In a new study, researchers validated a recently developed prognostic scoring system for use with patients who have aggressive large B-cell lymphoma (LBCL). In this analysis, the researchers found the tool to enable identification of patients with high-risk disease prior to starting first-line treatment. The study’s results were reported in the journal Blood Advances.

The prognostic tool combines 2 risk factors: total metabolic tumor volume (TMTV) >220 cm3, as determined by F18-fluorodeoxyglucose-positron emission tomography/computed tomography, and an Eastern Cooperative Oncology Group performance status (ECOG-PS) of ≥2. With inclusion of these 2 risk factors, the researchers had previously found the prognostic tool to be useful in identifying risk status in 301 older patients in the phase 3 REMARC study ( Identifier: NCT01122472) who had aggressive LBCL.

In the current study, the researchers evaluated the use of this prognostic tool in patients across 2 clinical trials and in real-world clinics. The clinical trials were the PETAL trial ( Identifier: NCT00554164) and the GOYA trial ( Identifier: NCT01287741). Patients of all ages with aggressive LBCL were included from these trial populations. Results were compared with those obtained using the International Prognostic Index (IPI).

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There were 2174 patients included in this study, of whom 510 were included in the PETAL trial, 1315 were in the GOYA trial, and 349 were patients of real-world clinics. The use of 3 risk categories showed significant discrimination in outcomes. The low-risk category was defined as having no risk factors, while the intermediate-risk category had 1 risk factor, and the high-risk category had 2 risk factors.

Across patients included in PETAL, GOYA, and real-world populations, the presence of 2 risk factors was linked to a worse outcome than the absence of any risk factors was. In patients of the PETAL trial, the presence of 2 risk factors, compared with no risk factors, was associated with a worse progression-free survival (PFS; hazard ratio [HR], 3.32 (95% CI, 2.00-5.50; P <.001) and worse overall survival (OS; HR, 3.85; 95%CI, 2.20-6.80; P <.001). In the GOYA population, similar results were seen for PFS (HR, 2.85; 95% CI, 2.11-3.84; P <.001) and OS (HR, 3.35; 95% CI, 2.34-4.78; P <.001). Likewise, for patients in the real-world series, results were similar with 2 risk factors for both PFS (HR, 3.85; 95% CI, 2.50-5.90; P <.001) and OS (HR, 4.61; 95% CI, 2.90-7.30; P <.001), compared with 0 risk factors.

Additionally, the researchers reported that, compared with low-risk status, intermediate-risk status was associated with significantly poorer outcomes. The researchers also determined that this prognostic model using TMTV and ECOG-PS scores performed better than the IPI did in some analyses.

The researchers concluded “the combination of TMTV and ECOG-PS is a reliable tool that may be used in complement to IPI with important clinical implications for upfront identification of those aggressive LBCL patients who can feasibly be implemented into studies exploring the efficacy of novel regimens directed at specific targets.”

Disclosures: Some authors have declared affiliations with or received grant support from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.


Thieblemont C, Chartier L, Duhrsen U, et al. A tumor volume and performance status model to predict outcome prior to treatment in diffuse large B-cell lymphoma. Blood Adv. Published online August 31, 2022. doi:10.1182/bloodadvances.2021006923