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Metabolic tumor volume (MTV) is a quantitative biomarker of tumor burden and has been shown to predict treatment response. This study investigates the association between MTV at baseline PET and health-related quality of life (HRQoL) across different disease stages.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This post-hoc analysis included 441 patients with newly diagnosed cHL and available baseline PET imaging, enrolled in the GHSG trials HD16, HD17, and HD18. MTV was quantified using a fixed threshold of SUV\u2009\u2265\u20094.0 (SUV4.0) via the LifeX Analytics workstation. HRQoL was assessed using the EORTC QLQ-C30 questionnaire at baseline and, for HD18 patients, again at 2-year follow-up. Multiple regression models adjusted for sex, age, and trial\/stage were used for statistical analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Higher MTV was associated with higher baseline HRQoL burden across several domains: fatigue (\u03b2\u2009=\u20090.14, 95% CI [0.05; 0.24]), dyspnea (\u03b2\u2009=\u20090.21, 95% CI [0.11; 0.30]), appetite loss (\u03b2\u2009=\u20090.13, 95% CI [0.03; 0.23]), and sleep disturbance (\u03b2\u2009=\u20090.12, 95% CI [0.02; 0.22]). In contrast, higher MTV was negatively associated with physical functioning (\u03b2\u2009=\u2009\u20130.18, 95% CI [\u20130.27; \u20130.08]) and global health status (\u03b2\u2009=\u2009\u20130.15, 95% CI [\u20130.25; \u20130.06]). The strongest associations were observed in patients with advanced-stage disease (HD18). At 2-year follow-up in HD18, no associations between MTV at baseline and HRQoL were found, with the exception of pain, which remained the only associated domain (\u03b2\u2009=\u20090.15, 95% CI [0.00; 0.30]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Baseline MTV is strongly associated with HRQoL before therapy in patients with newly diagnosed cHL, particularly in those with advanced-stage disease. Reassuringly, there seems to be no major influence of initial disease burden on HRQoL within the second year of recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov: HD16 (NCT00736320; first posted August 15, 2008), HD17 (NCT01356680; first posted May 19, 2011), HD18 (NCT00515554; first posted August 13, 2007).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00259-025-07569-5","type":"journal-article","created":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T08:53:50Z","timestamp":1760172830000},"page":"1847-1855","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association between metabolic tumor burden and health-related quality of life in patients with classic Hodgkin lymphoma"],"prefix":"10.1007","volume":"53","author":[{"given":"Marie","family":"Lommen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jasmin J.","family":"Weindler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janina","family":"Jablonski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Rosenbrock","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Borchmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karolin","family":"Behringer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katrin S.","family":"Roth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominic","family":"Ufton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Dietlein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carsten","family":"Kobe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3481-7997","authenticated-orcid":false,"given":"Justin","family":"Ferdinandus","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,11]]},"reference":[{"key":"7569_CR1","doi-asserted-by":"publisher","first-page":"3020","DOI":"10.1016\/j.acra.2023.12.016","volume":"31","author":"H Knaup","year":"2024","unstructured":"Knaup H, Weindler J, van Heek L, Voltin CA, Fuchs M, Borchmann P, et al. 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No individual patient data is presented in this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}},{"value":"JF reports honoraria from Takeda Oncology and Roche. DU reports research funding by the Collaborative Research Centre 1451 (Sonderforschungsbereich 1451). PB reports institutional grants, honoraria, and travel support from Takeda Oncology. KB reports honoraria from Takeda. All other authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}