[18F]FDG PET-CT in patients with DLBCL treated with CAR-T cell therapy: a practical approach of reporting pre- and post-treatment studies

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...

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Bibliographic Details
Published in:European journal of nuclear medicine and molecular imaging 2022-02, Vol.49 (3), p.953-962
Main Authors: Cohen, Dan, Luttwak, Efrat, Beyar-Katz, Ofrat, Hazut Krauthammer, Shir, Bar-On, Yael, Amit, Odelia, Gold, Ronit, Perry, Chava, Avivi, Irit, Ram, Ron, Even-Sapir, Einat
Format: Article
Language:English
Subjects:
Antigens
B-cell lymphoma
Cardiology
CD19 antigen
Cell therapy
Cell- and Tissue-Based Therapy
Chimeric antigen receptors
Computed tomography
Fluorine isotopes
Fluorodeoxyglucose F18
Hematology
Humans
Imaging
Lymphocytes
Lymphocytes T
Lymphoma, Large B-Cell, Diffuse - drug therapy
Lymphoma, Large B-Cell, Diffuse - therapy
Mathematical analysis
Medical imaging
Medical prognosis
Medicine
Medicine & Public Health
Multivariate analysis
Nuclear Medicine
Oncology
Original Article
Orthopedics
Parameter identification
Patients
Positron emission
Positron emission tomography
Positron Emission Tomography Computed Tomography - methods
Prognosis
Radiology
Receptors, Chimeric Antigen - therapeutic use
Retrospective Studies
Therapy
Tomography
Toxicity
Transfusion
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Summary: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 [ 18 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   17.1 (HR 10.3; Pv   450 U/l (HR 7.7; Pv   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  
ISSN:1619-7070
1619-7089
DOI:10.1007/s00259-021-05551-5