Prognostic value of presalvage metabolic tumor volume in patients with relapsed/refractory diffuse large B-cell lymphoma

Abstract

Identification of new prognostic factors in relapsed/refractory (rel/ref) diffuse large B-cell lymphoma (DLBCL) is essential for developing risk-adapted approaches. We retrospectively analyzed prognostication based on metabolic tumor volume (MTV) in rel/ref DLBCL (n = 108) before platinum-based salvage chemotherapy. Using 41% SUVmax threshold, patients achieving complete response (CR) exhibited significantly lower baseline values of MTV, compared to those achieving partial response (PR) or with progression of disease (medians MTV 16.26 versus 72.51 versus 98.11 ml, respectively). As a continuous variable, log₂(MTV) was predictive of failure to achieve CR (1-unit increase odds ratio [OR] = 1.58, p < 0.001). Log₂(MTV) significantly predicted progression-free survival (PFS) and overall survival (OS), and one-unit increase in log₂(MTV) was associated with shorter PFS (hazard ratio [HR] = 1.12, p = 0.035) and OS (HR = 1.17, p = 0.007). However, heterogeneity in the selection of post-salvage chemotherapy approaches may have affected survival. These data demonstrate the ability of presalvage MTV to discriminate responders from non-responders to platinum-based chemotherapy and predict survival.

Keywords:

• Diffuse large B-cell lymphoma
• metabolic tumor volume
• platinum-based chemotherapy

Author contributions

J. P. A., R. A. K., I. S. L., and C. H. M. conceptualized and designed the study, collected the data, analyzed the data, and wrote the manuscript, P. B. C. and B. M. M. collected the data, A. B. and T. P. W. analyzed the data, F. M. , D. K., and I. M. R. analyzed the data and wrote the manuscript; all authors read and approved the final version of the manuscript.

Disclosure statement

J. P. A. has received honoraria from OncLive and Oncinfo, and has served on advisory board from ADC Therapeutics. An immediate family member has served on advisory boards from Puma Biotechnology, Inovio Pharmaceuticals, Agios Pharmaceuticals, Forma Therapeutics and Foundation Medicine. A. B. has received honoraria from Kite, a Gilead Company and has served on advisory board from Jazz and received research support from Gilead and ATARA. I. S. L. has served on advisory boards from Seattle Genetics, Janssen Scientific and Verastem. C. H. M. has served on advisory boards from ADC therapeutics, Incyte, Merck, Seattle Genetics, Molecular templates and has received research support from Merck and Seattle Genetics.

Additional information

Funding

J. P. A. is a K12 Scholar supported by the National Cancer Institute of the National Institutes of Health under Award Number K12CA226330. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. I. S. L. is supported by Grant 1R01CA233945 from the National Cancer Institute, the Dwoskin, and Anthony Rizzo Families Foundations and Jaime Erin Follicular Lymphoma Research Consortium.