Prognostic significance of fludeoxyglucose positron emission tomography delta radiomics following bridging therapy in patients with large B-cell lymphoma undergoing CAR T-cell therapy.

Autor:	Ladbury C; Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, United States., Hao C; Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, United States., Watkins WT; Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, United States., Sampath S; Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, United States., Wong J; Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, United States., Amini A; Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, United States., Sokolov K; Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, United States., Yeh J; Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, United States., Al Feghali KA; RefleXion Medical, Inc., Hayward, CA, United States., de Jong D; RefleXion Medical, Inc., Hayward, CA, United States., Maniyedath A; RefleXion Medical, Inc., Hayward, CA, United States., Shirvani S; RefleXion Medical, Inc., Hayward, CA, United States., Nikolaenko L; Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States., Mei M; Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States., Herrera A; Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States., Popplewell L; Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States., Budde LE; Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States., Dandapani S; Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, United States.
Jazyk:	angličtina
Zdroj:	Frontiers in immunology [Front Immunol] 2024 Oct 01; Vol. 15, pp. 1419788. Date of Electronic Publication: 2024 Oct 01 (Print Publication: 2024).
DOI:	10.3389/fimmu.2024.1419788
Abstrakt:	Purpose/objectives: Bridging radiation therapy (bRT) is increasingly being utilized prior to chimeric antigen receptor (CAR) T-cell therapy for large B-cell lymphoma (LBCL). It is unknown how the extent of cytoreduction during bRT impacts outcomes. Materials/methods: We retrospectively reviewed patients with LBCL treated with bRT followed by CAR T-cell therapy. Metabolic tumor volume (MTV), maximum standardized uptake value (SUV max ), SUV mean , and total lesion glycolysis (TLG) were extracted from F18-fluorodeoxyglucose positron emission tomography (PET) scans acquired prior to bRT and between completion of bRT and CAR T-cell infusion. Delta radiomics based on changes of these values were then calculated. The association between delta radiomics and oncologic outcomes [progression-free survival (PFS), freedom from distant progression (FFDP), and local control (LC)] were then examined. Results: Thirty-three sites across 23 patients with LBCL were irradiated. All metabolically active disease was treated in 10 patients. Following bRT, median overall decreases (including unirradiated sites) in MTV, SUV max , SUV mean , and TLG were 22.2 cc (63.1%), 8.9 (36.8%), 3.4 (31.1%), and 297.9 cc (75.8%), respectively. Median decreases in MTV, SUV max , SUV mean , and TLG in irradiated sites were 15.6 cc (91.1%), 17.0 (74.6%), 6.8 (55.3%), and 157.0 cc (94.6%), respectively. Median follow-up was 15.2 months. A decrease in SUV max of at least 54% was associated with improved PFS (24-month PFS: 83.3% vs. 28.1%; p = 0.037) and FFDP (24-month FFDP: 100% vs. 62.4%; p < 0.001). A decrease in MTV of at least 90% was associated with improved FFDP (24-month FFDP: 100% vs. 62.4%; p < 0.001). LC was improved in sites with decreases in SUV max of at least 71% (24-month LC: 100% vs. 72.7%; p < 0.001). Decreases of MTV by at least 90% (100% vs. 53.3%; p = 0.038) and TLG by at least 95% (100% vs. 56.3%; p = 0.067) were associated with an improved complete response rate. Conclusion: bRT led to substantial reductions in MTV, SUV max , SUV mean , and TLG. The relative extent of these decreases correlated with improved outcomes after CAR T-cell infusion. Prospective cohorts should validate the value of interim PET following bRT for quantifying changes in disease burden and associated prognosis. Competing Interests: Authors KF, DJ, AM and SS were employed by company RefleXion Medical Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. This research was supported by grant funding RefleXion Medical for presentation and publication costs. The contents of the manuscript were reviewed but not dictated by RefleXion Medical. The first and senior authors had final authority on what to include in the final draft of the manuscript. (Copyright © 2024 Ladbury, Hao, Watkins, Sampath, Wong, Amini, Sokolov, Yeh, Al Feghali, de Jong, Maniyedath, Shirvani, Nikolaenko, Mei, Herrera, Popplewell, Budde and Dandapani.)
Databáze:	MEDLINE
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