Definitions and use of tumor bulk in phase 3 lymphoma trials: a comprehensive literature review Article Swipe
Luke Wang
,
Eliza Chung
,
Cameron Wellard
,
Allison Barraclough
,
Belinda A. Campbell
,
Geoffrey Chong
,
Pietro R Di Ciaccio
,
Gareth P. Gregory
,
Greg Hapgood
,
Anna Johnston
,
Constantine S. Tam
,
Stephen Opat
,
Erica M. Wood
,
Zoe McQuilten
,
Eliza A. Hawkes
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1182/bloodadvances.2024015072
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1182/bloodadvances.2024015072
Tumor “bulk” has historically been considered an important prognostic marker and a clinical tool to guide treatment in patients with lymphoma. However, its use and definitions in trial designs vary significantly, and it is unclear how this has influenced the relevance of bulk in contemporary practice. This comprehensive literature review evaluated the definitions, applications, and prognostic impact of bulk in phase 3 randomized trials in 4 major lymphoma subtypes. Overall, 87 studies were identified across follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), peripheral T-cell lymphoma (PTCL), and Hodgkin lymphoma (HL) with a wide range of bulk thresholds used (5 cm, 6 cm, 7 cm, 7.5 cm, 10 cm, and >1/3 mediastinal mass ratio [MMR]). The most common threshold was as follows: FL, 7 cm (58%); DLBCL, 7.5 cm and 10 cm (44% each); PTCL, 7.5 cm (66%); and HL, one-third MMR (91%). Bulk threshold was used by trials to determine eligibility (66%), stratification (24%), as a prognostic risk factor (37%), and as a decision tool for risk-adapted treatment, for example, radiotherapy (29%); however, bulk definitions used for these varied both between, and within, lymphoma subtypes and even within single trials in 25%. Furthermore, 32 studies incorporated bulk in prognostic analyses with only 5 showing significance for differential survival outcomes. Our analysis demonstrates high inconsistency in thresholds defining tumor bulk and use of bulk in phase 3 lymphoma trials across eligibility, stratification, therapeutic risk adaptation, and prognostication. This highlights an urgent need for international consensus on definitions of bulk within trials to improve its prognostic and predictive values and refine its application in clinical practice.
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Metadata
- Type
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- Language
- en
- Landing Page
- https://doi.org/10.1182/bloodadvances.2024015072
- https://ashpublications.org/bloodadvances/article-pdf/doi/10.1182/bloodadvances.2024015072/2352623/bloodadvances.2024015072.pdf
- OA Status
- gold
- Cited By
- 2
- References
- 114
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4406573195
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4406573195Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1182/bloodadvances.2024015072Digital Object Identifier
- Title
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Definitions and use of tumor bulk in phase 3 lymphoma trials: a comprehensive literature reviewWork title
- Type
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reviewOpenAlex work type
- Language
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enPrimary language
- Publication year
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2025Year of publication
- Publication date
-
2025-01-18Full publication date if available
- Authors
-
Luke Wang, Eliza Chung, Cameron Wellard, Allison Barraclough, Belinda A. Campbell, Geoffrey Chong, Pietro R Di Ciaccio, Gareth P. Gregory, Greg Hapgood, Anna Johnston, Constantine S. Tam, Stephen Opat, Erica M. Wood, Zoe McQuilten, Eliza A. HawkesList of authors in order
- Landing page
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https://doi.org/10.1182/bloodadvances.2024015072Publisher landing page
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https://ashpublications.org/bloodadvances/article-pdf/doi/10.1182/bloodadvances.2024015072/2352623/bloodadvances.2024015072.pdfDirect link to full text PDF
- Open access
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YesWhether a free full text is available
- OA status
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goldOpen access status per OpenAlex
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https://ashpublications.org/bloodadvances/article-pdf/doi/10.1182/bloodadvances.2024015072/2352623/bloodadvances.2024015072.pdfDirect OA link when available
- Concepts
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Lymphoma, Medicine, Oncology, Clinical trial, Internal medicine, Computational biology, Cancer research, Bioinformatics, BiologyTop concepts (fields/topics) attached by OpenAlex
- Cited by
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2Total citation count in OpenAlex
- Citations by year (recent)
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2025: 2Per-year citation counts (last 5 years)
- References (count)
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114Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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