PET/CT is used to evaluate relapsed/refractory non-Hodgkin lymphoma (NHL) prior to chimeric antigen receptor T-cell (CAR-T) infusion at two time points: pre-leukapheresis (pre-leuk) and pre-lymphodepletion chemotherapy (pre-LD). We hypothesized that changes in PET/CT between these time points predict outcomes after CAR-T. Metabolic tumor volume (MTV), total lesion glycolysis (TLG), and other metrics were calculated from pre-leuk and pre-LD PET/CT scans in patients with NHL who received axicabtagene ciloleucel, and assessed for association with outcomes. Sixty-nine patients were analyzed. While single time point PET/CT characteristics were not associated with risk of PD or death, increases from pre-leuk to pre-LD in parenchymal MTV, nodal MTV, TLG of the largest lesion, and total number of lesions were associated with increased risk of death (p < 0.05 for all). LASSO analysis identified increasing extranodal MTV and increasing TLG of the largest lesion as strong predictors of death (AUC 0.74). Greater pre-LD total MTV was associated with higher risk of grade 3+ immune effector cell-associated neurotoxicity syndrome (ICANS) (p = 0.042). Increasing metabolic disease burden during CAR-T manufacturing is associated with increased risk of progression and death. A two variable risk score stratifies prognosis prior to CAR-T infusion and may inform risk-adapted strategies.
PET/CT在嵌合抗原受体T细胞（CAR-T）输注前两个时间点用于评估复发/难治性非霍奇金淋巴瘤（NHL）：单采前（pre-leuk）和淋巴细胞清除化疗前（pre-LD）。我们假设这两个时间点之间PET/CT的变化能够预测CAR-T治疗后的结局。研究人员根据接受阿基仑赛治疗的NHL患者在单采前和清淋前的PET/CT扫描结果，计算了代谢肿瘤体积（MTV）、总病灶糖酵解（TLG）等指标，并评估其与治疗结局的相关性。共分析了69例患者。虽然单一时间点的PET/CT特征与疾病进展或死亡风险无关，但从单采前到清淋前，实质MTV、淋巴结MTV、最大病灶TLG以及病灶总数的增加均与死亡风险升高相关（所有p值均<0.05）。LASSO分析确定结外MTV增加和最大病灶TLG增加是预测死亡的强有力指标（AUC 0.74）。清淋前更高的总MTV与3级及以上免疫效应细胞相关神经毒性综合征（ICANS）的风险增加相关（p=0.042）。CAR-T制备过程中代谢性疾病负担的增加与疾病进展和死亡风险升高相关。一个包含两个变量的风险评分可在CAR-T输注前对预后进行分层，并为风险适应性治疗策略提供参考。
肿瘤(癌症)患者之家