Despite the plethora of regimens and the chemosensitivity of aggressive B-cell lymphomas, many patients fail to respond well to treatment. These patients who relapse early or do not respond to first-line therapies, have a high mortality risk and are thus classified as ‘high-risk’ patients. A number of clinical, molecular and pathological parameters can predict patients with aggressive disease and poor survival outcomes. The risk factors include age, general patient fitness, genetic abnormalities, performance status, disease stage, and involvement of extranodal sites. 1
Non-Hodgkin lymphoma (NHL)
NHLs are a diverse group of haematological malignancies that include aggressive lymphomas Iike diffuse large B-cell lymphoma (DLBCL), as well as high-grade B-cell lymphoma (HGBL) with MYCand BCL2or BCL6rearrangements (double-hit), and indolent lymphomas, such as follicular lymphoma (FL). 1
Diffuse large B-cell lymphoma (DLBCL)
DLBCL is the most common type of aggressive NHL. Approximately 30% of patients with DLBCL do not respond to first-line treatment with the standard of care rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). 1The main aim of clinicians is to be able to identify early the patients that have a higher chance of failing treatment. To achieve this, multiple trials have sought to identify prognostic markers and establish risk-based protocols for the management of high-risk DLBCL patients.
The GOYA trial, a subanalysis of which was presented by Marek Trněnýin an interview with the Lymphoma Hub at the 2019 EHA meeting, is one such trial. In the analysis of the GOYA trial, investigators sought to identify high-risk DLBCL patients within 12 months of treatment, by measuring total metabolic tumor volume (TMTV). It was concluded that patients in the fourth quartile had a significantly higher risk of relapsing and a specific TMTV cut-off value for high-risk patients was identified.