Department of Hematology, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain.
Ann Hematol. 2021 Sep;100(9):2303-2310. doi: 10.1007/s00277-021-04560-6. Epub 2021 Jul 8.
Chimeric antigen receptor (CAR) T-cell therapy provides long-term remissions in patients with relapsed or refractory (R/R) large B-cell lymphoma (LBCL). Total metabolic tumor volume (TMTV) assessed by 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET) has a confirmed prognostic value in the setting of chemoimmunotherapy, but its predictive role with CAR T-cell therapy is not fully established. Thirty-five patients with R/R LBCL who received CAR T-cells were included in the study. TMTV and maximum standardized uptake value (SUVmax) were measured at baseline and 1-month after CAR T-cell infusion. Best response included 9 (26%) patients in complete metabolic response (CMR) and 16 (46%) in partial metabolic response (PMR). At a median follow-up of 7.6 months, median PFS and OS were 3.4 and 8.2 months, respectively. A high baseline TMTV (≥ 25 cm) was associated with a lower PFS (median PFS, 2.3 vs. 8.9 months; HR = 3.44 [95% CI 1.18-10.1], p = 0.02). High baseline TMTV also showed a trend towards shorter OS (HR = 6.3 [95% CI 0.83-47.9], p = 0.08). Baseline SUVmax did not have a significant impact on efficacy endpoints. TMTV and SUVmax values showed no association with adverse events. Metabolic tumor burden parameters measured by 18FDG-PET before CAR T-cell infusion can identify LBCL patients who benefit most from this therapy.
嵌合抗原受体 (CAR) T 细胞疗法可为复发或难治性 (R/R) 大 B 细胞淋巴瘤 (LBCL) 患者提供长期缓解。在化疗免疫治疗中，18F-氟脱氧葡萄糖正电子发射断层扫描 (18FDG-PET) 评估的总代谢肿瘤体积 (TMTV) 具有明确的预后价值，但在 CAR T 细胞治疗中的预测作用尚未完全确定。本研究纳入了 35 例接受 CAR T 细胞治疗的 R/R LBCL 患者。在 CAR T 细胞输注前和输注后 1 个月测量 TMTV 和最大标准化摄取值 (SUVmax)。最佳反应包括 9 例（26%）完全代谢缓解 (CMR) 和 16 例（46%）部分代谢缓解 (PMR)。在中位随访 7.6 个月时，中位 PFS 和 OS 分别为 3.4 和 8.2 个月。高基线 TMTV（≥25 cm）与较低的 PFS 相关（中位 PFS，2.3 与 8.9 个月；HR=3.44[95%CI 1.18-10.1]，p=0.02）。高基线 TMTV 也显示出 OS 较短的趋势（HR=6.3[95%CI 0.83-47.9]，p=0.08）。基线 SUVmax 对疗效终点没有显著影响。TMTV 和 SUVmax 值与不良事件没有关联。CAR T 细胞输注前 18FDG-PET 测量的代谢肿瘤负荷参数可识别从这种治疗中获益最大的 LBCL 患者。
