Non-Hodgkin’s lymphoma followup guidelines – pro

Guideliens disagree how long to follow lymphomas but the literaure favors those who do NOT recommend routine imaging. NCCN (DLCL and follicular) recommends:

•Repeating all positive studies at end of treatment
•Imaging every 3 to 6 months for 5 years, then yearly or as clinically indicated, based on disease site and clinical presentation

In contrast to the North American guidelines, the 2007 European Society of Medical Oncology (ESMO) specifically advises against routine imaging except to evaluate residual disease. These guidelines recommend:

•PET scan at end of treatment, if available
•Minimal radiologic examinations in patients with DLBCL at 6, 12, and 24 months after end of treatment, when indicated by site of disease

2007 International Working Group Guidelines for Lymphoma advise that follow-up will vary according to whether treatment was administered in a clinical trial or clinical practice, or whether it was given with curative or palliative intent. The panel advises against routine imaging given the lack of evidence supporting its role.


Zelenetz A, Abramson JS, Advani A, et al. NCCN Clinical Practice Guidelines in Oncology: Non-Hodgkin’s Lymphomas. Version 2, 2011. Available at:

Jost L. Newly diagnosed large B-cell non-Hodgkin’s lymphoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 2007;18(Suppl 2):ii55–ii56.
Cheson BD, Pfistner B, Juweid ME, et al. Revised response criteria for malignant lymphoma. J Clin Oncol 2007;25:579–586.

Cheson BD. The International Harmonization Project for response criteria in lymphoma clinical trials. Hematol Oncol Clin North Am 2007;21:841–854.

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