Prognostic value of tumor bulk in modern management of common lymphoma subtypes: an Australasian Lymphoma and Related Diseases Registry study

Chung, E; Ciaccio, PD; Wang, L; Wellard, C; Barraclough, A; Campbell, BA; Chong, G; Gregory, GP; Hapgood, G; Johnston, AM; Tam, CS; Opat, S; Wood, EM; McQuilten, ZK; Hawkes, EA

Author(s): Chung, E; Ciaccio, PD; Wang, L; Wellard, C; Barraclough, A; Campbell, BA; Chong, G; Gregory, GP; Hapgood, G; Johnston, AM; Tam, CS; Opat, S; Wood, EM; McQuilten, ZK; Hawkes, EA;
Details: Publication Year 2026-03-01,Volume 111,Issue #3,Page 1007-1016
Journal Title: Haematologica
Publication Type: Research article
Abstract: The presence of a single large site of disease or so-called tumor 'bulk' in lymphoma has been variably associated with outcomes and influenced management decisions. However, challenges arise in using bulk as a prognosticator due to varied definitions across different lymphoma subtypes but also within studies of each subtype, increased utility of positron emission tomography in decision-making and recent incorporation of novel therapies. We analyzed data from the Australasian Lymphoma Registry regarding presence and influence of bulk on outcomes and treatment decisions in six key subtypes: diffuse large B-cell, follicular, marginal zone, T-cell, Hodgkin and Burkitt lymphoma. Of the 5,090 eligible patients identified between 2016-2025, 88% had documented information on the presence of bulk (registry definition >5 cm). Patients with bulk were more likely to receive systemic chemotherapy alone, and less likely to have localized treatment alone (radiotherapy and/or surgery), compared to those without bulk. Bulk was associated with inferior overall survival in patients with diffuse large B-cell lymphoma, and superior overall survival in those with Hodgkin lymphoma, in the univariate analyses. Exploratory analyses using disease-specific bulk definitions from clinicians practicing in Australia and New Zealand showed inferior progression-free survival in patients with diffuse large B-cell lymphoma (bulk >7.5 cm) and inferior overall survival in those with Burkitt lymphoma (bulk >10 cm), but not other subtypes. We demonstrated real-world evidence of management heterogeneity for patients with bulk, with potential prognostic implications. International standardization of the definition of bulk is urged for uniform utility in positron emission tomography-based and molecular prognostication across clinical studies. Trial registered with the Australian New Zealand Clinical Trials Registry: ANZCTRN12617000050358.
Publisher: Ferrata-Storti Foundation
Keywords: Humans; Registries; Prognosis; Female; Male; Middle Aged; Australia/epidemiology; Aged; Adult; *Lymphoma/therapy/mortality/diagnosis/pathology/epidemiology; Disease Management; Adolescent; Young Adult; Aged, 80 and over
Department(s): Radiation Oncology
Publisher's Version: https://doi.org/10.3324/haematol.2025.287919
Open Access at Publisher's Site: https://doi.org/10.3324/haematol.2025.287919
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2025-10-10 06:00:19

Last Modified: 2026-03-12 02:07:42