Staging of lymphoma under chimeric antigen receptor T-cell therapy: reasons for discordance among imaging response criteria
Abstract Background Chimeric antigen receptor T-cell therapy (CART) prolongs survival for patients with refractory or relapsed lymphoma. Discrepancies among different response criteria for lymphoma under CART were recently shown. Our objective was to evaluate reasons for discordance among different...
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | Cancer Imaging |
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| Online Access: | https://doi.org/10.1186/s40644-023-00566-7 |
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| author | Michael Winkelmann Viktoria Blumenberg Kai Rejeski Veit L. Bücklein Maria Ingenerf Marcus Unterrainer Christian Schmidt Franziska J. Dekorsy Peter Bartenstein Jens Ricke Michael von Bergwelt-Baildon Marion Subklewe Wolfgang G. Kunz |
| author_facet | Michael Winkelmann Viktoria Blumenberg Kai Rejeski Veit L. Bücklein Maria Ingenerf Marcus Unterrainer Christian Schmidt Franziska J. Dekorsy Peter Bartenstein Jens Ricke Michael von Bergwelt-Baildon Marion Subklewe Wolfgang G. Kunz |
| author_sort | Michael Winkelmann |
| collection | DOAJ |
| description | Abstract Background Chimeric antigen receptor T-cell therapy (CART) prolongs survival for patients with refractory or relapsed lymphoma. Discrepancies among different response criteria for lymphoma under CART were recently shown. Our objective was to evaluate reasons for discordance among different response criteria and their relation to overall survival. Methods Consecutive patients with baseline and follow-up imaging at 30 (FU1) and 90 days (FU2) after CART were included. Overall response was determined based on Lugano, Cheson, response evaluation criteria in lymphoma (RECIL) and lymphoma response to immunomodulatory therapy criteria (LYRIC). Overall response rate (ORR) and rates of progressive disease (PD) were determined. For each criterion reasons for PD were analyzed in detail. Results 41 patients were included. ORR was 68%, 68%, 63%, and 68% at FU2 by Lugano, Cheson, RECIL, and LYRIC, respectively. PD rates differed among criteria with 32% by Lugano, 27% by Cheson, 17% by RECIL, and 17% by LYRIC. Dominant reasons for PD according to Lugano were target lesion (TL) progression (84.6%), new appearing lesions (NL; 53.8%), non-TL progression (27.3%), and progressive metabolic disease (PMD; 15.4%). Deviations among the criteria for defining PD were largely explained by PMD of preexisting lesions that are defined as PD only by Lugano and non-TL progression, which is not defined as PD by RECIL and in some cases classified as indeterminate response by LYRIC. Conclusions Following CART, lymphoma response criteria show differences in imaging endpoints, especially in defining PD. The response criteria must be considered when interpreting imaging endpoints and outcomes from clinical trials. |
| first_indexed | 2024-03-13T10:12:36Z |
| format | Article |
| id | doaj.art-73278b75b00246d0a561f64ef37870ed |
| institution | Directory Open Access Journal |
| issn | 1470-7330 |
| language | English |
| last_indexed | 2024-03-13T10:12:36Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Cancer Imaging |
| spelling | doaj.art-73278b75b00246d0a561f64ef37870ed2023-05-21T11:25:52ZengBMCCancer Imaging1470-73302023-05-0123111110.1186/s40644-023-00566-7Staging of lymphoma under chimeric antigen receptor T-cell therapy: reasons for discordance among imaging response criteriaMichael Winkelmann0Viktoria Blumenberg1Kai Rejeski2Veit L. Bücklein3Maria Ingenerf4Marcus Unterrainer5Christian Schmidt6Franziska J. Dekorsy7Peter Bartenstein8Jens Ricke9Michael von Bergwelt-Baildon10Marion Subklewe11Wolfgang G. Kunz12Department of Radiology, University Hospital, LMU MunichLaboratory for Translational Cancer Immunology, Gene Center of the LMU MunichLaboratory for Translational Cancer Immunology, Gene Center