PET-imaging assessment for guiding strategy in patients with relapsed/refractory large B-cell lymphoma receiving CAR T-cells.
Tous les auteurs :
Galtier J, Vercellino L, Chartier L, Olivier P, Tabouret-Viaud C, Mesguich C, Di Blasi R, Durand A, Raffy L, Gros FX, Madelaine I, Meignin V, Mebarki M, Rubio MT, Feugier P, Casasnovas O, Meignan M, Thieblemont C
The aim of this study was to evaluate the prognostic impact of the FDG-PET response at one month (M1) and three months (M3) after anti-CD19 CAR T-cells in a multicenter cohort of 160 patients with relapsed/refractory large B-cell lymphomas (R/R LBCL). In total, 119 (75%) patients reached M1 evaluation; 64 (53%, 64/119) had a complete response (CMR); 91% were Deauville Score (DS) 1-3. PFS and OS were significantly worse in patients with DS-5 at one month, than in patients with DS 1-3 (PFS HR=6.37 (95%CI: 3.5-11.5) / OS HR=3.79 (95%CI: 1.7-8.5) and DS-4 (PFS HR=11.99 (95%CI: 5.0-28.9) / OS HR=12.49 (95%CI=2.8-55.8). The 1-year PFS rates were 78.9% (95%CI, 58.9 to 89.9) for DS-4 at M1, similar to 67.3% (95%CI, 51.8 to 78.8) for patients with DS 1-3 at M1, very different to 8.6% (95%CI, 1.8 to 22.4) for DS-5, respectively. Only 8/30 (26%) patients with DS-4 progressed. Response at M3 evaluated in 90 (57%) patients was prognostic for PFS with lower discrimination (HR=3.28 (95%CI: 1.5-7.0), p=0.003) but did not predict OS (HR = 0.61 (95%CI: 0.2-2.3) p=0.45). Patients with high baseline total metabolic tumor volume (TMTV) >80ml had worse PFS (HR=2.05 (95%CI: 1.2-3.5), p=0.009) and OS (HR=4.52 (95%CI: 2.5-8.1), p80ml, and DS-5 at M1 for OS. In conclusion, baseline TMTV and response at M1 strongly predicts outcomes of patients with R/R LBCL undergoing CAR T-cells.
Haematologica. 2022 06 9;: