Blood cancers

No role for routine blood tests in detecting relapse of lymphoma

Dr Eliza Hawkes

Routine blood tests should not be used for surveillance of patients in remission from aggressive lymphoma because they have little value in detecting relapse, Victorian oncologists say.

A study of 346 patients in remission from aggressive lymphoma found that none of the routine lab tests – including erythrocyte sedimentation rate (ESR), lactate dehydrogenease (LDH), Full Blood Examination (FBE) and lymphocyte and monocyte counts – had significant benefit for detecting relapse in asymptomatic patients.

The review covered patients with diffuse large B cell lymphoma (DLBCL), Hodgkin’s lymphoma, T cell lymphoma or Burkitt lymphoma who received curative intent first line treatment between 2000 and 2015 and were in documented complete remission.

In the 56 (16%) patients who relapsed, routine laboratory testing detected relapse in only three patients (5%).  For the vast majority of patients relapse was detected clinically based on symptoms and signs (43 patients, 80%) or by imaging (10 patients, 15%).

The three cases of relapse detected in asymptomatic patients by abnormal blood tests in isolation represented only 1% of patients. Relapse was diagnosed for one TCL patient with neutropaenia and thrombocytopaenia,and two HL patients; one with elevated LDH and one with elevated ESR.

Nevertheless, none of the individual lab tests – ESR, LDH, FBE, or lymphocyte and monocyte counts – showed any significant value in detecting lymphoma relapse, they found.

Overall, blood tests had a sensitivity of 42% and their positive predictive value of 9%. There was no significant difference in survival in patients who underwent a routine blood test within three months prior to relapse versus those who did not.

Writing in the British Journal of Cancer, the researchers, led by Dr Eliza Hawkes, medical oncologist at Austin Hospital, Melbourne, say that routine blood tests are a major source of anxiety for patients in remission. And with 15% of tests showing abnormal results, many patients will be subject to expensive , invasive and unnecessary follow-up investigations.

Despite the lack of evidence to support their use, routine follow up lab tests still featured in guidelines for lymphoma management, they note.

With the study showing that clinical symptoms are the single most important predictor of relapse, the role of routine lab tests should be reevaluated, they suggest.

“This study confirms that common blood tests do not reliably detect relapse of aggressive lymphoma in asymptomatic patients treated in the modern era and should not be recommended by current international guidelines. They are no longer performed in this context in our institutions,” they conclude.

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