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Purpose <p>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.</p> Methods <p>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.</p> Results <p>A total of 212 R/R DLBCL patients were analysed. Baseline median SUVmax was 16.4 and median TMTV&#xa0;41.3 cm3. A baseline TMTV cut-off of 30 cm<sup>3</sup> significantly stratified patients for PFS and OS, in both univariate and multivariate analysis, along with LDH.</p> <p>Complete metabolic response (DS 1–3) at M1 was significantly associated with better PFS <sub>M1</sub> and OS <sub>M1</sub> than DS4-5 (for PFS <sub>M1</sub>: median of 21.8 vs 1.8 vs months; <i>p</i> &lt; 0.0001; for OS <sub>M1</sub>: median not reached versus median of 6.3&#xa0;months; <i>p</i> &lt; 0.0001). DS5 identified patients with the worst outcomes (for PFS <sub>M1</sub>: median of 0.1&#xa0;month and for OS <sub>M1</sub>: median of 4.5&#xa0;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.</p> Conclusion <p>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.</p>

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Standardized FDG-PET interpretation during CAR T-cell therapy in R/R DLBCL: a DESCAR-T study

  • 期刊论文

  • 发表日期：

    2026年7月25日

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  • Yassine Al Tabaa,
  • Clément Bailly,
  • Xavier Palard-Novello,
  • Anne-Ségolène Cottereau,
  • Jérémie Tordo,
  • Pierre Sesques,
  • Guillaume Cartron,
  • Roch Houot,
  • Roberta Di Blasi,
  • Guillaume Manson,
  • Bastien Lesne,
  • Loïc Ysebaert,
  • Salim Kanoun,
  • Emelie Van Zele,
  • Steven Le Gouill,
  • Benoît Tessoulin,
  • Caroline Bodet-Milin,
  • Françoise Kraeber-Bodéré,
  • Laetitia Vercellino

摘要

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.