Journal of Hematology & Oncology (Apr 2024)

Conventional and novel [18F]FDG PET/CT features as predictors of CAR-T cell therapy outcome in large B-cell lymphoma

  • Doris Leithner,
  • Jessica R. Flynn,
  • Sean M. Devlin,
  • Audrey Mauguen,
  • Teng Fei,
  • Shang Zeng,
  • Junting Zheng,
  • Brandon S. Imber,
  • Harper Hubbeling,
  • Marius E. Mayerhoefer,
  • Akshay Bedmutha,
  • Efrat Luttwak,
  • Magdalena Corona,
  • Parastoo B. Dahi,
  • Alejandro Luna de Abia,
  • Ivan Landego,
  • Richard J. Lin,
  • M. Lia Palomba,
  • Michael Scordo,
  • Jae H. Park,
  • Ana Alarcon Tomas,
  • Gilles Salles,
  • Daniel Lafontaine,
  • Laure Michaud,
  • Gunjan L. Shah,
  • Miguel-Angel Perales,
  • Roni Shouval,
  • Heiko Schöder

DOI
https://doi.org/10.1186/s13045-024-01540-x
Journal volume & issue
Vol. 17, no. 1
pp. 1 – 5

Abstract

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Abstract Relapse and toxicity limit the effectiveness of chimeric antigen receptor T-cell (CAR-T) therapy for large B-cell lymphoma (LBCL), yet biomarkers that predict outcomes and toxicity are lacking. We examined radiomic features extracted from pre-CAR-T 18F-fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) scans (n = 341) of 180 patients (121 male; median age, 66 years). Three conventional (maximum standardized uptake value [SUVmax], metabolic tumor volume [MTV], total lesion glycolysis [TLG]) and 116 novel radiomic features were assessed, along with inflammatory markers, toxicities, and outcomes. At both pre-apheresis and pre-infusion time points, conventional PET features of disease correlated with elevated inflammatory markers. At pre-infusion, MTV was associated with grade ≥ 2 cytokine release syndrome (odds ratio [OR] for 100 mL increase: 1.08 [95% confidence interval (CI), 1.01–1.20], P = 0.031), and SUVmax was associated with failure to achieve complete response (CR) (OR 1.72 [95% CI, 1.24–2.43], P < 0.001). Higher pre-apheresis and pre-infusion MTV values were associated with shorter progression-free survival (PFS) (HR for 10-unit increase: 1.11 [95% CI, 1.05–1.17], P < 0.001; 1.04 [95% CI, 1.02–1.07], P < 0.001) and shorter overall survival (HR for 100-unit increase: 1.14 [95% CI, 1.07–1.21], P < 0.001; 1.04 [95% CI, 1.02–1.06], P < 0.001). A combined MTV and LDH measure stratified patients into high and low PFS risk groups. Multiple pre-infusion novel radiomic features were associated with CR. These quantitative conventional [18F]FDG PET/CT features obtained before CAR-T cell infusion, which were correlated with inflammation markers, may provide prognostic biomarkers for CAR-T therapy efficacy and toxicity. The use of conventional and novel radiomic features may thus help identify high-risk patients for earlier interventions.

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