Outcome Prediction in Patients With Large B-cell Lymphoma Undergoing Chimeric Antigen Receptor T-cell Therapy
Conrad-Amadeus Voltin,
Philipp Gödel,
Laura Beckmann,
Jan-Michel Heger,
Carsten Kobe,
Nadine Kutsch,
Peter Borchmann,
Markus Dietlein,
Ken Herrmann,
Matthias Stelljes,
Kambiz Rahbar,
Georg Lenz,
H. Christian Reinhardt,
Marcel Teichert,
Richard Noppeney,
Jörn C. Albring,
Robert Seifert,
Bastian von Tresckow,
Sarah Flossdorf,
Christine Hanoun
Affiliations
Conrad-Amadeus Voltin
1 Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
Philipp Gödel
2 First Department of Internal Medicine, Center for Integrated Oncology Aachen–Bonn–Cologne–Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
Laura Beckmann
2 First Department of Internal Medicine, Center for Integrated Oncology Aachen–Bonn–Cologne–Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
Jan-Michel Heger
2 First Department of Internal Medicine, Center for Integrated Oncology Aachen–Bonn–Cologne–Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
Carsten Kobe
1 Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
Nadine Kutsch
2 First Department of Internal Medicine, Center for Integrated Oncology Aachen–Bonn–Cologne–Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
Peter Borchmann
2 First Department of Internal Medicine, Center for Integrated Oncology Aachen–Bonn–Cologne–Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
Markus Dietlein
1 Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
Ken Herrmann
4 Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Matthias Stelljes
5 Department of Medicine A—Hematology, Oncology, and Pneumology, West German Cancer Center (WTZ), University Hospital Münster, University of Münster, Germany
Kambiz Rahbar
6 Department of Nuclear Medicine, University Hospital Münster, University of Münster, Germany
Georg Lenz
5 Department of Medicine A—Hematology, Oncology, and Pneumology, West German Cancer Center (WTZ), University Hospital Münster, University of Münster, Germany
H. Christian Reinhardt
3 Cologne Essen Lymphoma Working Group (CLWG), Cologne and Essen, Germany
Marcel Teichert
7 Department of Hematology and Stem Cell Transplantation, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Richard Noppeney
7 Department of Hematology and Stem Cell Transplantation, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Jörn C. Albring
5 Department of Medicine A—Hematology, Oncology, and Pneumology, West German Cancer Center (WTZ), University Hospital Münster, University of Münster, Germany
Robert Seifert
4 Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Bastian von Tresckow
3 Cologne Essen Lymphoma Working Group (CLWG), Cologne and Essen, Germany
Sarah Flossdorf
8 Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Christine Hanoun
7 Department of Hematology and Stem Cell Transplantation, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
The introduction of chimeric antigen receptor (CAR) T-cell therapy has led to a fundamental shift in the management of relapsed and refractory large B-cell lymphoma. However, our understanding of risk factors associated with non-response is still insufficient and the search for predictive biomarkers continues. Some parameters measurable on 18F-fluorodeoxyglucose positron emission tomography (PET) may be of additional value in this context. A total of 47 individuals from three German university centers who underwent re-staging with PET prior to CAR T-cell therapy were enrolled into the present study. After multivariable analysis considering tumor characteristics and patient factors that might affect progression-free survival (PFS), we investigated whether metabolic tumor volume (MTV) or maximum standardized uptake value (SUVmax) further improve risk stratification. Their most suitable cut-offs were determined by Cox and logistic regression. Forward selection identified extra-nodal disease as the most predictive factor of those routinely available, and we found it to be associated with significantly inferior overall survival after CAR T-cell treatment (P = 0.012). Furthermore, patients with MTV and SUVmax higher than the optimal threshold of 11 mL and 16.7, respectively, experienced shorter PFS (P = 0.016 and 0.002, respectively). Hence, these risk factors might be useful for selection of individuals likely to benefit from CAR T-cell therapy and their management.
