Role of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Predicting the Adverse Effects of Chimeric Antigen Receptor T Cell Therapy in Patients with Non-Hodgkin Lymphoma
Role of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Predicting the Adverse Effects of Chimeric Antigen Receptor T Cell Therapy in Patients with Non-Hodgkin Lymphoma
复制标题
氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描在预测嵌合抗原受体 T 细胞治疗非霍奇金淋巴瘤患者不良反应中的作用
DOI：
10.1016/j.bbmt.2019.02.008
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发表时间：
2019-06-01
影响因子：
4.3
通讯作者：
Zhao, Kui
中科院分区：
文献类型：
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作者：
Wang, Jiasheng;Hu, Yongxian;Zhao, Kui
靶向cd19的嵌合抗原受体(CAR)-T细胞疗法在复发/难治性非霍奇金淋巴瘤（NHL）患者中显示出巨大的疗效，但与严重的不良反应相关，如细胞因子释放综合征（CRS）。据推测，NHL基线疾病负担可能会影响临床结局和CRS，但在以往的研究中尚未对此进行详细探讨。通过氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET-CT）测量的代谢肿瘤体积（MTV）和病灶总糖酵解（TLG）是基线肿瘤负荷的定量指标。使用FDG PET-CT，我们计算了19例NHL患者的基线和car - t细胞治疗后的MTV和TLG。中位数MTV为72厘米(3)(范围，。2 ~ 1137.7 cm(3))，中位TLG为555.9(范围，。011至8990.3)。中位随访5个月（1 ~ 12个月）后，最佳总有效率为79.0%。基线MTV和TLG在有反应和无反应的患者之间无显著差异（P= 0.62和P= 0.62）。95年,分别)。Cox回归分析显示，基线MTV和TLG与总生存率无显著相关性（P= 0.67， P= 0.67）。分别为45)。轻中度CRS（0 ~ 2级）患者MTV和TLG明显低于重度CRS（3 ~ 4级）患者（MTV比较P= 0.008， TLG比较P= 0.011）。通过FDG PET-CT，我们还证明了CAR-T细胞治疗与NHL患者的假进展和局部免疫激活有关。我们的数据表明，基线疾病负担较高的患者CRS更严重，CAR-T细胞治疗与淋巴瘤假性进展和局部免疫激活相关。(C) 2019年美国血液和骨髓移植学会。
CD19-targeting chimeric antigen receptor (CAR)-T cell therapy has shown great efficacy in patients with relapsed/refractory non-Hodgkin lymphoma (NHL) but has been associated with serious adverse effects, such as cytokine release syndrome (CRS). It has been speculated that NHL baseline disease burden might affect clinical outcome and CRS, but this has not been explored in detail in any previous study. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG), as measured by fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET-CT), are quantitative indicators of baseline tumor burden. Using FDG PET-CT, we calculated baseline and post-CAR-T cell therapy MTV and TLG in 19 patients with NHL. The median MTV was 72 cm(3) (range,.02 to 1137.7 cm(3)), and the median TLG was 555.9 (range,.011 to 8990.3). After a median follow-up of 5 months (range, 1 to 12 months), the best overall response rate was 79.0%. The baseline MTV and TLG did not differ significantly between patients with response and those without response (P=.62 and .95, respectively). On Cox regression analysis, baseline MTV and TLG were not significantly associated with overall survival (P=.67 and .45, respectively). Patients with mild and moderate CRS (grade 0 to 2) had significantly lower MTV and TLG than those with severe CRS (grade 3 to 4) (P=.008 for MTV comparison, P=.011 for TLG comparison). Using FDG PET-CT, we also demonstrated that CAR-T cell therapy in patients with NHL was associated with pseudoprogression and local immune activation. Our data indicate that patients with higher baseline disease burden have more severe CRS, and that CAR-T cell therapy is associated with lymphoma pseudoprogression and local immune activation. (C) 2019 American Society for Blood and Marrow Transplantation.