of the LMU MunichLaboratory for Translational Cancer Immunology, Gene Center of the LMU MunichDepartment of Radiology, University Hospital, LMU MunichDepartment of Radiology, University Hospital, LMU MunichDepartment of Medicine III, University Hospital, LMU MunichDepartment of Nuclear Medicine, University Hospital, LMU MunichDepartment of Nuclear Medicine, University Hospital, LMU MunichDepartment of Radiology, University Hospital, LMU MunichDepartment of Medicine III, University Hospital, LMU MunichLaboratory for Translational Cancer Immunology, Gene Center of the LMU MunichDepartment of Radiology, University Hospital, LMU MunichAbstract Background Chimeric antigen receptor T-cell therapy (CART) prolongs survival for patients with refractory or relapsed lymphoma. Discrepancies among different response criteria for lymphoma under CART were recently shown. Our objective was to evaluate reasons for discordance among different response criteria and their relation to overall survival. Methods Consecutive patients with baseline and follow-up imaging at 30 (FU1) and 90 days (FU2) after CART were included. Overall response was determined based on Lugano, Cheson, response evaluation criteria in lymphoma (RECIL) and lymphoma response to immunomodulatory therapy criteria (LYRIC). Overall response rate (ORR) and rates of progressive disease (PD) were determined. For each criterion reasons for PD were analyzed in detail. Results 41 patients were included. ORR was 68%, 68%, 63%, and 68% at FU2 by Lugano, Cheson, RECIL, and LYRIC, respectively. PD rates differed among criteria with 32% by Lugano, 27% by Cheson, 17% by RECIL, and 17% by LYRIC. Dominant reasons for PD according to Lugano were target lesion (TL) progression (84.6%), new appearing lesions (NL; 53.8%), non-TL progression (27.3%), and progressive metabolic disease (PMD; 15.4%). Deviations among the criteria for defining PD were largely explained by PMD of preexisting lesions that are defined as PD only by Lugano and non-TL progression, which is not defined as PD by RECIL and in some cases classified as indeterminate response by LYRIC. Conclusions Following CART, lymphoma response criteria show differences in imaging endpoints, especially in defining PD. The response criteria must be considered when interpreting imaging endpoints and outcomes from clinical trials.https://doi.org/10.1186/s40644-023-00566-7CAR T-cell therapy18F-FDG PET/CTLugano criteriaChesonRECILLYRIC |
| spellingShingle | Michael Winkelmann Viktoria Blumenberg Kai Rejeski Veit L. Bücklein Maria Ingenerf Marcus Unterrainer Christian Schmidt Franziska J. Dekorsy Peter Bartenstein Jens Ricke Michael von Bergwelt-Baildon Marion Subklewe Wolfgang G. Kunz Staging of lymphoma under chimeric antigen receptor T-cell therapy: reasons for discordance among imaging response criteria Cancer Imaging CAR T-cell therapy 18F-FDG PET/CT Lugano criteria Cheson RECIL LYRIC |
| title | Staging of lymphoma under chimeric antigen receptor T-cell therapy: reasons for discordance among imaging response criteria |
| title_full | Staging of lymphoma under chimeric antigen receptor T-cell therapy: reasons for discordance among imaging response criteria |
| title_fullStr | Staging of lymphoma under chimeric antigen receptor T-cell therapy: reasons for discordance among imaging response criteria |
| title_full_unstemmed | Staging of lymphoma under chimeric antigen receptor T-cell therapy: reasons for discordance among imaging response criteria |
| title_short | Staging of lymphoma under chimeric antigen receptor T-cell therapy: reasons for discordance among imaging response criteria |
| title_sort | staging of lymphoma under chimeric antigen receptor t cell therapy reasons for discordance among imaging response criteria |
| topic | CAR T-cell therapy 18F-FDG PET/CT Lugano criteria Cheson RECIL LYRIC |
| url | https://doi.org/10.1186/s40644-023-00566-7 |
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