Clinical Epidemiology and Ageing

Baseline circulating tumour DNA and total metabolic tumour volume as early outcome predictors in aggressive large B-cell lymphoma. A real-world 112-patient cohort.

Le Goff E, Blanc-Durand P, Roulin L, Lafont C, Loyaux R, MBoumbae D-L, Benmaad I, Claudel A, Poullot E, Robe C, Gricourt G, Aissat A, Copie-Bergman C, Lemonnier F, Gaulard P, Itti E, Haioun C, Delfau-Larue M-H Br J Haematol. 2023;202(1):54-64.

Approximately 20%-50% of patients with large B-cell lymphoma (LBCL) experience poor outcomes. We aimed to evaluate the combined prognostic value of circulating tumour DNA (ctDNA) and total metabolic tumour volume (TMTV) in LBCL. This observational single-centre study included 112 newly diagnosed LBCL patients, receiving R-CHOP/R-CHOP-like chemotherapies. CtDNA load was calculated following next-generation sequencing of cell-free DNA (cfDNA) using a targeted 40-gene lymphopanel. TMTV was measured using a fully automated artificial intelligence-based method for lymphoma lesion segmentation. CtDNA was detected in cfDNA samples from 95 patients with a median concentration of 3.15 log haploid genome equivalents per mL. TMTV measurements were available for 102 patients. The median TMTV was 501 mL. High ctDNA load (>3.57 log hGE/mL) or high TMTV (>200 mL) were associated with shorter 1-year PFS (44% vs. 83%, p < 0.001 and 64% vs. 97%, p = 0.002, respectively). When combined, three prognostic groups were identified. The shortest PFS was observed when both TMTV and ctDNA load were high (p < 0.001). Even with a short follow up, combining ctDNA load with TMTV improved the risk stratification of patients with aggressive LBCL. In the near future, very high-risk patients could benefit from CAR T-cell therapy or bispecific antibodies as first-line treatments.

MeSH terms: Artificial Intelligence; Circulating Tumor DNA; Fluorodeoxyglucose F18; Humans; Lymphoma, Large B-Cell, Diffuse; Positron Emission Tomography Computed Tomography; Prognosis; Retrospective Studies; Tumor Burden
DOI: 10.1111/bjh.18809