Abstract:
BACKGROUND: Chimeric antigen receptor (CAR) T-cell therapy has attracted
considerable attention since its recent endorsement by the Food and Drug
Administration, as it has emerged as a promising immunotherapeutic modality
within the landscape of oncology. This study explores the prognostic utility of [18F]
Fluorodeoxyglucose positron emission tomography ([18F]FDG PET) in lymphoma
patients undergoing CAR T-cell therapy. Through meta-analysis, pooled hazard
ratio (HR) values were calculated for specific PET metrics in this context.
METHODS: PubMed, Scopus, and Ovid databases were explored to search for
relevant topics. Dataset retrieval from inception until March 12, 2024, was carried
out. The primary endpoints were impact of specific PET metrics on overall
survival (OS) and progression-free survival (PFS) before and after treatment.
Data from the studies were extracted for a meta-analysis using Stata 17.0.
RESULTS: Out of 27 studies identified for systematic review, 15 met the criteria for
meta-analysis. Baseline OS analysis showed that total metabolic tumor volume
(TMTV) had the highest HR of 2.66 (95% CI: 1.52-4.66), followed by Total-body
total lesion glycolysis (TTLG) at 2.45 (95% CI: 0.98-6.08), and maximum
standardized uptake values (SUVmax) at 1.30 (95% CI: 0.77-2.19). TMTV and TTLG were statistically significant (p < 0.0001), whereas SUVmax was not (p =
0.33). For PFS, TMTV again showed the highest HR at 2.65 (95% CI: 1.63-4.30),
with TTLG at 2.35 (95% CI: 1.40-3.93), and SUVmax at 1.48 (95% CI: 1.08-2.04), all
statistically significant (p ≤ 0.01). The DSUVmax was a significant predictor for PFS
with an HR of 2.05 (95% CI: 1.13-3.69, p = 0.015).
CONCLUSION: [18F]FDG PET parameters are valuable prognostic tools for
predicting outcome of lymphoma patients undergoing CAR T-cell therapy.
