TY  - JOUR
AU  - Winkelmann, Michael
AU  - Achhammer, Philipp
AU  - Blumenberg, Viktoria
AU  - Rejeski, Kai
AU  - Bücklein, Veit L
AU  - Schmidt, Christian
AU  - Sheikh, Gabriel T
AU  - Brendel, Matthias
AU  - Ricke, Jens
AU  - von Bergwelt-Baildon, Michael
AU  - Subklewe, Marion
AU  - Kunz, Wolfgang G
TI  - Predictive value of maximum tumor dissemination (Dmax) in lymphoma patients treated with CD19-specific CAR T-Cells.
JO  - Cancer imaging
VL  - 25
IS  - 1
SN  - 1470-7330
CY  - London
PB  - BioMed Central
M1  - DZNE-2025-01338
SP  - 135
PY  - 2025
AB  - CD19-specific chimeric antigen receptor T-cell therapy (CART) has emerged as effective treatment for relapsed or refractory (r/r) lymphoma. The maximum distance (Dmax) of lymphoma lesions holds potential as prognostic imaging biomarker in lymphoma treated with conventional therapies, but evidence in the context of CART remains scarce and further studies are needed to clarify its clinical relevance. We evaluated Dmax at baseline imaging as a potential prognostic tool for assessment of metabolic and overall response, progression-free survival (PFS) and overall survival (OS).Consecutive r/r lymphoma patients with (PET/)CT imaging at baseline (BL) before lymphodepletion and subsequent CAR T-cell transfusion were included. Dmax was measured in cm at BL. Patients were divided by tertiles into three equal sized groups according to Dmax. Ann Arbor stages were calculated at baseline and the sum of product diameters (SPD) was used to represent tumor burden (TB). Overall response according to Lugano criteria and the Deauville score were determined at day 90 PET/CT imaging.Thirty-nine patients met the inclusion criteria. Median Dmax was 40.0 cm (IQR: 16.4-70.3 cm) at BL. Median TB decreased from BL with 4,095 mm2 to 770 mm2 at FU imaging. Median TB at BL was significantly higher in the Dmax intermediate and high group compared to the Dmax low group (p = 0.005) with 7,222 mm2 (IQR: 3,355-11,941 mm2), 4,649 mm2 (IQR: 2,376-10,406 mm2) and 1,739 mm2 (IQR: 715-7,402 mm2), respectively. Dmax intermediate and high group showed significantly higher Ann Arbor stages (p < 0.001). The survival analysis revealed a significantly (p = 0.030) shorter PFS in the Dmax high group compared to the other patients (91 vs. 364 days), but no relevant differences in OS (p = 0.151).Patients with high Dmax showed a shorter PFS, but no significant differences in OS. Dmax is a useful parameter for characterizing tumor dissemination, which could also be incorporated into scores due to its interval scale.
KW  - Humans
KW  - Male
KW  - Female
KW  - Middle Aged
KW  - Immunotherapy, Adoptive: methods
KW  - Positron Emission Tomography Computed Tomography: methods
KW  - Aged
KW  - Antigens, CD19: immunology
KW  - Adult
KW  - Lymphoma: therapy
KW  - Lymphoma: pathology
KW  - Lymphoma: diagnostic imaging
KW  - Lymphoma: immunology
KW  - Prognosis
KW  - Receptors, Chimeric Antigen: immunology
KW  - Tumor Burden
KW  - Aged, 80 and over
KW  - Retrospective Studies
KW  - Predictive Value of Tests
KW  - 18F-FDG PET/CT (Other)
KW  - Ann-Arbor, Deauville-Score (Other)
KW  - CAR t-cell therapy (Other)
KW  - Dissemination features (Other)
KW  - Dmax, Dmaxbulk (Other)
KW  - Lugano criteria (Other)
KW  - Lymphoma (Other)
KW  - Antigens, CD19 (NLM Chemicals)
KW  - Receptors, Chimeric Antigen (NLM Chemicals)
LB  - PUB:(DE-HGF)16
C6  - pmid:41275261
C2  - pmc:PMC12670812
DO  - DOI:10.1186/s40644-025-00959-w
UR  - https://pub.dzne.de/record/282578
ER  -