Monitoring Lymphoma in Remission

Core Surveillance Strategy

The European Society for Medical Oncology recommends surveillance to consist of history and physical examination every 3 months for the first 2 years, every 6 months for years 3-5, then annually, combined with complete blood count and LDH at 3, 6, 12, and 24 months 1, 2
History and physical examination should be performed every 3-4 months in the first 2 years, with complete blood count at 3, 6, 12, and 24 months 1, 2, 3, 4
LDH measurement should be performed at the same intervals as complete blood count 2
The American Society of Hematology suggests that blood work should only be performed as clinically indicated in years 3-5 1
Annual history and physical examination is recommended beyond 5 years, with attention to secondary malignancies and late treatment effects 1, 2, 3, 4

Routine surveillance CT or PET scans are not recommended because they are ineffective and costly 1
The National Comprehensive Cancer Network states that CT imaging may be considered only in specific circumstances, such as in Hodgkin lymphoma patients or when clinical findings are equivocal 1, 3, 4
PET surveillance is explicitly discouraged, except in cases where it may be useful for detecting relapse in certain types of lymphoma 1, 3, 4, 5, 6

The European Society for Medical Oncology recommends thyroid function testing at 1, 2, and 5 years minimum for patients who received neck irradiation 2, 3, 4
Annual breast cancer screening is recommended for women over 35 years who received radiation above the diaphragm 2, 3, 4
Cardiovascular monitoring is recommended for all patients who received anthracyclines or chest/mediastinal radiation 3, 4, 7, 8, 9

Biopsy is mandatory before initiating salvage therapy, according to the American Society of Hematology 1, 7, 8, 9
A full restaging workup should include CT chest/abdomen/pelvis or PET/CT, complete blood count, comprehensive metabolic panel, LDH, and uric acid 7, 8, 9

Routine surveillance imaging should not be ordered in asymptomatic patients, as it has no survival benefit and potential for false positives 1
Patient-reported symptoms should not be ignored between scheduled visits, as they detect the majority of relapses 1, 2
Long-term monitoring beyond 5 years should not be skipped, as the focus shifts to secondary malignancies and late treatment effects rather than lymphoma relapse 1, 2
Treatment-specific surveillance should not be forgotten, including thyroid dysfunction, cardiac toxicity, and secondary breast cancer in appropriate populations 2, 3, 4