Purpose

Follicular lymphoma (FL) is a heterogeneous B-cell lymphoma both in presentation and at progression. For most patients it is a chronic, relapsing indolent disease with overall survival expectations now potentially beyond 20 years. However, a significant minority (~20%) of patients experience early progression after treatment or histological transformation into aggressive lymphoma, and their disease has no longer an indolent behavior.

The Follicular Lymphoma International Prognostic Index (FLIPI) was the first prognostic index dedicated to FL. FLIPI separates three groups of patients with significant differences in overall survival (OS). However, FLIPI is not accurate enough to guide individual treatment decisions.

We hypothesize that combining quantitative PET features (radiomics; i.e. assessment of metabolic heterogeneity) in combination with FLIPI components will result in a better-performing prognostic index and allowing individualized estimates of probability of relapse and survival, as has been published by our PETRA Consortium for diffuse large B-cell lymphoma.

Objectives

  • To identify radiomics features and their temportal changes on FDG-PET to predict time-to-treatment in patients on the Wait and See approach

  • To adapt and implement a tumor burden delineation workflow at lesion and patient level

  • To identify where quantitative PET/CT data can guide treatment decisions to determine an individualized approach to first-line and second-line therapy

  • To develop a prediction model for tumor progression in FL patients

  • To evaluate the predictive capabilities of radiomic features in several (inter)national patient cohorts