focus is on monitoring for late effects of therapy. The treatment of Hodgkin lymphoma has evolved greatly over the past few decades; toxicity continues to decrease and the already high cure rate is improving. With diminishing use of alkylating agents and radiation therapy, the profile of late

Summary

  • The main focus of follow-up is recurrent disease in the first 5 years, as the majority of relapses occur in this time period. However, the focus shifts to late side effects beyond this time period.

  • In general, a majority of recurrences can be detected initially by history and physical examination rather than by routine imaging studies or blood tests such as erythrocyte sedimentation rate, complete blood count, and chemistry panel.

  • Routine surveillance CT scans can detect a proportion of recurrent

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    The ACR seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document.

    Christopher R. Flowers, MD, MS, provides consulting for the Prescription Solutions Pharmacy and Therapeutics division. Consultation involves advice on FDA-regulated drugs only. None of the consultation overlaps with existing or planned ACR guidelines. Anas Younes, MD, has received an honoraria from: Novartis, Seattle Genetics, Millenium,Clegene, Curis, Sanofi, Pharmacyclics and Incyte; and research support from: Novartis, Johnson & Johnson, Seattle Genetics, Merck, Genentech, Infinity, and Gilead.

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