Total Lesion Glycolysis Improves Tumor Burden Evaluation and Risk Assessment at Diagnosis in Hodgkin Lymphoma

Abstract

Hodgkin lymphoma (HL) is a hematological malignancy with an excellent prognosis. However, we still need to identify those patients that could experience failed standard frontline chemotherapy. Tumor burden evaluation and standard decisions are based on Ann Arbor (AA) staging, but this approach may be insufficient in predicting outcomes. We aim to study new ways to assess tumor burden through volume-based PET parameters to improve the risk assessment of HL patients. We retrospectively analyzed 101 patients with HL from two hospitals in the Balearic Islands between 2011 and 2018. Higher metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were significantly associated with a higher incidence of III-IV AA stages, B-symptoms, hypoalbuminemia, lymphopenia, and higher IPS. Standardized uptake value (SUVmax) was significantly related to AA stage and hypoalbuminemia. We found that TLG or the combination of SUVmax, TLG, and MTV significantly improved the risk assessment when compared to AA staging. We conclude that TLG is the best single PET/CT-related tumor-load parameter that significantly improves HL risk assessment when compared to AA staging. If confirmed in a larger and validated sample, this information could be used to modify standard frontline therapy and justifies the inclusion of TLG inside an HL prognostic score.

Baseline metabolic tumour burden improves risk stratification in Hodgkin lymphoma: A Children's Oncology Group study

“…However, PET volumetric parameters are associated with prognosis, even when controlling for LMA 8,12 . Other research suggests that bPET quantitative metrics are superior to Ann Arbor staging for risk stratification 17 . Thus, bPET‐based measures of total body tumour volume provide additional prognostic information beyond Ann Arbor stage and the presence of LMA.…”

“…Thus, TLG 2.5 was defined as MTV 2.5 × SUV mean of MTV 2.5 , and TLG 40% was defined as MTV 40% × SUV mean of MTV 40% . These thresholds have been used commonly for segmentation in lymphomas 7–11,13–20 …”

“…These thresholds have been used commonly for segmentation in lymphomas. [7][8][9][10][11][13][14][15][16][17][18][19][20] Only regions of focal FDG-avidity within extranodal sites were considered to be disease; for example, if the spleen or bone marrow were diffusely FDG-avid but had no focal findings on other imaging studies (e.g. CT, MRI, ultrasound), they were not considered to be involved by lymphoma.…”

Classical Hodgkin Lymphoma: A Joint Clinical and PET Model to Predict Poor Responders at Interim Assessment

“…Recent studies in the literature propose other clinical and PET/CT-derived markers for response to treatment [ 7 , 8 , 9 ], event-free survival [ 10 , 11 ], progression-free survival, and overall survival [ 12 , 13 , 14 ] prediction. 18 F-FDG PET/CT textural and radiomic features were also demonstrated to be useful tools in lymphoma for histological prediction, prognostic assessment, and bone marrow involvement definition.…”

Lymphoma: New Diagnosis and Current Treatment Strategies

“…The identification of high-risk patients before start of treatment is still a particular challenge. In the Special Issue, Herraez et al report a retrospective survey assessing the tumor burden though volume-based PET parameters instead of using the Ann Arbor classification technique [ 5 ]. They found that a higher metabolic tumor volume and total lesion glycolysis (TLG) were significantly associated with a higher incidence of stages III–IV, B-symptoms, hypoalbuminemia, and lymphopenia, and a higher international prognostic score.…”