ArticleHaematologica2026
Prognostic value of tumor bulk in modern management of common lymphoma subtypes: an Australasian Lymphoma and Related Diseases Registry study.
Article in Haematologica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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