Skill Checkup: A 74-Year-Old Woman With a History of Treated Diffuse Large B-Cell Lymphoma Has Fatigue and Splenomegaly

Zachary Cohn, MD


March 30, 2023

PET/CT is necessary in order to assess the extent and sites of disease prior to selection of therapy. In this case, PET/CT revealed an enlarged spleen, extensive lymphadenopathy, and several skeletal sites; there was no evidence of central nervous system (CNS) involvement.

In addition, a repeat biopsy is recommended after PET/CT to confirm relapsed disease, as positivity could represent posttreatment inflammation. It is also needed to ensure that there is no transformation, especially if the original lymphoma was low grade. Additionally, a biopsy is required to rule out carcinoma, infection, or an inflammatory condition.

PET/CT is also used to confirm response to therapy. Additionally, CT plays a role in surveillance imaging for detection of relapse in patients with stage III/IV disease. The National Comprehensive Cancer Network (NCCN)  and the European Society for Medical Oncology (ESMO) recommend CT no more than once every 6 months up to 2 years following completion of therapy, unless clinically indicated.

Typically, bone imaging is needed only in patients with unexplained bone pain or elevated alkaline phosphatase levels.

Biomarkers and other prognostic indicators are available at diagnosis to guide risk stratification, although there is a lack of biologic indicators to inform selection of therapy at relapse.

Immunohistochemistry is typically used to establish the initial diagnosis and to aid in risk stratification, but it does not play a role in relapse.


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