Early PET response predicts the risk of relapse after 2L axi-cel in large B-cell lymphoma
Year: 2026
Type: article
Study design: Observational Study
Abstract: ABSTRACT: Patients with large B-cell lymphoma who progress after second-line (2L) chimeric antigen receptor T cell (CAR T) therapy have an increasing number of post-CAR T treatment options available and should be considered for timely intervention if at high risk of CAR T failure. In this national cohort of 302 patients receiving 2L axicabtagene ciloleucel (axi-cel), we assessed the use of early fluorodeoxyglucose positron emission tomography (PET) response to guide post-CAR T management. A total of 245 patients with treatment response at 1 month were grouped according to depth of response by Deauville score (DS): complete metabolic response or focal residual activity in the bridging radiotherapy field (DS1-3/DS4RT), partial response (PR) DS4, and PR DS5. DS response categories were significantly associated with risk of progression, progression-free survival, and overall survival. Patients with DS4 and DS5 response had a 50% and 73% risk of progression by month 6, respectively, compared with 25% for DS1-3/DS4RT (DS4: hazard ratio [HR], 3.07 [95% CI: 1.85-5.07] and DS5: HR, 5.20 [95% CI: 2.95-9.16]; P< .0001), which was independently significant in multivariable analyses. In a risk model using DS categories and preinfusion lactate dehydrogenase levels ≥2 upper limit of normal, we identified a high-risk group with significant risk of early failure (HR, 5.21 [95% CI: 3.27-8.29]; P< .001). Our results demonstrate the prognostic value of early PET response in patients treated with 2L axi-cel, independent of preinfusion risk factors. Responding high-risk patients had ≥70% risk of progression by month 6 and should be strongly considered for early post-CAR T therapies.
Source: Blood Advances
Authors: Andrea Kuhnl, Amy A. Kirkwood, Michael Northend, Rajesh Alajangi, Ben Uttenthal, Jane Norman, Hwai Hiew, Frances Seymour, Bernard D. Maybury, Wendy Osborne, Francesca Sillito, Ahmed Abdulgawad, Ceri Jones, Alison Delaney, William Townsend, Aikaterini Panopoulou, John G. Gribben, Edward Bataillard, Amrith Mathew, Nicolas Martinez-Calle, Lavanya Gajendran, Andrew J. Davies, Nikesh Chavda, Emil Kumar, Robin Sanderson, Sachin Kamat, George Petrides, Claire Roddie, Tobias Menne, Sridhar Chaganti
Institutions: King's College Hospital, University College London, University Hospitals Bristol and Weston NHS Foundation Trust, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, University Hospital Southampton NHS Foundation Trust, Leeds Teaching Hospitals NHS Trust, University Hospitals Birmingham NHS Foundation Trust, Freeman Hospital, Newcastle University, Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, The Christie Hospital, University Hospital of Wales, University of Oxford, Oxford University Hospitals NHS Trust, Queen Mary University of London, Barts Cancer Institute, Imperial College Healthcare NHS Trust, Nottingham University Hospitals NHS Trust, St George's Hospital, St George's, University of London
Language: English
Topic: CAR-T cell therapy research
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,800
OpenAlex ID: W7141155122