Total Metabolic Tumor Volume Is a Strong Independent Prognostic Factor in Follicular Lymphomas: Results From a Sub‐Study of the FOLL12 Trial
Year: 2025
Type: article
Abstract: Discordant results have been generated regarding the prognostic role of Total Metabolic Tumor Volume (TMTV) in Follicular Lymphoma (FL). The use of prospective data and the adoption of the newly defined standardized SUV4 method for calculating TMTV may generate stronger evidence. We conducted a pre-planned post hoc analysis of the prospective multicenter randomized phase III FOLL12 trial for newly diagnosed high tumor burden FL (grade 1-3a), which mandated baseline staging with PET. Baseline PET/CT scans were reviewed centrally, and TMTV was calculated using the fixed threshold of SUV4. Kaplan-Meier and Cox regression were used for survival analysis. The primary study endpoint was Progression free Survival (PFS). A total of 689 FL patients were available for TMTV definition. Median TMTV was 161 mL (IQR 50 to 388 mL) and the best cutoff value was set at 180 mL. Patients with high TMTV had a significantly lower 5-year PFS compared to those with low TMTV: 59% (95% CI, 53-65%) vs. 74% (95% CI, 69-78%) HR 1.61 (95% CI, 1.24-2.09). Prognostic role of TMTV was independent of study arm, chemotherapy regimen, and FLIPI2. Combined with FLIPI-2, we identified three groups with different 5-yr PFS rates, with the lowest rates (51%) for patients with high TMTV and high FLIPI2. Combined TMTV and FLIPI model was also prognostic to predict the risk of early progression and of death. Applying the SUV4 standard method pre-treatment TMTV is confirmed as a strong and independent predictor of PFS in FL patients. Integrating TMTV with FLIPI-2 improves risk assessment.
Source: American Journal of Hematology
DOI: 10.1002/ajh.27711
Authors: Rexhep Durmo, Stephane Chauvie, Carla Minoia, Fabrizio Bergesio, Federico Fallanca, Simona Peano, Luigi Marcheselli, Antonella Anastasia, Carola Boccomini, Paolo Corradini, Jacopo Olivieri, Luca Arcaini, Federica Cavallo, Adalberto Ibatici, Luca Nassi, Vittoria Tarantino, Antonello Pinto, Caterina Stelitano, Alessandro Pulsoni, Francesca Ricci, Salvatrice Mancuso, Emanuele Cencini, Nicola Di Renzo, Clara Mannarella, Angelo Palmas, Pierluigi Zinzani, Caterina Bocci, Francesca Rossi, Angelo Michele Carella, Massimo Federico, Annibale Versari, Luca Guerra, Stefano Luminari
Institutions: Azienda Sanitaria Unità Locale di Reggio Emilia, Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo, Istituto Tumori Bari, IRCCS Ospedale San Raffaele, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, Fondazione IRCCS Istituto Nazionale dei Tumori, Azienda sanitaria universitaria Friuli Centrale, University of Pavia, Policlinico San Matteo Fondazione, University of Turin, Ospedale Policlinico San Martino, Azienda Ospedaliero-Universitaria Careggi, Ospedale Vincenzo Cervello, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Azienda ospedaliera "Bianchi-Melacrino-Morelli", Sapienza University of Rome, Fondazione Humanitas per la Ricerca, University of Palermo, University of Siena, Azienda Ospedaliera Universitaria Senese, Ospedale Vito Fazzi, Istituto di Ematologia di Bologna, University of Bologna, L'organizzazione Ospedale di Civitanova M, Casa Sollievo della Sofferenza, University of Modena and Reggio Emilia, University of Milano-Bicocca
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,450
OpenAlex ID: W4410370244