Total metabolic tumor volume as a survival predictor for patients with diffuse large B-cell lymphoma in the GOYA study

Haematologica. 2022 Jul 1;107(7):1633-1642. doi: 10.3324/haematol.2021.278663.

Abstract

This retrospective analysis of the phase III GOYA study investigated the prognostic value of baseline metabolic tumor volume parameters and maximum standardized uptake values for overall and progression-free survival (PFS) in treatment-naïve diffuse large B-cell lymphoma. Baseline total metabolic tumor volume (determined for tumors >1 mL using a threshold of 1.5 times the mean liver standardized uptake value +2 standard deviations), total lesion glycolysis, and maximum standardized uptake value positron emission tomography data were dichotomized based on receiver operating characteristic analysis and divided into quartiles by baseline population distribution. Of 1,418 enrolled patients, 1,305 had a baseline positron emission tomography scan with detectable lesions. Optimal cut-offs were 366 cm3 for total metabolic tumor volume and 3,004 g for total lesion glycolysis. High total metabolic tumor volume and total lesion glycolysis predicted poorer PFS, with associations retained after adjustment for baseline and disease characteristics (high total metabolic tumor volume hazard ratio: 1.71, 95% confidence interval [CI]: 1.35- 2.18; total lesion glycolysis hazard ratio: 1.46; 95% CI: 1.15-1.86). Total metabolic tumor volume was prognostic for PFS in subgroups with International Prognostic Index scores 0-2 and 3-5, and those with different cell-of-origin subtypes. Maximum standardized uptake value had no prognostic value in this setting. High total metabolic tumor volume associated with high International Prognostic Index or non-germinal center B-cell classification identified the highest-risk cohort for unfavorable prognosis. In conclusion, baseline total metabolic tumor volume and total lesion glycolysis are independent predictors of PFS in patients with diffuse large B-cell lymphoma after first-line immunochemotherapy.

Publication types

  • Clinical Trial, Phase III
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Fluorodeoxyglucose F18*
  • Glycolysis
  • Humans
  • Lymphoma, Large B-Cell, Diffuse*
  • Positron Emission Tomography Computed Tomography / methods
  • Positron-Emission Tomography
  • Prognosis
  • Radiopharmaceuticals
  • Retrospective Studies
  • Tumor Burden

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18

Grants and funding

Funding: The GOYA study was supported by F. Hofmann-La Roche Ltd, with scientific support from the Fondazione Italiana Linfomi. Editorial support (in the form of writing assistance, collating author comments, assembling tables/figures, grammatical editing, and referencing) under the direction of Lale Kostakoglu was provided by Katie Smith, PhD, and Molly Heitz, PhD, of Ashfield MedComms, an Ashfield Health company, and funded by F. Hofmann-La Roche Ltd.