A low total metabolic tumor volume independently predicts for a longer time to first treatment in initially observed, low tumor burden follicular lymphoma

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Cited 3 times in Scopus logo

Cited 4 times in Web of Science logo

Cited 5 times in Europe PMC logo

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This study was supported by Fondo de Investigaciones Sanitarias, Instituto de Salud Carlos III and European Regional Development Fund Una manera de hacer Europa [grant numbers: PI19/00925 (LM), PI19/00887 (ALG and EG)].

Analysis of institutional authors

Mozas, PCorresponding AuthorRivero, AAuthorRivas-Delgado, AAuthorNadeu, FAuthorCorrea, JgAuthorPineyroa, JaAuthorPerez-Valencia, AiAuthorGomez-Hernando, MAuthorGine, EAuthorDelgado, JAuthorVillamor, NAuthorCampo, EAuthorMagnano, LAuthorLopez-Guillermo, AAuthorSetoain, XAuthor

December 19, 2023

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Article

Publicated to:Hematological Oncology. 42 (1): e3235- - 2024-01-01 42(1), DOI: 10.1002/hon.3235

Authors: Mozas, Pablo; Casanueva-Eliceiry, Sebastian; Rivero, Andrea; Serna, Angel; Simo, Marc; Rodriguez, Sonia; Rivas-Delgado, Alfredo; Nadeu, Ferran; Correa, Juan Gonzalo; Pineyroa, Juan Antonio; Perez-Valencia, Amanda Isabel; Guinetti-Ortiz, Katia; Gomez-Hernando, Marta; Gine, Eva; Delgado, Julio; Villamor, Neus; Campo, Elias; Magnano, Laura; Setoain, Xavier; Lopez-Guillermo, Armando

Affiliations

Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain. - Author

Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain. - Author

Ctr Invest Biomed Red Bioingn Biomat & Nanomed CIB, Madrid, Spain - Author

Ctr Invest Biomed Red Canc CIBERONC, Madrid, Spain - Author

Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain. - Author

Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain. - Author

Department of Hematology, Hospital Universitari Vall D'Hebron, Barcelona, Spain. - Author

Department of Nuclear Medicine, Hospital Clínic de Barcelona, Barcelona, Spain. - Author

Department of Nuclear Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain. - Author

Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain. - Author

Hematopathology Unit, Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Spain. - Author

Hosp Clin Barcelona, Dept Hematol, Barcelona, Spain - Author

Hosp Clin Barcelona, Dept Nucl Med, Barcelona, Spain - Author

Hosp Clin Barcelona, Dept Pathol, Hematopathol Unit, Barcelona, Spain - Author

Hosp Clin Barcelona, Dept Radiol, Barcelona, Spain - Author

Hosp Univ Vall dHebron, Dept Nucl Med, Barcelona, Spain - Author

Hosp Universitari Vall dHebron, Dept Hematol, Barcelona, Spain - Author

Inst Invest Biomed August Pi i Sunyer IDIBAPS, Barcelona, Spain - Author

Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. - Author

Univ Barcelona, Fac Med & Ciencies Salut, Dept Med, Barcelona, Spain - Author

Abstract

Watchful waiting is an acceptable management strategy for advanced-stage, low tumor burden (LTB) patients with follicular lymphoma (FL). However, the prediction of how long this treatment-free observation period will last remains imperfect. We explored whether total metabolic tumor volume (TMTV) and other positron emission tomography parameters were predictive of time to first treatment (TTFT). We analyzed 97 grade 1-3A advanced-stage LTB FL patients and found that a high TMTV was associated with other tumor burden features at diagnosis. Patients with a TMTV above our established cutoff of 50 mL had a significantly shorter median duration of observation (2.6 vs. 8.8 years; p = 0.001). At 5 years, 77% of patients with a high TMTV and 46% of patients with a low TMTV required treatment. In the multivariable analysis, a high TMTV was the only independent factor predicting TTFT (hazard ratio = 2.09; p = 0.017). Overall, TMTV is a strong predictor of the duration of observation in LTB FL patients. Upon validation of our cutoff in external series and standardization of the methodology, the TMTV could become an additional factor to consider deferring or initiating treatment in otherwise LTB patients.

Keywords

AdultAdvanced-stageArticleBendamustineBeta 2 microglobulinBone cancerBone marrowCancer combination chemotherapyCancer diagnosisCancer gradingCancer stagingCancer survivalCellsClinical featureCohort analysisCyclophosphamideCyclophosphamide plus doxorubicin plus prednisolone plus rituximab plus vincristineCytopeniaExternal validityFdg-petFemaleFirst-line treatmentFluorodeoxyglucose f 18Fluorodeoxyglucose f18Follicular lymphomaFollicular lymphoma international prognostic indexGuidelinesHemoglobinHigh risk patientHistologyHumanHumansImage analysisIodinated contrast mediumLactate dehydrogenaseLactate dehydrogenase blood levelLow-dose computed tomographyLymph node metastasisLymphoma, follicularMajor clinical studyMaleMaximum standardized uptake valueMean standardized uptake valueMetabolic tumor volumeNon-hodgkin-lymphomaPolicyPositron emission tomography computed tomographyPositron emission tomography-computed tomographyPredictionPrednisolonePrima prognostic indexProceduresPrognosisPrognostic assessmentProgression free survivalProportional hazards modelProportional hazards modelsRecommendationsRetrospective studiesRetrospective studyRituximabStandardizationStandardized uptake valueSurvival rateTherapy delayTime to first treatmentTime to treatmentTotal metabolic tumor volumeTreatment responseTrialTumor burdenTumor volumeVincristineWatchWatchful waiting

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Hematological Oncology due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2024 there are still no calculated indicators, but in 2023, it was in position 23/98, thus managing to position itself as a Q1 (Primer Cuartil), in the category Hematology.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 3.84, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-20, the following number of citations:

WoS: 4
Scopus: 3
Europe PMC: 5

Impact and social visibility

Leadership analysis of institutional authors

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Mozas Fernández, Pablo) .