{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T07:52:12Z","timestamp":1772610732171,"version":"3.50.1"},"reference-count":54,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI19\/0003"],"award-info":[{"award-number":["PI19\/0003"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["FI24\/00294"],"award-info":[{"award-number":["FI24\/00294"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PT20\/00023"],"award-info":[{"award-number":["PT20\/00023"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Gilead Sciences","award":["GLD18\/00117"],"award-info":[{"award-number":["GLD18\/00117"]}]},{"DOI":"10.13039\/501100023561","name":"Ministerio de Universidades","doi-asserted-by":"crossref","award":["FPU21\/02671"],"award-info":[{"award-number":["FPU21\/02671"]}],"id":[{"id":"10.13039\/501100023561","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003030","name":"Ag\u00e8ncia de Gesti\u00f3 d\u2019Ajuts Universitaris i de Recerca","doi-asserted-by":"publisher","award":["2021SGR628"],"award-info":[{"award-number":["2021SGR628"]}],"id":[{"id":"10.13039\/501100003030","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Xarxa de Banc de Tumors de Catalunya"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Introduction: Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma. Approximately 20% of patients experience early relapse within 24 months (POD24) of immunochemotherapy (ICT), a subgroup associated with poor prognosis and not well-identified by current prognostic indices. Given that tumor mutational burden (TMB) has been associated with outcome in various cancers, we investigated its potential as a prognostic biomarker in FL. Methods: TMB was estimated by next-generation sequencing using a 409-gene panel in a cohort of 119 patients diagnosed with FL grades 1\u20133A and treated with frontline immunotherapy or ICT. Results: Although TMB was not associated with clinical variables in non-transformed FL patients, higher TMB values were observed in patients harboring the t(14;18) translocation, mutations in BCL2, TNFRSF14, or genes involved in cellular migration (GNA13, GNAI2). Notably, patients with high TMB (&gt;2.55 mutations per megabase) showed longer progression-free survival, lymphoma-specific survival, and overall survival, and had fewer mutations affecting the mTORC1 pathway. A higher proportion of POD24 patients was observed in the low TMB subgroup. In 25 paired diagnosis-relapse samples, TMB remained globally stable, although variations in the molecular landscape were observed. In addition, we analyzed TMB in a separate cohort of patients presenting transformed FL at diagnosis (n = 16). Higher TMB was also associated with the t(14;18) chromosomal translocation, but not with clinical features or survival. Conclusions: These findings support the potential of TMB as a prognostic biomarker in FL, providing molecular understanding beyond established clinical indices and aiding in the identification of patients at higher risk of early progression following ICT.<\/jats:p>","DOI":"10.3390\/cancers18050737","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T13:58:03Z","timestamp":1772114283000},"page":"737","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tumor Mutational Burden as a Prognostic Biomarker in Follicular Lymphoma"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2907-5049","authenticated-orcid":false,"given":"Marta","family":"Lafuente","sequence":"first","affiliation":[{"name":"Group of Applied Clinical Research in Hematology, Cancer Research Program Hospital del Mar Research Institute, 08003 Barcelona, Spain"},{"name":"Department of Medicine and Life Sciences, Pompeu Fabra University, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3137-3443","authenticated-orcid":false,"given":"Ram\u00f3n","family":"Diez-Feij\u00f3o","sequence":"additional","affiliation":[{"name":"Group of Applied Clinical Research in Hematology, Cancer Research Program Hospital del Mar Research Institute, 08003 Barcelona, Spain"},{"name":"Department of Medicine and Life Sciences, Pompeu Fabra University, 08003 Barcelona, Spain"},{"name":"Department of Hematology, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Garc\u00eda-Recio","sequence":"additional","affiliation":[{"name":"Department of Hematology, University Hospital Son Espases\/Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8185-9786","authenticated-orcid":false,"given":"Nieves","family":"Garcia-Gisbert","sequence":"additional","affiliation":[{"name":"Group of Applied Clinical Research in Hematology, Cancer Research Program Hospital del Mar Research Institute, 08003 Barcelona, Spain"},{"name":"Department of Pathology, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5853-0843","authenticated-orcid":false,"given":"Maria Concepci\u00f3n","family":"Fern\u00e1ndez-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Group of Applied Clinical Research in Hematology, Cancer Research Program Hospital del Mar Research Institute, 08003 Barcelona, Spain"},{"name":"Department of Pathology, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raquel","family":"Longar\u00f3n","sequence":"additional","affiliation":[{"name":"Group of Applied Clinical Research in Hematology, Cancer Research Program Hospital del Mar Research Institute, 08003 Barcelona, Spain"},{"name":"Department of Pathology, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junjie","family":"Ji","sequence":"additional","affiliation":[{"name":"Group of Applied Clinical Research in Hematology, Cancer Research Program Hospital del Mar Research Institute, 08003 Barcelona, Spain"},{"name":"Department of Medicine and Life Sciences, Pompeu Fabra University, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B\u00e1rbara","family":"Tazon-Vega","sequence":"additional","affiliation":[{"name":"Group of Applied Clinical Research in Hematology, Cancer Research Program Hospital del Mar Research Institute, 08003 Barcelona, Spain"},{"name":"Department of Pathology, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergio","family":"Pinz\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Hematology, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2612-0484","authenticated-orcid":false,"given":"Lierni","family":"Fern\u00e1ndez-Ibarrondo","sequence":"additional","affiliation":[{"name":"Group of Applied Clinical Research in Hematology, Cancer Research Program Hospital del Mar Research Institute, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Blanca","family":"S\u00e1nchez-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Group of Applied Clinical Research in Hematology, Cancer Research Program Hospital del Mar Research Institute, 08003 Barcelona, Spain"},{"name":"Department of Hematology, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Camacho","sequence":"additional","affiliation":[{"name":"Group of Applied Clinical Research in Hematology, Cancer Research Program Hospital del Mar Research Institute, 08003 Barcelona, Spain"},{"name":"Department of Pathology, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joan","family":"Gibert","sequence":"additional","affiliation":[{"name":"Group of Applied Clinical Research in Hematology, Cancer Research Program Hospital del Mar Research Institute, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9062-077X","authenticated-orcid":false,"given":"Antonio","family":"Gutierrez","sequence":"additional","affiliation":[{"name":"Department of Hematology, University Hospital Son Espases\/Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatriz","family":"Bellosillo","sequence":"additional","affiliation":[{"name":"Group of Applied Clinical Research in Hematology, Cancer Research Program Hospital del Mar Research Institute, 08003 Barcelona, Spain"},{"name":"Department of Medicine and Life Sciences, Pompeu Fabra University, 08003 Barcelona, Spain"},{"name":"Department of Pathology, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4652-4825","authenticated-orcid":false,"given":"Antonio","family":"Salar","sequence":"additional","affiliation":[{"name":"Group of Applied Clinical Research in Hematology, Cancer Research Program Hospital del Mar Research Institute, 08003 Barcelona, 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