European journal of nuclear medicine and molecular imaging · 2026
Standardized FDG-PET interpretation during CAR T-cell therapy in R/R DLBCL: a DESCAR-T study.
СтатьяНазвание и аннотация: Перевод в очереди
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Al Tabaa Yassine, Bailly Clément, Palard-Novello Xavier, Cottereau Anne-Ségolène, Tordo Jérémie, Sesques Pierre, Cartron Guillaume, Houot Roch, Di Blasi Roberta, Manson Guillaume, Lesne Bastien, Ysebaert Loïc, Kanoun Salim, Van Zele Emelie, Le Gouill Steven, Tessoulin Benoît, Bodet-Milin Caroline, Kraeber-Bodéré Françoise, Vercellino Laetitia
Аннотация
PURPOSE: CAR T-cell therapy has changed the management of relapsed/refractory (R/R) Diffuse large B-cell lymphoma (DLBCL). Fluorodeoxyglucose Positron Emission Tomography Computed Tomography (PET/CT) plays a central role in lymphoma response assessment, but its prognostic use remains insufficiently standardized in this setting.
METHODS: Patients from the French DESCAR-T registry treated in third line or beyond with commercial anti-CD19 CAR T-cells in real-life, and having centrally reviewed PET/CT before infusion, and at one month (M1) or three months (M3) post-infusion were included. For each visit, Total Metabolic Tumor Volume (TMTV) and SUVmax were measured. Deauville score (DS) and response according to 2014 Lugano classification were registered on follow-up PET/CT. Optimal TMTV cut-offs at baseline, M1 and M3 follow-up for progression-free survival (PFS) and overall survival (OS) and the prognostic impact of DS at M1 and M3 were determined.
RESULTS: A total of 212 R/R DLBCL patients were analysed. Baseline median SUVmax was 16.4 and median TMTV 41.3 cm3. A baseline TMTV cut-off of 30 cm3 significantly stratified patients for PFS and OS, in both univariate and multivariate analysis, along with LDH. Complete metabolic response (DS 1-3) at M1 was significantly associated with better PFS M1 and OS M1 than DS4-5 (for PFS M1: median of 21.8 vs 1.8 vs months; p < 0.0001; for OS M1: median not reached versus median of 6.3 months; p < 0.0001). DS5 identified patients with the worst outcomes (for PFS M1: median of 0.1 month and for OS M1: median of 4.5 months). Similarly, at M3 DS1-3 was associated with a better outcome than DS4-5, and patients with DS5 had the worst outcome. In patients without complete metabolic response residual TMTV provided additional prognostic value.
CONCLUSION: Baseline TMTV and metabolic response assessed by DS, together with residual TMTV on follow-up PET/CT, are strong prognostic biomarkers in R/R DLBCL patients treated with anti-CD19 CAR T-cells.
METHODS: Patients from the French DESCAR-T registry treated in third line or beyond with commercial anti-CD19 CAR T-cells in real-life, and having centrally reviewed PET/CT before infusion, and at one month (M1) or three months (M3) post-infusion were included. For each visit, Total Metabolic Tumor Volume (TMTV) and SUVmax were measured. Deauville score (DS) and response according to 2014 Lugano classification were registered on follow-up PET/CT. Optimal TMTV cut-offs at baseline, M1 and M3 follow-up for progression-free survival (PFS) and overall survival (OS) and the prognostic impact of DS at M1 and M3 were determined.
RESULTS: A total of 212 R/R DLBCL patients were analysed. Baseline median SUVmax was 16.4 and median TMTV 41.3 cm3. A baseline TMTV cut-off of 30 cm3 significantly stratified patients for PFS and OS, in both univariate and multivariate analysis, along with LDH. Complete metabolic response (DS 1-3) at M1 was significantly associated with better PFS M1 and OS M1 than DS4-5 (for PFS M1: median of 21.8 vs 1.8 vs months; p < 0.0001; for OS M1: median not reached versus median of 6.3 months; p < 0.0001). DS5 identified patients with the worst outcomes (for PFS M1: median of 0.1 month and for OS M1: median of 4.5 months). Similarly, at M3 DS1-3 was associated with a better outcome than DS4-5, and patients with DS5 had the worst outcome. In patients without complete metabolic response residual TMTV provided additional prognostic value.
CONCLUSION: Baseline TMTV and metabolic response assessed by DS, together with residual TMTV on follow-up PET/CT, are strong prognostic biomarkers in R/R DLBCL patients treated with anti-CD19 CAR T-cells.