基线循环肿瘤 DNA 与总代谢肿瘤体积作为侵袭性大 B 细胞淋巴瘤的早期结局预测指标：一项真实世界 112 例患者队列

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.