Impact of spleen volume and volume change in non-Hodgkin lymphoma treated with chimeric antigen receptor t-cell therapy.

PURPOSE: Chimeric antigen receptor T-cell (CART) therapy targeting CD19 is effective for relapsed/refractory (r/r) lymphoma. As part of the lymphatic system, the spleen might influence CART outcomes. We examined how spleen volume (SV) and its changes affect progression-free (PFS) and overall survival (OS).

METHODS

Patients with baseline (BL) and 30-day follow-up (FU1) (PET)/CT scans were included. Spleens were 3D-segmented, and volume change (SVC) from BL to FU1 was calculated. Treatment response, overall response rate, and PFS were evaluated by Lugano criteria.

RESULTS

Among 68 patients, responders had a significantly greater SVC decrease from BL to FU1 than non-responders (p = 0.001). Those with baseline splenic involvement (SIBL) showed a smaller, non-significant SVCBL to FU1 decrease (p = 0.056). Survival analysis showed significant differences in OS (167 vs. 390 days, p = 0.040) and PFS (79 vs. 327 days, p = 0.008) based on median SVCBL to FU1. In combination with SIBL, SVC was significantly associated with PFS (p = 0.049), but not OS.

CONCLUSION

This study demonstrated that the early change in SV is associated with PFS and OS, regardless of splenic involvement and should be explored as a potential novel dynamic biomarker in the context of lymphoma patients receiving CART.