传统与新型 [(18)F]FDG PET/CT 特征作为大 B 细胞淋巴瘤 CAR-T 细胞治疗结局的预测因素

Relapse and toxicity limit the effectiveness of chimeric antigen receptor T-cell (CAR-T) therapy for large B-cell lymphoma (LBCL), yet biomarkers that predict outcomes and toxicity are lacking.

We examined radiomic features extracted from pre-CAR-T 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ([ 18 F]FDG PET/CT) scans (n = 341) of 180 patients (121 male; median age, 66 years). Three conventional (maximum standardized uptake value [SUVmax], metabolic tumor volume [MTV], total lesion glycolysis [TLG]) and 116 novel radiomic features were assessed, along with inflammatory markers, toxicities, and outcomes. At both pre-apheresis and pre-infusion time points, conventional PET features of disease correlated with elevated inflammatory markers. At pre-infusion, MTV was associated with grade 2 cytokine release syndrome (odds ratio [OR] for 100 mL increase: 1. 08 [95% confidence interval (CI), 1. 01-1. 20], P = 0. 031), and SUVmax was associated with failure to achieve complete response (CR) (OR 1. 72 [95% CI, 1. 24-2. 43], P < 0.

001). Higher pre-apheresis and pre-infusion MTV values were associated with shorter progression-free survival (PFS) (HR for 10-unit increase: 1. 11 [95% CI, 1. 05-1. 17], P < 0. 001; 1. 04 [95% CI, 1. 02-1. 07], P < 0. 001) and shorter overall survival (HR for 100-unit increase: 1. 14 [95% CI, 1. 07-1. 21], P < 0. 001; 1. 04 [95% CI, 1. 02-1. 06], P < 0. 001). A combined MTV and LDH measure stratified patients into high and low PFS risk groups.

Multiple pre-infusion novel radiomic features were associated with CR. These quantitative conventional [ 18 F]FDG PET/CT features obtained before CAR-T cell infusion, which were correlated with inflammation markers, may provide prognostic biomarkers for CAR-T therapy efficacy and toxicity. The use of conventional and novel radiomic features may thus help identify high-risk patients for earlier interventions.