TY - JOUR
T1 - Metabolic characteristics and prognostic differentiation of aggressive lymphoma using one-month post-CAR-T FDG PET/CT
AU - Breen, William G.
AU - Hathcock, Matthew A.
AU - Young, Jason R.
AU - Kowalchuk, Roman O.
AU - Bansal, Radhika
AU - Khurana, Arushi
AU - Bennani, N. Nora
AU - Paludo, Jonas
AU - Villasboas Bisneto, Jose C.
AU - Wang, Yucai
AU - Ansell, Stephen M.
AU - Peterson, Jennifer L.
AU - Johnston, Patrick B.
AU - Lester, Scott C.
AU - Lin, Yi
N1 - Funding Information:
JP received research funding from Karyopharm unrelated to this work. YW received research funding from Incyte, InnoCare, LOXO Oncology, Novartis, Genentech, and MorphoSys, and is on advisory committees for Eli Lilly and TG Therapeutics, all unrelated this work. SMA received research funding from Bristol Myers Squibb, ADC Therapeutics, Seattle Genetics, Regeneron, Affimed, AI Therapeutics, Pfizer, Trillium, and Takeda, all unrelated to this work. YL provided consultancy and received grant support from Kite/Gilead, Celgene/BMS, Bluebird Bio, Janssen, Legend BioTech, and Takeda. YL also provided consultancy for Juno/BMS, Gamida Cells, Iovance, Fosun Kite, and Pfizer. YL also received grant support from Merck and Boston Scientific. YL also provided data review for Sorrento and Pfizer, and served on the scientific advisory committee for NexImmune. All funds were paid to the institution with no personal compensation.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: F-18 fluorodeoxyglucose positron emission tomography computed tomography (PET/CT) is used to assess response of non-Hodgkin lymphoma (NHL) to chimeric antigen receptor T cell (CAR-T) therapy. We sought to describe metabolic and volumetric PET prognostic factors at one month post-CAR-T and identify which patients with partial response (PR) or stable disease (SD) are most likely to subsequently achieve complete response (CR), and which will develop progressive disease (PD) and death. Methods: Sixty-nine patients with NHL received axicabtagene ciloleucel CAR-T therapy. One-month post-CAR-T infusion and PET/CT scans were segmented with a fixed absolute SUV maximum (SUVMax) threshold of 2.5 using a semiautomated workflow with manual modification to exclude physiologic uptake as needed. Metabolic tumor volume (MTV), total lesion glycolysis (TLG), SUVMax, and other lesion characteristics were calculated and associated with risk of PD and death. Results: Patients with total MTV > 180 cc, presence of bone or parenchymal disease, SUVMax > 10, single lesion TLG > 245 g, or > 2 total lesions had increased risk of death. Patients with total MTV > 55 cc, total TLG > 250 cc, SUV Max > 10, or > 2 total lesions had increased risk of PD. For the subset of 28 patients with PR/SD, higher SUVMax was associated with increased risk of subsequent PD and death. While 86% of patients who had SUVMax ≥ 10 eventually had PD (HR 3.63, 1.13–11.66, p = 0.03), only 36% of those with SUVMax < 10 had PD. Conclusions: Higher SUVMax at one month post-CAR-T is associated with higher risk of PD and death. SUVMax ≥ 10 may be useful in guiding early salvage treatment decisions in patients with SD/PR at one month.
AB - Background: F-18 fluorodeoxyglucose positron emission tomography computed tomography (PET/CT) is used to assess response of non-Hodgkin lymphoma (NHL) to chimeric antigen receptor T cell (CAR-T) therapy. We sought to describe metabolic and volumetric PET prognostic factors at one month post-CAR-T and identify which patients with partial response (PR) or stable disease (SD) are most likely to subsequently achieve complete response (CR), and which will develop progressive disease (PD) and death. Methods: Sixty-nine patients with NHL received axicabtagene ciloleucel CAR-T therapy. One-month post-CAR-T infusion and PET/CT scans were segmented with a fixed absolute SUV maximum (SUVMax) threshold of 2.5 using a semiautomated workflow with manual modification to exclude physiologic uptake as needed. Metabolic tumor volume (MTV), total lesion glycolysis (TLG), SUVMax, and other lesion characteristics were calculated and associated with risk of PD and death. Results: Patients with total MTV > 180 cc, presence of bone or parenchymal disease, SUVMax > 10, single lesion TLG > 245 g, or > 2 total lesions had increased risk of death. Patients with total MTV > 55 cc, total TLG > 250 cc, SUV Max > 10, or > 2 total lesions had increased risk of PD. For the subset of 28 patients with PR/SD, higher SUVMax was associated with increased risk of subsequent PD and death. While 86% of patients who had SUVMax ≥ 10 eventually had PD (HR 3.63, 1.13–11.66, p = 0.03), only 36% of those with SUVMax < 10 had PD. Conclusions: Higher SUVMax at one month post-CAR-T is associated with higher risk of PD and death. SUVMax ≥ 10 may be useful in guiding early salvage treatment decisions in patients with SD/PR at one month.
KW - CAR-T
KW - Non-Hodgkin lymphoma
KW - PET/CT
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UR - http://www.scopus.com/inward/citedby.url?scp=85127237801&partnerID=8YFLogxK
U2 - 10.1186/s13045-022-01256-w
DO - 10.1186/s13045-022-01256-w
M3 - Letter
C2 - 35346315
AN - SCOPUS:85127237801
VL - 15
JO - Journal of Hematology and Oncology
JF - Journal of Hematology and Oncology
SN - 1756-8722
IS - 1
M1 - 36
ER -