Total Metabolic Tumor Volume Is a Strong Independent Prognostic Factor in Follicular Lymphomas: Results From a Sub‐Study of the <scp>FOLL12</scp> Trial
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.
Authors
- Fabrizio Bergesio
- Federica Cavallo (ORCID: https://orcid.org/0000-0003-4571-1060)
- Luca Guerra (ORCID: https://orcid.org/0000-0003-4197-2060)
- Francesca Gaia Rossi (ORCID: https://orcid.org/0000-0003-1428-1838)
- Vittoria Tarantino (ORCID: https://orcid.org/0000-0003-3205-0566)
- Francesca Ricci
- Nicola Di Renzo (ORCID: https://orcid.org/0000-0003-0604-6934)
- Luca Nassi
- Stefano Luminari (ORCID: https://orcid.org/0000-0001-8446-2285)
- Luca Arcaini (ORCID: https://orcid.org/0000-0002-9504-991X)
- S. Peano
- Salvatrice Mancuso (ORCID: https://orcid.org/0000-0002-7926-090X)
- Antonio Pinto (ORCID: https://orcid.org/0000-0002-9425-9026)
- Carola Boccomini (ORCID: https://orcid.org/0000-0002-4155-403X)
- Massimo Federico (ORCID: https://orcid.org/0000-0002-9889-3796)
- Emanuele Cencini (ORCID: https://orcid.org/0000-0002-0432-9706)
- Annibale Versari (ORCID: https://orcid.org/0000-0002-8675-2435)
- Stéphane Chauvie (ORCID: https://orcid.org/0000-0003-4394-5031)
- Caterina Cecilia Stelitano (ORCID: https://orcid.org/0000-0002-1520-2970)
- Clara Mannarella
- Carla Minoia (ORCID: https://orcid.org/0000-0002-5707-0689)
- Paolo Corradini (ORCID: https://orcid.org/0000-0002-9186-1353)
- Caterina Bocci
- Rexhep Durmo (ORCID: https://orcid.org/0000-0001-9210-666X)
- Federico Fallanca (ORCID: https://orcid.org/0000-0001-7375-520X)
- Jacopo Olivieri (ORCID: https://orcid.org/0000-0002-2582-3500)
- Luigi Marcheselli
- Alessandro Pulsoni (ORCID: https://orcid.org/0000-0001-7429-8004)
- Angelo Palmas (ORCID: https://orcid.org/0000-0002-0410-9754)
- Adalberto Ibatici
- Pier Luigi Zinzani (ORCID: https://orcid.org/0000-0002-2112-2651)
- Antonella Anastasia
- Angelo Michele Carella (ORCID: https://orcid.org/0000-0002-6710-7393)
Institutions
- University of Siena (IT)
- University of Modena and Reggio Emilia (IT)
- Humanitas University (IT)
- Vita-Salute San Raffaele University (IT)
- University of Pavia (IT)
- Casa Sollievo della Sofferenza (IT)
- Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT)
- Azienda Sanitaria Unità Locale di Reggio Emilia (IT)
- L'organizzazione Ospedale di Civitanova M (IT)
- Azienda ospedaliera "Bianchi-Melacrino-Morelli" (IT)
- Ospedale Vincenzo Cervello (IT)
- Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT)
- Azienda Ospedaliera San Gerardo (IT)
- Azienda Ospedaliero-Universitaria Careggi (IT)
- Istituto di Ematologia di Bologna (IT)
- Fondazione Intergruppo Italiano Linfomi Onlus (IT)
- Istituto Tumori Bari (IT)
- Azienda Ospedaliera Universitaria Senese (IT)
- Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo (IT)
- Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" (IT)
- Ospedale Policlinico San Martino (IT)
- Ospedale Vito Fazzi (IT)
- Istituti di Ricovero e Cura a Carattere Scientifico (IT)
- Fondazione IRCCS Istituto Nazionale dei Tumori (IT)
- Gruppo Italiano per il Trapianto di Midollo Osseo (IT)
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT)
- University of Turin (IT)
- University of Milano-Bicocca (IT)
- Sapienza University of Rome (IT)
- University of Palermo (IT)
- University of Bologna (IT)
- Politecnico di Milano (IT)
Publication Details
- Journal
- American Journal of Hematology
- Published
- 2025-05-14
- DOI
- https://doi.org/10.1002/ajh.27711
- Citations
- 3
- Primary Topic
- Lymphoma Diagnosis and Treatment
- Type
- article
- Field-Weighted Citation Impact
- 4.41