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<p>Early identification of relapsing/refractory diffuse large B-cell lymphoma (DLBCL) represents an unmet clinical need. A real-life cohort of newly diagnosed DLBCL (<i>n </i>= 120) treated with R-CHOP was investigated. Using the standardized uptake value (SUV) threshold of 4.0, PET/CT radiomics variables (SUVmax, tMTV, tTLG and Dmax) were collected. Circulating tumor DNA (ctDNA) analysis by CAPP-seq yielded baseline ctDNA levels and LymphGen molecular clustering. The best cut-off for both PET/CT parameters and ctDNA levels were identified by max-stat statistics. tMTV, tTLG and Dmax retained independent prognostic value when adjusted for ctDNA levels and were grouped together in a variable named high-risk PET. By multivariate analysis, ctDNA-high and high-risk PET independently predicted PFS and were combined into a 2-factor prognostic model (C-indices: 0.712 for PFS and 0.696 for OS). Molecular clustering, by capturing high-risk biological features of DLBCL, further improved outcome prediction. Consistently, BN2/EZB/ST2 clusters maintained an independent association with better PFS when adjusted for the 2-factor model variables and were therefore included in a 3-factor prognostic score (C-indices: 0.745 for PFS and 0.746 for OS), that identified a very high-risk group of patients (<i>n </i>= 22, 40-month PFS 12.1%) which should be prioritized for early response evaluation and for access to novel agents.</p>

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Integration of [18F]FDG-PET radiomics with liquid biopsy improves outcome prediction in newly diagnosed diffuse large B-cell lymphoma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月8日

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  • Riccardo Dondolin,
  • Federico Garrou,
  • Mohammad Almasri,
  • Lodovico Terzi Di Bergamo,
  • Chiara Cosentino,
  • Alessio Bruscaggin,
  • Matin Salehi,
  • Donatella Talotta,
  • Riccardo Bruna,
  • Giulia Maria Rivolta,
  • Matteo Bellia,
  • Jana Nabki,
  • Bashar Al Deeban,
  • Luca Cividini,
  • Samir Mouhssine,
  • Nawar Maher,
  • Joseph Ghanej,
  • Francesca Maiellaro,
  • Annalisa Andorno,
  • Francesca Mercalli,
  • Monica Leutner,
  • Angela Lorenzi,
  • Abdurraouf Mokhtar Mahmoud,
  • Wael Al Essa,
  • Ndeye Marie Diop,
  • Eleonora Secomandi,
  • Clara Deambrogi,
  • Silvia Rasi,
  • Renzo Luciano Boldorini,
  • Massimo Gentile,
  • Giuseppe Alberto Palumbo,
  • Valter Gattei,
  • Robin Foà,
  • Davide Rossi,
  • Gian Mauro Sacchetti,
  • Gianluca Gaidano,
  • Riccardo Moia

摘要

Early identification of relapsing/refractory diffuse large B-cell lymphoma (DLBCL) represents an unmet clinical need. A real-life cohort of newly diagnosed DLBCL (n = 120) treated with R-CHOP was investigated. Using the standardized uptake value (SUV) threshold of 4.0, PET/CT radiomics variables (SUVmax, tMTV, tTLG and Dmax) were collected. Circulating tumor DNA (ctDNA) analysis by CAPP-seq yielded baseline ctDNA levels and LymphGen molecular clustering. The best cut-off for both PET/CT parameters and ctDNA levels were identified by max-stat statistics. tMTV, tTLG and Dmax retained independent prognostic value when adjusted for ctDNA levels and were grouped together in a variable named high-risk PET. By multivariate analysis, ctDNA-high and high-risk PET independently predicted PFS and were combined into a 2-factor prognostic model (C-indices: 0.712 for PFS and 0.696 for OS). Molecular clustering, by capturing high-risk biological features of DLBCL, further improved outcome prediction. Consistently, BN2/EZB/ST2 clusters maintained an independent association with better PFS when adjusted for the 2-factor model variables and were therefore included in a 3-factor prognostic score (C-indices: 0.745 for PFS and 0.746 for OS), that identified a very high-risk group of patients (n = 22, 40-month PFS 12.1%) which should be prioritized for early response evaluation and for access to novel agents.