Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Department of Hematology, Hemostasis, Oncology and Stem-Cell Transplantation, Hannover, Germany.
Ann Nucl Med. 2021 Jan;35(1):132-138. doi: 10.1007/s12149-020-01544-w. Epub 2020 Nov 11.
The interplay between systemic inflammation, activity of lymphoid organs and lymphoma activity in CD19-targeting chimeric antigen receptor (CAR)-T-cell immunotherapy, and its significance for response and toxicity, is not well defined.
Using serial F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), metabolic parameters of lymphoma and lymphoid organs were analyzed in ten patients receiving Tisagenlecleucel (an autologous CD19 CAR-T cell product) for relapsed or refractory diffuse large B-cell lymphoma. The prevalence and severity of toxicity (e.g., neurotoxicity) were noted.
Achieving remission required early metabolic response (P = 0.0476). Early suppression of metabolic activity of lymphoid organs (spleen, P = 0.0368; lymph nodes, P = 0.0470) was associated with poor outcome. Lymphoma metabolic activity was significantly higher in patients with neurotoxicity (P = 0.0489).
Early metabolic changes in lymphoma lesions and off-target lymphoid organs parallel medium-term response to CAR-T-cell therapy. PET can identify patients at risk for severe toxicity.
在 CD19 靶向嵌合抗原受体 (CAR)-T 细胞免疫疗法中，全身炎症、淋巴器官活性与淋巴瘤活性之间的相互作用及其对反应和毒性的意义尚不清楚。
采用连续 F-氟脱氧葡萄糖 (FDG) 正电子发射断层扫描/计算机断层扫描 (PET/CT)，分析 10 例接受Tisagenlecleucel（一种自体 CD19 CAR-T 细胞产品）治疗复发或难治性弥漫性大 B 细胞淋巴瘤患者的淋巴瘤和淋巴器官的代谢参数。记录毒性（如神经毒性）的发生率和严重程度。
达到缓解需要早期代谢反应（P=0.0476）。早期抑制淋巴器官（脾脏，P=0.0368；淋巴结，P=0.0470）的代谢活性与不良预后相关。神经毒性患者的淋巴瘤代谢活性明显更高（P=0.0489）。
淋巴瘤病灶和非靶标淋巴器官的早期代谢变化与 CAR-T 细胞治疗的中期反应平行。PET 可识别发生严重毒性的风险患者。
