18F-FDG PET/CT for predicting prognosis of B-cell non-Hodgkin lymphoma patients treated with chimeric antigen receptor T cells: the value of pre-infusion and M1 image.
Objective: We aimed to evaluate the prognostic value of pre- and post-infusion 18F-FDG PET/CT for B-cell non-Hodgkin lymphoma B-NHL) patients treated with anti-CD19 chimeric antigen receptor T (CAR-T) cells. Methods: B-NHL patients who received CAR-T therapy and underwent 18F-FDG PET/CT examination one month before (pre-infusion) and after (M1) CAR-T infusion were collected and regularly followed up. Maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG) was recorded for each PET/CT performed, as well as some clinical and laboratory indexes. Progression-free survival (PFS) and overall survival (OS) were endpoints, estimated by the Kaplan-Meier method. Results: Ninety-three patients were included. The median follow-up time was 21.1 months. Multivariate analysis showed that extranodal (EN) sites and SUVmax at M1 were independent prognostic factors for PFS. Patients with EN sites ≥ 2 had shorter median PFS than those with EN sites < 2 (6.4 months vs. not reached [NR], P = 0.032). Patients with M1 SUVmax ≥ 12.4 had shorter median PFS than those with SUVmax < 12.4 (1.1 months vs. NR, P < 0.001). Regarding OS, International Prognostic Index (IPI) and SUVmax at M1 were strongly associated with subsequent outcomes. The median OS was 14.1 months for patients with IPI ≥ 3, compared with NR for those with IPI < 3 (P = 0.011). Patients with SUVmax < 12.9 at M1 had longer median OS compared to those with SUVmax ≥ 12.9 (NR vs. 12.0 months, P < 0.001). Conclusions: For B-NHL patients who received CAR-T therapy, M1 PET/CT had a more important prognostic value than the pre-infusion one. EN sites and SUVmax at M1 were independent risk factors for PFS, and IPI and SUVmax at M1 for OS. Integrating the clinical characteristics and PET/CT parameters can be helpful for early decision-making in patient management.
Background: Not applicable.