Baseline metabolic tumor volume predicts outcome in high-tumor-burden follicular lymphoma: A pooled analysis of three multicenter studies

Michel Meignan, Anne Ségolène Cottereau, Annibale Versari, Loïc Chartier, Jehan Dupuis, Sami Boussetta, Ilaria Grassi, René Olivier Casasnovas, Corinne Haioun, Hervé Tilly, Vittoria Tarantino, Julien Dubreuil, Massimo Federico, Gilles Salles, Stefano Luminari, Judith Trotman

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Identifying patients at high risk of progression and early death among those with high-tumor-burden follicular lymphoma (FL) is unsatisfactory with current prognostic models. This study aimed to determine the prognostic impact of the total metabolic tumor volume (TMTV) measured at baseline with [18F]fluorodeoxyglucose/positron emission tomography-computed tomography ([18F]FDG/PET-CT) scans and its added value to these models. Patients and Methods: A pooled analysis was performed by using patient data and centrally reviewed baseline PET-CT scans for 185 patients with FL who were receiving immunochemotherapy within three prospective trials. TMTV was computed by using the 41% maximum standardized uptake value thresholding method, and the optimal cutoff for survival prediction was determined. Results: Median age was 55 years, 92% of patients had stage III to IV disease, 37% had a Follicular Lymphoma International Prognostic Index (FLIPI) score of 3 to 5, and 31% had a FLIPI2 score of 3 to 5. With a median follow-up of 64 months, overall 5-year progression-free survival (PFS) was 55% and overall survival (OS) was 92%. Median TMTV was 297 cm3 (quartile 1 through quartile 3, 135 to 567 cm3). The optimal cutoff identified was 510 cm3, with a markedly inferior survival in the 29% of patients with TMTV > 510 cm3. Fiveyear PFS was 33% versus 65% (hazard ratio [HR], 2.90; P<.001), and 5-year OS was 85% versus 95% (HR, 3.45; P =.010). On multivariable analysis, TMTV (HR, 2.3; P =.002) and FLIPI2 score (HR, 2.2; P =.002) were independent predictors of PFS. In combination, they identify three risk groups: high TMTV and intermediateto-high FLIPI2 score with 5-year PFS of 20% (HR, 5.0; P <.001), high TMTV or intermediate-to-high FLIPI2 score with 5-year PFS of 46% (HR, 2.1; P =.007), and low TMTV and low FLIP2 with 5-year PFS of 69%. Conclusion: Baseline TMTV is a strong independent predictor of outcome in FL. In combination with FLIPI2 score, it identifies patients at high risk of early progression. It warrants further validation as a biomarker for development of first-line PET-adapted approaches in FL.

Original languageEnglish
Pages (from-to)3618-3626
Number of pages9
JournalJournal of Clinical Oncology
Volume34
Issue number30
DOIs
Publication statusPublished - Oct 20 2016

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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