Relapse patterns of localized non-Hodgkin's lymphoma of the head and neck after clinical remission: Results of a strict follow-up procedure

Background. No effective follow-up strategy for non-Hodgkin's lymphoma (NHL) has been identified to date. The aim of this study was to assess the value of a strict follow-up procedure in patients with NHL after they showed clinical remission. Methods. One hundred and twenty-one patients with localized NHL of the head and neck who had achieved clinical remission after radiation therapy and/or chemotherapy were followed with a strict follow-up strategy (consisting of a schedule of frequent office visits, imaging studies, and blood tests, even if the patient was asymptomatic). Results. Thirty-nine patients relapsed after remission. Twenty-two (56.4%) of the relapses were associated with symptoms. In the 17 patients with asymptomatic relapses (43.6%), an abnormal physical examination result initially indicated relapse in 10 patients. The other tests that initially indicated relapse included scheduled computed tomography scans (3 patients), scheduled gallium scans (2 patients), and serum lactate dehydrogenase levels (2 patients). According to the Ann Arbor stage at relapse, 72.7% of the patients with symptomatic relapses were stage III or IV, while 70.6% of the patients with asymptomatic relapses were stage I or II. Conclusions. These results indicate that a strict follow-up procedure is effective in detecting asymptomatic relapses, which generally involve a smaller tumor load than symptomatic relapses.