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.
CAR-T（CAR-T）细胞在血液系统恶性肿瘤中的应用推动了这种免疫治疗形式的显著进展。
CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
最大肿瘤播散 (Dmax) 对接受 CD19 特异性 CAR-T 细胞治疗的淋巴瘤患者的预测价值
英文原题：Predictive value of maximum tumor dissemination (Dmax) in lymphoma patients treated with CD19-specific CAR T-Cells.
查看英文原题
Predictive value of maximum tumor dissemination (Dmax) in lymphoma patients treated with CD19-specific CAR T-Cells.
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研究概要
Dmax 高的患者 PFS 较短，但 OS 无显著差异。Dmax 是表征肿瘤播散的有用参数，由于其具有等距量表特性，也可纳入评分系统。
研究思路结论见上方概要
目的
CD19特异性CAR-T 细胞疗法（CAR-T）已成为复发/难治性（r/r）淋巴瘤的有效治疗方法。淋巴瘤病灶的最大距离（Dmax）在传统治疗的淋巴瘤中具有作为预后影像生物标志物的潜力，但在CAR-T 背景下的证据仍然稀缺，需要进一步研究以阐明其临床相关性。我们评估了基线影像中的Dmax作为评估代谢和总体反应、无进展生存期（PFS）和总生存期（OS）的潜在预后工具。材料与方法
方法
连续纳入在淋巴细胞清除前及随后CAR-T 细胞输注前接受基线（BL）（PET/）CT成像的r/r淋巴瘤患者。Dmax在BL时以cm为单位测量。根据Dmax将患者按三分位数分为三个等大小的组。在基线时计算Ann Arbor分期，并使用乘积直径之和（SPD）代表肿瘤负荷（TB）。根据Lugano标准和Deauville评分确定的总体缓解在第90天PET/CT成像时进行评估。
结果
39例患者符合纳入标准。基线时中位Dmax为40.0 cm（IQR：16.4-70.3 cm）。中位TB从基线的4,095 mm²下降至随访影像时的770 mm²。Dmax中高组基线中位TB显著高于Dmax低组（p = 0.005），分别为7,222 mm²（IQR：3,355-11,941 mm²）、4,649 mm²（IQR：2,376-10,406 mm²）和1,739 mm²（IQR：715-7,402 mm²）。Dmax中高组显示出显著更高的Ann Arbor分期（p < 0.001）。生存分析显示，Dmax高组相比其他患者PFS显著更短（p = 0.030）（91 vs. 364天），但OS无相关差异（p = 0.151）。
展开英文摘要原文
OBJECTIVES
CD19-specific chimeric antigen receptor T-cell therapy (CART) has emerged as effective treatment for relapsed or refractory (r/r) lymphoma. The maximum distance (Dmax) of lymphoma lesions holds potential as prognostic imaging biomarker in lymphoma treated with conventional therapies, but evidence in the context of CART remains scarce and further studies are needed to clarify its clinical relevance. We evaluated Dmax at baseline imaging as a potential prognostic tool for assessment of metabolic and overall response, progression-free survival (PFS) and overall survival (OS). MATERIAL &
METHODS
Consecutive r/r lymphoma patients with (PET/)CT imaging at baseline (BL) before lymphodepletion and subsequent CAR T-cell transfusion were included. Dmax was measured in cm at BL. Patients were divided by tertiles into three equal sized groups according to Dmax. Ann Arbor stages were calculated at baseline and the sum of product diameters (SPD) was used to represent tumor burden (TB). Overall response according to Lugano criteria and the Deauville score were determined at day 90 PET/CT imaging.
RESULTS
Thirty-nine patients met the inclusion criteria. Median Dmax was 40.0 cm (IQR: 16.4-70.3 cm) at BL. Median TB decreased from BL with 4,095 mm 2 to 770 mm 2 at FU imaging. Median TB at BL was significantly higher in the Dmax intermediate and high group compared to the Dmax low group (p = 0.005) with 7,222 mm 2 (IQR: 3,355-11,941 mm 2 ), 4,649 mm 2 (IQR: 2,376-10,406 mm 2 ) and 1,739 mm 2 (IQR: 715-7,402 mm 2 ), respectively. Dmax intermediate and high group showed significantly higher Ann Arbor stages (p < 0.001). The survival analysis revealed a significantly (p = 0.030) shorter PFS in the Dmax high group compared to the other patients (91 vs. 364 days), but no relevant differences in OS (p = 0.151).
CONCLUSIONS
Patients with high Dmax showed a shorter PFS, but no significant differences in OS. Dmax is a useful parameter for characterizing tumor dissemination, which could also be incorporated into scores due to its interval scale.
论文信息
- 作者
- Winkelmann M、Achhammer P、Blumenberg V、Rejeski K、Bücklein VL、Schmidt C、Sheikh GT、Brendel M
- 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 Society2025 Nov 22
- 原文标识
- PubMed 41275261 · DOI 10.1186/s40644-025-00959-w
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