Abstract
The goal of this study was to investigate the value of CT-textural features and volume-based PET parameters in comparison to serologic markers for response prediction in patients with diffuse large B-cell lymphoma (DLBCL) undergoing cluster of differentiation (CD19)-chimeric antigen receptor (CAR)-T cell therapy. We retrospectively analyzed the whole-body (WB)-metabolic tumor volume (MTV), the WB-total lesion glycolysis (TLG) and first order textural features derived from 18F-FDG-PET/CT, as well as serologic parameters (C-reactive protein [CRP] and lactate dehydrogenase [LDH], leucocytes) prior and after CAR-T cell therapy in 21 patients with DLBCL (57.7 ± 14.7 year; 7 female). Interleukin 6 (IL-6) and IL-2 receptor peaks were monitored after treatment onset and compared with patient outcome judged by follow-up 18F-FDG-PET/CT. In 12/21 patients (57%), complete remission (CR) was observed, whereas 9/21 patients (43%) showed partial remission (PR). At baseline, WB-MTV and WB-TLG were lower in patients achieving CR (35 ± 38 mL and 319 ± 362) compared to patients achieving PR (88 ± 110 mL and 1487 ± 2254; p < 0.05). The “entropy” proved lower (1.81 ± 0.09) and “uniformity” higher (0.33 ± 0.02) in patients with CR compared to PR (2.08 ± 0.22 and 0.28 ± 0.47; p < 0.05). Patients achieving CR had lower levels of CRP, LDH and leucocytes at baseline compared to patients achieving PR (p < 0.05). In the entire cohort, WB-MTV and WB-TLG decreased after therapy onset (p < 0.01) becoming not measurable in the CR-group. Leucocytes and CRP significantly dropped after therapy (p < 0.01). The IL-6 and IL-2R peaks after therapy were lower in patients with CR compared to PR (p > 0.05). In conclusion, volume-based PET parameters derived from PET/CT and CT-textural features have the potential to predict therapy response in patients with DLBCL undergoing CAR-T cell therapy.
Highlights
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin’s lymphoma in adults with a prevalence of almost 40% [1]
In 12/21 DLBCL patients (57%), complete remission (CR) was observed after chimeric antigen receptor (CAR)-T cell therapy, whereas
We investigated the predictive value of textural features derived from had a cytokine release syndrome (CRS) grade III and 1/21 patient had a CRS grade IV
Summary
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin’s lymphoma in adults with a prevalence of almost 40% [1]. Standard treatment regimens are efficacious, but up to 15% of patients will exhibit primary refractory disease and another 30–. In the refractory/relapsed DLBCL patients, incidence of disease recurrence is high, even after salvage therapy combined with autologous stem cell support, leading to a dismal long-term survival rate [4]. In this setting, novel treatment strategies are explored. CAR (chimeric antigen receptor)-T cells, which consist of genetically modified autologous. T cells by retroviral or lentiviral vectors containing DNA encoding a CAR [1]. It has been shown that CD19 CAR-T cells provide high and durable response rates even in refractory and relapsed DLBCL [5–7]
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