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[18F]FDG PET-CT in patients with DLBCL treated with CAR-T cell therapy: a practical approach of reporting pre- and post-treatment studies.
- Source :
- European Journal of Nuclear Medicine & Molecular Imaging; Feb2022, Vol. 49 Issue 3, p953-962, 10p, 4 Charts, 3 Graphs
- Publication Year :
- 2022
-
Abstract
- Purpose: The introduction of CD19-specific chimeric antigen receptor T-cell therapy (CAR-T) for treatment of relapsed/refractory diffuse large B cell lymphoma (R/R DLBCL) gives hope to patients with otherwise dismal prognosis. Therapy outcomes, however, depend upon selection of patients and accurate early identification of non-responders. Patients treated with CAR-T usually undergo [<superscript>18</superscript>F]FDG PET-CT at time of decision (TD), time of CAR-T transfusion (TT), 1 month (M1), and 3 months (M3) post-therapy. The purpose of the current study was to identify the specific parameters that should be addressed when reporting PET-CT studies in the clinical setting of CAR-T therapy. Methods: A total of 138 PET-CT scans (30 TD, 42 TT, 44 M1, 22 M3) of 48 patients treated with CAR-T were included. SUVmax, TMTV, and TLG were calculated in all scans. Response was assessed using the Deauville scale and ΔSUVmax method. Overall survival (OS) was the primary endpoint. Median follow-up was 12.8 (IQR 6.4–16.0) months from CAR-T infusion. Results: In a univariate analysis, TD-SUVmax > 17.1 and TT-SUVmax > 12.1 were associated with shorter OS (Pv < 0.05). In a multivariate analysis, three factors were significantly associated with shorter OS: TD-SUVmax > 17.1 (HR 10.3; Pv < 0.01), LDH > 450 U/l (HR 7.7; Pv < 0.01), and ECOG score > 1 (HR 5.5; Pv = 0.04). Data from TD and TT PET-CT scans were not predictive of toxicity. On M1-PET-CT, patients with a Deauville score > 3 had significantly shorter OS (median 7.9 months, versus not reached, Pv < 0.01). ΔSUVmax ≤ 66% on M1-PET-CT predicted shorter OS when M1-SUVmax was compared to TD-SUVmax (Pv = 0.02) but not to TT-SUVmax (Pv = 0.38). Conclusion: Pre-treatment SUVmax may guide patient selection for CAR-T therapy. On M1-PET-CT, Deauville score and ΔSUVmax from TD may identify early therapy failure. These parameters are easy to obtain and should be included in the PET-CT report. [ABSTRACT FROM AUTHOR]
- Subjects :
- PROGRESSION-free survival
DIFFUSE large B-cell lymphomas
B cell lymphoma
PATIENT selection
CELLULAR therapy
CHIMERIC antigen receptors
STATISTICS
MULTIVARIATE analysis
CELL receptors
CANCER patients
PRE-tests & post-tests
TREATMENT effectiveness
RADIOPHARMACEUTICALS
POSITRON emission tomography
SURVIVAL analysis (Biometry)
DESCRIPTIVE statistics
DEOXY sugars
COMPUTED tomography
T cells
Subjects
Details
- Language :
- English
- ISSN :
- 16197070
- Volume :
- 49
- Issue :
- 3
- Database :
- Complementary Index
- Journal :
- European Journal of Nuclear Medicine & Molecular Imaging
- Publication Type :
- Academic Journal
- Accession number :
- 154982431
- Full Text :
- https://doi.org/10.1007/s00259-021-05551-5