接受嵌合抗原受体T细胞疗法的弥漫性大B细胞淋巴瘤患者治疗后早期F-FDG PET/CT的预后价值

Prognostic value of early post-treatment F-FDG PET/CT in diffuse large B-cell lymphoma patients receiving chimeric antigen receptor T-cell therapy.

作者信息

Mirshahvalad Seyed Ali, Kohan Andres, Kulanthaivelu Roshini, Ortega Claudia, Metser Ur, Hodgson David, Kridel Robert, Chen Christine, Bhella Sita, Chin Kelly Yuen Wai, Veit-Haibach Patrick

机构信息

Joint Department of Medical Imaging, University Medical Imaging Toronto (UMIT), University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, Toronto, ON, Canada.

Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.

出版信息

Cancer Imaging. 2025 Jun 8;25(1):70. doi: 10.1186/s40644-025-00888-8.

DOI:10.1186/s40644-025-00888-8

PMID:40484967

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12147336/

Abstract

PURPOSE

To evaluate the prognostic value of early post-treatment F-FDG PET/CT in diffuse large B-cell lymphoma (DLBCL) patients undergoing chimeric antigen receptor T-cell (CAR-T) therapy.

METHODS

In this retrospective study, 159 patients referred for imaging prior to CAR-T therapy between January 2018 and May 2023 were reviewed. Of those, 51 with both baseline pre-infusion and one-month post-treatment F-FDG PET/CTs were included. F-FDG PET/CT parameters were derived, including standard uptake values (SUVs), metabolic tumour volume (MTV), total lesion glycolysis (TLG), and Dmax. Additionally, the delta changes from the baseline were calculated. Time to progression/death was documented. For progression-free survival (PFS) and overall survival (OS), univariate analysis was performed using the Kaplan-Meier method. The significance of the difference was measured using the Mantel-Cox log-rank test. Significant parameters entered the multiple Cox regression.

RESULTS

Overall, 51 patients (mean age = 56y) entered the study. All had Deauville scores of 4 (14/51; 28%) or 5 (37/51; 72%) at baseline. At one month, 28% of patients showed a complete metabolic response, while 72% had F-FDG-avid significant residual disease. Investigating those with residual disease, SUVmax, SUVpeak, SUVmax-to-Liver ratio and MTV were significantly lower in the one-month post-treatment scan. For PFS evaluation, serum LDH, one-month post-treatment SUVmax-to-liver ratio, one-month post-treatment TLG, and baseline Dmax entered the multivariate analysis. The one-month post-treatment SUVmax-to-liver ratio (Hazard ratio [HR] = 5.21; p = 0.004) and baseline Dmax (HR = 13.8; p = 0.013) retained significance, being independent predictors of PFS. For OS, serum LDH, delta SUVmean-to-liver ratio, delta percentage TLG, and one-month post-treatment Dmax were included in the multivariate analysis. The delta percentage TLG (HR = 4.37; p = 0.023) remained significant as an independent predictor of OS.

CONCLUSION

Early post-treatment F-FDG PET/CT can provide valuable prognostic information for DLBCL patients receiving CAR-T. The most significant predictors of outcomes would be the baseline extent of the disease, one-month post-treatment avidity, and changes in the metabolic burden from baseline.

摘要

目的

评估治疗后早期F-FDG PET/CT对接受嵌合抗原受体T细胞（CAR-T）治疗的弥漫性大B细胞淋巴瘤（DLBCL）患者的预后价值。

方法

在这项回顾性研究中，对2018年1月至2023年5月期间接受CAR-T治疗前接受影像学检查的159例患者进行了回顾。其中，51例患者同时有输注前基线和治疗后1个月的F-FDG PET/CT检查结果。得出F-FDG PET/CT参数，包括标准摄取值（SUV）、代谢肿瘤体积（MTV）、总病变糖酵解（TLG）和最大摄取值（Dmax）。此外，还计算了与基线相比的变化量。记录无进展生存期（PFS）和总生存期（OS）。采用Kaplan-Meier法进行单因素分析。使用Mantel-Cox对数秩检验测量差异的显著性。将有显著意义的参数纳入多因素Cox回归分析。

结果

总体而言，51例患者（平均年龄=56岁）纳入研究。所有患者基线时的Deauville评分为4分（14/51；28%）或5分（37/51；72%）。在1个月时，28%的患者显示出完全代谢缓解，而72%的患者有F-FDG摄取阳性的显著残留病灶。对有残留病灶的患者进行研究发现，治疗后1个月扫描时的SUVmax、SUVpeak、SUVmax与肝脏比值和MTV显著降低。对于PFS评估，血清乳酸脱氢酶（LDH）、治疗后1个月的SUVmax与肝脏比值、治疗后1个月的TLG和基线Dmax纳入多因素分析。治疗后1个月的SUVmax与肝脏比值（风险比[HR]=5.21；p=0.004）和基线Dmax（HR=13.8；p=0.013）仍具有显著性，是PFS的独立预测因素。对于OS，血清LDH、SUVmean与肝脏比值变化量、TLG变化百分比和治疗后1个月的Dmax纳入多因素分析。TLG变化百分比（HR=4.37；p=0.023）作为OS的独立预测因素仍具有显著性。