A polyamine-centric, blood-based metabolite panel predictive of poor response to CAR-T cell therapy in large B cell lymphoma
Johannes F. Fahrmann, Neeraj Saini, Chang Chia‐Chi, Ehsan Irajizad, Paolo Strati, Ranjit Nair, Luis Fayad, Sairah Ahmed, Hun Ju Lee, Swaminathan P. Iyer, Raphaël Steiner, Jody V. Vykoukal, Ranran Wu, Jennifer B. Dennison, Loretta J. Nastoupil, Preetesh Jain, Michael Wang, Michael R. Green, Jason R. Westin, Viktoria Blumenberg, Marco L. Davila, Richard E. Champlin, Elizabeth J. Shpall, Partow Kebriaei, Christopher R. Flowers, Michael D. Jain, Robert R. Jenq, Christoph K. Stein‐Thoeringer, Marion Subklewe, Sattva S. Neelapu, Samir Hanash
Abstract
Anti-CD19 chimeric antigen receptor (CAR) T cell therapy for relapsed or refractory (r/r) large B cell lymphoma (LBCL) results in durable response in only a subset of patients. MYC overexpression in LBCL tumors is associated with poor response to treatment. We tested whether an MYC-driven polyamine signature, as a liquid biopsy, is predictive of response to anti-CD19 CAR-T therapy in patients with r/r LBCL. Elevated plasma acetylated polyamines were associated with non-durable response. Concordantly, increased expression of spermidine synthase, a key enzyme that regulates levels of acetylated spermidine, was prognostic for survival in r/r LBCL. A broad metabolite screen identified additional markers that resulted in a 6-marker panel (6MetP) consisting of acetylspermidine, diacetylspermidine, and lysophospholipids, which was validated in an independent set from another institution as predictive of non-durable response to CAR-T therapy. A polyamine centric metabolomics liquid biopsy panel has predictive value for response to CAR-T therapy in r/r LBCL.