CAR-T（CAR-T）细胞疗法在非肿瘤性疾病中的应用
Chimeric antigen receptor T (CAR-T) cell therapy in non-oncological diseases.
CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
CAR-T 细胞治疗期间淋巴瘤分期：影像学缓解标准间不一致的原因
英文原题：Staging of lymphoma under chimeric antigen receptor T-cell therapy: reasons for discordance among imaging response criteria.
查看英文原题
Staging of lymphoma under chimeric antigen receptor T-cell therapy: reasons for discordance among imaging response criteria.
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研究概要
在 CAR-T 治疗后，淋巴瘤疗效评价标准在影像学终点上存在差异，尤其是在界定 PD 时。
中文摘要
背景
CAR-T 细胞治疗（CAR-T）可延长难治或复发淋巴瘤患者生存。近期研究显示，不同淋巴瘤 CAR-T 疗效评估标准之间存在差异。本研究旨在评估不同疗效评估标准不一致的原因及其与总生存期的关系。
方法
纳入 CAR-T 后第 30 天（FU1）和第 90 天（FU2）具有基线及随访影像的连续患者。依据 Lugano、Cheson、淋巴瘤疗效评估标准（RECIL）和免疫调节治疗淋巴瘤疗效标准（LYRIC）确定总体反应，分析总缓解率（ORR）和疾病进展（PD）率，并详细分析各标准判定 PD 的原因。
结果
共纳入 41 例患者。FU2 时，Lugano、Cheson、RECIL 和 LYRIC 标准的 ORR 分别为 68%、68%、63% 和 68%。不同标准判定的 PD 率不同：Lugano 为 32%，Cheson 为 27%，RECIL 和 LYRIC 均为 17%。按 Lugano 判定 PD 的主要原因包括靶病灶（TL）进展（84.6%）、新病灶（NL）出现（53.8%）、非靶病灶进展（27.3%）及代谢性疾病进展（PMD；15.4%）。不同标准在 PD 判定上的差异主要由既存病灶 PMD 及非靶病灶进展造成；前者只有 Lugano 定义为 PD，后者不被 RECIL 判为 PD，且在部分病例中 LYRIC 判定为未确定反应。
结论
CAR-T 后淋巴瘤疗效评估标准的影像终点存在差异，尤其在 PD 判定方面。解读影像终点和临床试验结局时，必须考虑所采用的评估标准。
展开英文摘要原文
BACKGROUND
Chimeric antigen receptor T-cell therapy (CART) prolongs survival for patients with refractory or relapsed lymphoma. Discrepancies among different response criteria for lymphoma under CART were recently shown. Our objective was to evaluate reasons for discordance among different response criteria and their relation to overall survival.
METHODS
Consecutive patients with baseline and follow-up imaging at 30 (FU1) and 90 days (FU2) after CART were included. Overall response was determined based on Lugano, Cheson, response evaluation criteria in lymphoma (RECIL) and lymphoma response to immunomodulatory therapy criteria (LYRIC). Overall response rate (ORR) and rates of progressive disease (PD) were determined. For each criterion reasons for PD were analyzed in detail.
RESULTS
41 patients were included. ORR was 68%, 68%, 63%, and 68% at FU2 by Lugano, Cheson, RECIL, and LYRIC, respectively. PD rates differed among criteria with 32% by Lugano, 27% by Cheson, 17% by RECIL, and 17% by LYRIC. Dominant reasons for PD according to Lugano were target lesion (TL) progression (84.6%), new appearing lesions (NL; 53.8%), non-TL progression (27.3%), and progressive metabolic disease (PMD; 15.4%). Deviations among the criteria for defining PD were largely explained by PMD of preexisting lesions that are defined as PD only by Lugano and non-TL progression, which is not defined as PD by RECIL and in some cases classified as indeterminate response by LYRIC.
CONCLUSIONS
Following CART, lymphoma response criteria show differences in imaging endpoints, especially in defining PD. The response criteria must be considered when interpreting imaging endpoints and outcomes from clinical trials.
论文信息
- 作者
- Winkelmann M、Blumenberg V、Rejeski K、Bücklein VL、Ingenerf M、Unterrainer M、Schmidt C、Dekorsy FJ
- 第一作者单位
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.Germany
- 通讯作者单位
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. wolfgang.kunz@med.lmu.de.Germany
- 期刊
- Cancer imaging : the official publication of the International Cancer Imaging Society2023 May 15
- 原文标识
- PubMed 37189191 · DOI 10.1186/s40644-023-00566-7
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