Metabolic tumour volume--a biomarker derived from PET imaging--can more accurately predict progression-free survival for large B-cell lymphoma patients than the widely used International Prognostic Index.

By identifying patients who are more likely to have poor outcomes early, the PET biomarker can contribute to the individualisation of therapies.

This research was published in The Journal of Nuclear Medicine. Chimaeric antigen receptor (CAR) T-cell therapy, a novel treatment approach that has been rapidly adopted by regulatory agencies, has substantially changed the management of patients with relapsed and refractory large B-cell lymphoma.

While this cellular therapy has reshaped the treatment landscape for large B-cell lymphoma, patient stratification remains a challenge.

"CAR T-cell therapy has significantly advanced the treatment of large B-cell lymphoma; however, it s still unclear what baseline parameters and infusion time point are optimal,"  said Conrad-Amadeus Voltin, MD, nuclear medicine physician at the University Hospital Cologne, Cologne, Germany.

"Quantitative PET biomarkers such as metabolic tumour volume may provide valuable information that can play a central role in personalised treatment planning."

In the study, Voltin and colleagues analysed data from six European academic centres, encompassing 111 patients who underwent PET imaging before CAR T-cell therapy.

The researchers used metabolic tumour volume derived from the PET scans to predict progression-free survival. It was then compared to the International Prognostic Index and several novel risk scores to determine which approach more accurately predicted outcomes after CAR T-cell treatment.

Metabolic tumour volume was found to be an important predictor of progression-free survival, outperforming the International Prognostic Index commonly used by clinicians.

The researchers found that higher metabolic tumour burden was associated with worse outcomes. "This quantitative measurement has the potential to significantly improve pre-treatment risk stratification for large B-cell lymphoma patients,"  said Voltin.

"Those with high metabolic tumour burden may benefit from personalised bridging strategies to reduce the tumour volume prior to receiving CAR T-cell therapy." 

He continued, "Quantitative PET biomarkers such as metabolic tumour volume may further enhance the value of PET for personalised treatment planning, not only in the specific setting of CAR T-cell therapy but also across other treatment regimens and lymphoma subtypes."

Article: Risk Assessment in Large B-Cell Lymphoma Using Metabolic Tumor Volume: Real-World Data from a Multicenter Cohort of Patients Undergoing CAR T-Cell Therapy

Source: Society of Nuclear Medicine and Molecular Imaging