Because CT scanning is the only way to follow what is happening in lymphoma, oncologists assume that it should be done in CLL. Nothing could be further from the truth. In the issue of Blood of February 10th a paper from the German group looked at the value of CT scanning in a dataset that included the CLL4, CLL5 and CLL8 phase 3 clinical trials. This included 1372 patients. In these trials progression was an end point. There were 481 events that were counted as progressive disease. Of these 372 (77%) were picked up by the blood count or by symptoms and physical examination. CT scan picked up 44 progressions (9%) and ultrasound 29 cases (6%). A decision to retreat the patient was made on the basis of CT scan on only 2 patients out of 176. CT scanning had an impact on the prognosis of patients in CR after chemotherapy but not after immunochemotherapy.
They conclude that the methods used for staging and follow-up of patients with CLL should be blood counts and clinical history and examination, as recommended in the IWCLL Guidelines. There are specific clinical situations where CT scanning might be useful. These include when treatment with alemtuzumab is contemplated; glands >5cm in diameter predict a poor response. Another reason might be when FISH shows an 11q deletion, especially in younger patients and yet another indication would be in preparation for a stem cell allograft.