Baseline total metabolic tumor volume (TMTV) is associated with treatment outcomes for patients with high-tumor-burden follicular lymphoma, according to a study published in the Journal of Clinical Oncology.1

It is difficult to identify patients at high risk of progression and early mortality using current prognostic models. Researchers assessed the prognostic impact of TMTV measured at baseline with [18F]fluorodeoxyglucose/positron emission tomography-computed tomography ([18F]FDG/PET-CT) scans among patients with follicular lymphoma.

Investigators conducted a pooled analysis using data from 185 patients with follicular lymphoma who received immunochemotherapy as part of 3 prospective clinical trials. Of those, 92% 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.

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Median follow-up was 64 months; overall 5-year progression-free survival and overall survival were 55% and 92%, respectively.

The 29% of patients with TMTV at baseline greater than 510 cm3 had substantially reduced survival [hazard ratio [HR] for 5-year overall survival, 3.45; P = .010). These patients also had a nearly 3-fold higher risk of progression at 5 years (HR, 2.90; P < .001).

RELATED: Baseline Metabolic Tumor Volume Predicts Prognosis of Follicular Lymphoma

After adjusting for confounding factors, TMTV (HR, 2.3; P = .002) and FLIPI2 score (HR, 2.2; P = .002) were independent predictors of progression-free survival. In combination with FLIPI2 score, TMTV identifies patients at high risk of disease progression.                 


  1. Meignan M, Cottereau AS, Versari A, et al. Baseline metabolic tumor volume predicts outcome in high–tumor-burden follicular lymphoma: a pooled analysis of three multicenter studies. J Clin Oncol. 2016 Aug 22. doi: 10.1200/JCO.2016.66.9440 [Epub ahead of print]