基线 [(18)F]FDG PET/CT 对接受 CAR-T 细胞治疗的 DLBCL 患者不良事件的预测价值

Objectives : Evaluation of the predictive potential of pre-CAR-T [ 18 F]FDG PET/CT in Diffuse Large B-Cell Lymphoma (DLBCL) patients concerning Cytokine Release Syndrome (CRS) and Immune Effector Cell-associated Neurotoxicity Syndrome (ICANS). Methods : Eighteen DLBCL patients (mean age: 60 12 years) who underwent pre-therapeutic [ 18 F]FDG-PET/CT and CAR-T cell therapy were retrospectively included. Median follow-up time was ten months (IQR6-16) after CAR-T cell infusion. Age, sex, serum lactate dehydrogenase (LDH), interleukin-6 (IL-6), C-reactive protein (CRP), and modified Endothelial Activation and Stress Index (mEASIX) were obtained. Potential occurrence of CRS/ICANS and the SUV max were evaluated. Pearson and Spearman correlations, group comparisons (Mann-Whitney U-test) and the odds ratio (OR) were calculated.

P values below 0. 05 were defined as statistically significant and 95%-confidence intervals (CI) were calculated. Results : Pre-therapeutic SUV max correlated positively with LDH (r = 0. 5; p = 0. 02), with the grade of CRS (r = 0. 5; p = 0. 03) and with the grade of ICANS (r = 0. 6; p = 0. 01). Appearance of ICANS was significantly correlated with pre-therapeutic SUV max ( p = 0. 03; U = 7. 0; Z = -2. 2).

Using ROC analysis and Youden's index, an SUV max threshold of 17 (AUC: 0. 865; p < 0. 01) was defined. Patients exceeding a pre-therapeutic SUV max of 17 had a significantly higher risk of CRS grade > 1 (OR = 22; CI 2, 314; p = 0. 03) and ICANS grade > 1 (OR = 18; CI 1, 271; p = 0. 04). Conclusions : Pre-therapeutic SUV max may be a useful marker for identifying DLBCL patients at risk for CRS and ICANS.