Prognostic Impact of 18F-FDG PET/CT in Patients With Aggressive B-Cell Lymphoma Treated With Anti-CD19 Chimeric Antigen Receptor T Cells

• Published in: Clinical nuclear medicine 2021-08, Vol.46 (8), p.627-634
• Main Authors: Sesques, Pierre, Tordo, Jérémie, Ferrant, Emmanuelle, Safar, Violaine, Wallet, Florent, Dhomps, Anthony, Brisou, Gabriel, Bouafia, Fadhela, Karlin, Lionel, Ghergus, Dana, Golfier, Camille, Lequeu, Helène, Lazareth, Anne, Vercasson, Marlène, Hospital-Gustem, Carole, Schwiertz, Vérane, Choquet, Marion, Sujobert, Pierre, Novelli, Silvana, Mialou, Valérie, Hequet, Olivier, Carras, Sylvain, Fouillet, Ludovic, Lebras, Laure, Guillermin, Yann, Leyronnas, Cécile, Cavalieri, Doriane, Janier, Marc, Ghesquières, Hervé, Salles, Gilles, Bachy, Emmanuel
• Format: Article
• Language: English
• ISSN: 0363-9762; 1536-0229
• DOI: 10.1097/RLU.0000000000003756

PURPOSE OF THE REPORTWe aimed to evaluate the role of 18F-FDG PET/CT in predicting patient outcome following chimeric antigen receptor T (CAR T) cells infusion in aggressive B-cell lymphoma. METHODS18F-FDG PET/CT data before leukapheresis, before CAR T-cell infusion and 1 month (M1) after CAR T-cell infusion, from 72 patients were retrospectively analyzed. SUVmax, total lesion glycolysis (TLG), metabolic tumor volume (MTV), and parameters describing tumor kinetics were calculated for each 18F-FDG PET/CT performed. The aim was to evaluate the prognostic value of 18F-FDG PET/CT metabolic parameters for predicting progression-free survival (PFS) and overall survival (OS) following CAR T-cell therapy. RESULTSRegarding PFS, ∆MTVpre-CAR and ∆TLGpre-CAR were found to be more discriminating compared with metabolic parameters at preinfusion. Median PFS in patients with a ∆MTVpre-CAR of less than 300% was 6.8 months (95% confidence interval [CI], 2.8 months to not reached) compared with 2.8 months (95% CI, 0.9-3.0 months) for those with a value of 300% or greater (P = 0.004). Likewise, median PFS in patients with ∆TLGpre-CAR of less than 420% was 6.8 months (95% CI, 2.8 months to not reached) compared with 2.7 months (95% CI, 1.3-3.0 months) for those with a value of 420% or greater (P = 0.0148). Regarding OS, metabolic parameters at M1 were strongly associated with subsequent outcome. SUVmax at M1 with a cutoff value of 14 was the most predictive parameter in multivariate analysis, outweighing other clinicobiological variables (P < 0.0001). CONCLUSIONSDisease metabolic volume kinetics before infusion of CAR T cells seems to be superior to initial tumor bulk itself for predicting PFS. For OS, SUVmax at M1 might adequately segregate patients with different prognosis.