Work

The ratio of brain to liver glucose activity and prognosis with CAR-T in non-Hodgkin lymphoma

Year: 2025

Type: article

Abstract: CD19 targeting chimeric antigen receptor T-cell (CAR-T) therapy has improved prognosis in patients with B-cell non-Hodgkin lymphoma (NHL), and a fraction are potentially cured [ 1 , 2 , 3 ]. However, some patients have a short response duration and those without a rapid and deep response are at higher risk of treatment failure. Positron emission tomography combined with computerized tomography (PET/CT) using 18 F-fluoro-2-deoxy-D-glucose ( 18 F-FDG) is routinely performed before CAR-T cell therapy to determine the disease burden [ 4 ]. The basis of PET/CT imaging is the higher dependence of tumor cells on glycolysis for energy generation, a phenomenon known as the Warburg effect. The Deauville response scoring system compares lesional uptake to reference organs, including mediastinal blood pool and liver [ 5 ]. Other volumetric measures of tumor burden include metabolic tumor volume (MTV) and total lesion glycolysis (TLG). The brain-to-liver glucose ratio (B2LR) is defined as the ratio of glucose uptake in the brain compared to the liver based on 18 F-FDG PET/CT [ 6 ]. In multiple myeloma, the B2LR is prognostic both for progression-free survival (PFS) and overall survival (OS) after CAR-T therapy [ 6 ]. A B2LR ≤ 2.5 correlated with the presence of extramedullary disease (EMD), but remained an independent predictor even in the presence of EMD with respect to PFS and OS [ 6 ]. We hypothesized that the B2LR would provide prognostic insights on the outcomes of NHL patients undergoing CAR-T cell therapy.

Source: Blood Cancer Journal

DOI: 10.1038/s41408-025-01425-3