Outcome Prediction in Patients With Large B-cell Lymphoma Undergoing Chimeric Antigen Receptor T-cell Therapy
Conrad‐Amadeus Voltin, Philipp Gödel, Laura Beckmann, Jan‐Michel Heger, Carsten Kobe, Nadine Kutsch, Peter Borchmann, Markus Dietlein, Ken Herrmann, Matthias Stelljes, Kambiz Rahbar, Georg Lenz, Hans Christian Reinhardt, Marcel Teichert, Richard Noppeney, Jörn C. Albring, Robert Seifert, Bastian von Tresckow, Sarah Flossdorf, Christine Hanoun
Abstract
The introduction of chimeric antigen receptor (CAR) T-cell therapy has led to a fundamental shift in the management of relapsed and refractory large B-cell lymphoma. However, our understanding of risk factors associated with non-response is still insufficient and the search for predictive biomarkers continues. Some parameters measurable on 18 F-fluorodeoxyglucose positron emission tomography (PET) may be of additional value in this context. A total of 47 individuals from three German university centers who underwent re-staging with PET prior to CAR T-cell therapy were enrolled into the present study. After multivariable analysis considering tumor characteristics and patient factors that might affect progression-free survival (PFS), we investigated whether metabolic tumor volume (MTV) or maximum standardized uptake value (SUV max ) further improve risk stratification. Their most suitable cut-offs were determined by Cox and logistic regression. Forward selection identified extra-nodal disease as the most predictive factor of those routinely available, and we found it to be associated with significantly inferior overall survival after CAR T-cell treatment ( P = 0.012). Furthermore, patients with MTV and SUV max higher than the optimal threshold of 11 mL and 16.7, respectively, experienced shorter PFS ( P = 0.016 and 0.002, respectively). Hence, these risk factors might be useful for selection of individuals likely to benefit from CAR T-cell therapy and their management.