Influence of modified Lugano criteria by pre-infusion tumor kinetics on early survival prediction for patients with lymphoma under chimeric antigen receptor T-cell therapy.

Abstract

e19500 Background: Chimeric antigen receptor T-cell therapy (CART) is effective for patients with refractory or relapsed (r/r) lymphoma with prolongation of survival. We aimed to improve the prediction of Lugano criteria for overall survival (OS) at 30-day follow-up (FU1) by including the pre-infusion tumor growth rate (TGRpre-BL) and its early change to 30-day FU1 imaging (TGRpost-BL). Methods: Consecutive patients with pre-baseline (pre-BL), baseline (BL) and FU imaging around day 30 with CT or PET/CT before CART were included. TGR was defined as change of Lugano criteria-based tumor burden between pre-BL, BL and FU examinations in relation to days between imaging exams. Overall response and PFS were determined based on Lugano criteria. Proportional Cox regression analysis studied association of TGR with OS. For survival analysis, OS was analyzed using Kaplan-Meier survival curves. Results: 59 out of 81 patients met the inclusion criteria. At 30-day FU 8 patients (16%) had a CR, 25 patients (42%) a PR, 15 patients (25%) a SD, and 11 patients (19%) a PD according to Lugano criteria. The Median TGRpre-BL was -0.6 mm2/d, 24.4 mm2/d, -5.1 mm2/d, and 18.6 mm2/d and the median TGRpost-BL was -16.7 mm2/d, -102.0 mm2/d, -19.8 mm2/d and 8.5 mm2/d in CR, PR, SD, and PD patients, respectively. PD patients could be subclassified into a cohort with an increase in TGR (7 of 11 patients [64%], PD TGRpre-to-post-BL INCR) and a cohort with a decrease in TGR (4 of 11 patients [36%], PD TGRpre-to-post-BL DECR) from pre- to post-BL. PD TGRpre-to-post-BL DECR patients exhibited similar OS to patients classified as SD, while PD TGRpre-to-post-BL INCR patients had significantly shorter OS (65 days vs 471 days, p < 0.001). Conclusions: In the context of CART, the additional use of TGRpre-BL and its change to TGRpost-BL determined at 30-day FU1 showed better OS prognostication for patients with overall progressive disease according to Lugano criteria. Therefore, this modification of the Lugano classification should be explored as a potential novel imaging biomarker of early response. [Table: see text]