Combining Total Metabolic Tumor Volume With Beta-2-Microglobulin Levels Predicts Outcomes in High-Burden Follicular Lymphoma Patients

We aimed to explore the predictive value of total metabolic tumor volume (TMTV) and beta-2-microglobulin (B2M) levels in patients with follicular lymphoma (FL) with a high tumor burden receiving standard first-line immunochemotherapy. We analyzed 125 patients with the following characteristics: median age, 61 years (55; 67), advanced-stage disease, 88.8%; high FLIPI, 49.6%; TMTV, > 510 cm³; B2M, > 3 mg/L (24.8%); and R-CHOP-like treatment, 86.4%. We defined the following categories: low-risk (36%), TMTV ≤ 510 cm³ and B2M ≤ 3 mg/L; intermediate-risk (45.6%), TMTV > 510 cm³ or B2M > 3 mg/L; and high-risk (18.4%), TMTV > 510 cm³ and B2M > 3 mg/L. The 5-year overall survival rates were estimated to be 96.1%, 89.1% and 73.7% for low-, intermediate- and high-risk patients, respectively (p = 0.003). Patients at intermediate and high risk according to the TMTV/B2M score were at high risk of disease progression within 24 months of treatment initiation (HR = 2.45 [95% CI: 1.23–4.85] and HR = 3.75 [95% CI: 1.7–8.2], respectively). This TMTV/B2M score may identify patients with the highest unmet medical needs.