The prognostic value of the tumor metabolic volume in predicting the response to therapy in patients with diffuse large B-cell lymphoma

Background. Metabolic tumor volume (MTV) is an insufficiently studied parameter of positron emission tomography, combined with computer tomography (PET/CT), which has been gaining increasing interest in modern oncology in recent years. It is important to use MTV as a prognostic marker in diffuse large B-cell lymphoma (DLBCL).

Aim. To analyze the results of therapy in patients with DLBCL and to identify their relationship with MTV, determined by PET/CT data before the start of treatment, after 2 and 6 courses of therapy.

Materials and methods. The prospective study included 80 patients with a morphologically verified diagnosis of DLBCL who were treated at the A.F. Tsyba Medical Radiological Research Center from 2021 to 2024. All patients underwent therapy using R-CHOP regimens (66.25 %) and R-CHOP-like regimens (33.75 %). Each of the patients underwent 3 PET/CT studies with MTV registration – at the staging stage, after 2 and after 6 treatment courses. The median follow-up was 19.5 (4.97–45.53) months. The survival rate was calculated using the Kaplan–Mayer technique, the MTV threshold values were calculated using ROC analysis taking into account the Yuden index.

Results. On the initial PET/CT, the threshold value of MTV was 37.12 cm3 (p = 0.006). In patients with a value above the threshold, failures of classical first-line therapy were statistically significantly more common. The threshold value of MTV in PET/CT after 2 courses of treatment was 19.15 cm3 (p = 0.032), in PET/CT after 6 courses – 8.73 cm3 (p = 0.028). In patients with an MTV value above the threshold, according to the results of PET/CT performed after the 2nd and 6th courses, cases of disease progression were also statistically significantly more frequent.

Conclusion. MTV is a new prognostic factor in modern oncological practice and should be evaluated in all patients with DLBCL and taken into account when making decisions regarding therapy tactics.

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