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Predicting Remission With CAR T-Cell Therapy in Large B-Cell Lymphoma: Focus on FDG-PET Imaging

By: Sarah Campen, PharmD
Posted: Friday, May 13, 2022

Early fluorodeoxyglucose–positron-emission tomography (FDG-PET) imaging response may predict the risk of CD19 chimeric antigen receptor (CAR) T-cell failure in patients with relapsed or refractory large B-cell lymphoma, according to the results of a multicenter retrospective analysis published as a Research Letter in Blood Advances. Andrea Kuhnl, MD, of King’s College Hospital, London, and colleagues assessed early FDG-PET response after CAR T-cell therapy using the 5-point Deauville score. Patients achieving early Deauville scores of 1 or 2 showed excellent long-term outcomes, whereas a score of 5 was associated with poor outcomes and considered treatment failure.

“Our results indicate that early FDG-PET [Deauville score] categories provide a standardized, broadly available tool to predict durable remission after CD19 CAR-T and could inform early post–CAR-T management and response-adapted stratification in clinical trials,” stated the study authors.

In this study, 171 patients with relapsed or refractory large B-cell lymphoma who were treated with CAR T-cell therapy across three centers in the United Kingdom were analyzed. In all, 130 patients were treated with axicabtagene ciloleucel, and 41 were treated with tisagenlecleucel; the median postinfusion follow-up was 14.5 months.

The response rate to CAR T-cell therapy at the 1-month assessment was 76%. At 6 months after treatment, 36% of responders had progressive disease. Both durability of response and progression-free survival were significantly associated with the 1-month Deauville scores: the risk of early disease progression was 15% for a Deauville score of 1 or 2, 32% for a score of 3, 37% for a score of 4, and 100% for a score of 5; and 12-month progression-free survival was 77.1%, 63.5%, 43.5%, and 0%, respectively.

Disclosure: For a full list of the study authors’ disclosures, visit ashpublications.org.


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