Conventional and novel [(18)F]FDG PET/CT features as predictors of CAR-T cell therapy outcome in large B-cell lymphoma Journal Article
| Authors: | Leithner, D.; Flynn, J. R.; Devlin, S. M.; Mauguen, A.; Fei, T.; Zeng, S.; Zheng, J.; Imber, B. S.; Hubbeling, H.; Mayerhoefer, M. E.; Bedmutha, A.; Luttwak, E.; Corona, M.; Dahi, P. B.; Luna de Abia, A.; Landego, I.; Lin, R. J.; Palomba, M. L.; Scordo, M.; Park, J. H.; Tomas, A. A.; Salles, G.; Lafontaine, D.; Michaud, L.; Shah, G. L.; Perales, M. A.; Shouval, R.; Schöder, H. |
| Article Title: | Conventional and novel [(18)F]FDG PET/CT features as predictors of CAR-T cell therapy outcome in large B-cell lymphoma |
| 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. © The Author(s) 2024. |
| Keywords: | cancer survival; controlled study; aged; major clinical study; overall survival; clinical feature; positron emission tomography; letter; progression free survival; tumor marker; prediction; high risk patient; disease severity; immunotherapy; biomarker; lymphoma; fluorodeoxyglucose f 18; clinical effectiveness; glycolysis; apheresis; clinical outcome; cytokine release syndrome; diffuse large b cell lymphoma; metabolic tumor volume; maximum standardized uptake value; cancer prognosis; total lesion glycolysis; human; male; female; car-t; radiomics; positron emission tomography-computed tomography; chimeric antigen receptor t-cell immunotherapy |
| Journal Title: | Journal of Hematology & Oncology |
| Volume: | 17 |
| ISSN: | 1756-8722 |
| Publisher: | Biomed Central Ltd |
| Date Published: | 2024-04-23 |
| Start Page: | 21 |
| Language: | English |
| DOI: | 10.1186/s13045-024-01540-x |
| PROVIDER: | scopus |
| PMCID: | PMC11035117 |
| PUBMED: | 38649972 |
| DOI/URL: | |
| Notes: | Letter -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Roni Shouval -- Source: Scopus |
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