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Purpose <p>Total metabolic tumor volume (TMTV) at baseline becomes a key biomarker in several lymphoma subtypes. Variability in segmentation methods such as 41%SUVmax and SUVmax &gt; 4 has limited its clinical application. Additionally, immune-checkpoint-inhibitors introduced challenges in response assessment due to pseudoprogression, complicating the use of traditional metrics. This study investigates the prognostic impact of baseline- and residual-TMTV and introduces a novel personalized-liver-based-threshold (pTMTV<sub>liver</sub>) to enhance precision in patient stratification.</p> Methods <p>We analyzed 91 patients with relapsed/refractory diffuse-large-B-cell lymphoma and follicular lymphoma from the GATA trial, comparing patient’s outcome according to three segmentation methods: TMTV<sub>41%</sub>, TMTV<sub>4</sub>, and pTMTV<sub>liver</sub>. pTMTV<sub>liver</sub> used a threshold of 200%SUVmean<sub>liver</sub> aligning with 125%SUVmax<sub>liver</sub> to enhance standardization and reduce variability.</p> Results <p>Baseline-TMTV significantly influenced prognosis with higher TMTV correlating with shorter PFS and OS (<i>p</i> &lt; 0.0001 for all methods). Residual-TMTV, particularly with pTMTV<sub>liver</sub> and TMTV<sub>4</sub>, stratified no-CMR patients with the lowest predictive errors and better predictive accuracy compared to TMTV<sub>41%</sub> Multivariate analyses confirmed residual-pTMTV<sub>liver</sub> as superior for prognostic performance for PFS (HR:5.10; C-index:0.724) and OS (HR:4.00; C-index:0.853) compared to TMTV<sub>4</sub> and Deauville Score (DS). The DS alone did not fully capture the heterogeneity of outcomes of DS4-5 patients.</p> Conclusion <p>Baseline- and residual-TMTV strongly influence prognosis and response in lymphoma patients. The novel personalized pTMTV<sub>liver</sub> method offers improved accuracy of patient stratification, particularly for those with DS4-5, providing more reliable risk assessment. Larger cohorts are needed to validate these findings and optimize residual-TMTV-based clinical applications.</p>

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Personalized baseline and residual TMTV influence treatment response and outcomes in relapsed/refractory lymphomas: results from the GATA study

  • 期刊论文

  • 发表日期：

    2025年2月22日

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  • Solène Malmon,
  • Olivier Casasnovas,
  • Marguerite Fournier,
  • Guillaume Cartron,
  • Salim Kanoun,
  • Anne Ségolène Cottereau,
  • Charles Herbaux,
  • Yassine Al Tabaa

摘要

Purpose

Total metabolic tumor volume (TMTV) at baseline becomes a key biomarker in several lymphoma subtypes. Variability in segmentation methods such as 41%SUVmax and SUVmax > 4 has limited its clinical application. Additionally, immune-checkpoint-inhibitors introduced challenges in response assessment due to pseudoprogression, complicating the use of traditional metrics. This study investigates the prognostic impact of baseline- and residual-TMTV and introduces a novel personalized-liver-based-threshold (pTMTVliver) to enhance precision in patient stratification.

Methods

We analyzed 91 patients with relapsed/refractory diffuse-large-B-cell lymphoma and follicular lymphoma from the GATA trial, comparing patient’s outcome according to three segmentation methods: TMTV41%, TMTV4, and pTMTVliver. pTMTVliver used a threshold of 200%SUVmeanliver aligning with 125%SUVmaxliver to enhance standardization and reduce variability.

Results

Baseline-TMTV significantly influenced prognosis with higher TMTV correlating with shorter PFS and OS (p < 0.0001 for all methods). Residual-TMTV, particularly with pTMTVliver and TMTV4, stratified no-CMR patients with the lowest predictive errors and better predictive accuracy compared to TMTV41% Multivariate analyses confirmed residual-pTMTVliver as superior for prognostic performance for PFS (HR:5.10; C-index:0.724) and OS (HR:4.00; C-index:0.853) compared to TMTV4 and Deauville Score (DS). The DS alone did not fully capture the heterogeneity of outcomes of DS4-5 patients.

Conclusion

Baseline- and residual-TMTV strongly influence prognosis and response in lymphoma patients. The novel personalized pTMTVliver method offers improved accuracy of patient stratification, particularly for those with DS4-5, providing more reliable risk assessment. Larger cohorts are needed to validate these findings and optimize residual-TMTV-based clinical applications.