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Dynamic Imaging of Chimeric Antigen Receptor T Cells with [18F]Tetrafluoroborate Positron Emission Tomography/Computed Tomography
Published on: February 17, 2022
Imaging-based Toxicity and Response Pattern Assessment Following CAR T-Cell Therapy
Daniel A Smith1, Elias Kikano1, Sree Harasha Tirumani1
1From the Department of Radiology (D.A.S., E.K., S.H.T., N.H.R.) and Department of Medicine, Division of Hematology and Oncology (P.C.), University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106; and Blood and Marrow Transplant Program, The Ohio State University, Columbus, Ohio (M.d.L.).
Chimeric antigen receptor (CAR) T-cell therapy for lymphoma can cause cytokine release syndrome (CRS). Thoracic imaging findings like pleural effusions and atelectasis correlate with higher CRS grades, aiding clinical management.
Area of Science:
- Oncology
- Immunotherapy
- Radiology
Background:
- Chimeric antigen receptor (CAR) T-cell immunotherapy is a key treatment for refractory lymphoma.
- CAR T-cell therapy can lead to serious side effects, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).
- The role of imaging in managing these toxicities is not fully understood.
Purpose of the Study:
- To investigate the association between imaging findings and the clinical grade of CRS and ICANS following CAR T-cell therapy.
- To evaluate treatment response patterns using imaging.
- To assess the utility of imaging in the post-CAR T-cell treatment period.
Main Methods:
- Retrospective analysis of 38 patients with refractory B-cell lymphoma treated with CAR T-cell infusion.
- Clinical toxicity grading using ASTCT consensus criteria.
- Evaluation of thoracic and head imaging (radiographs, CT, MRI) for abnormalities.
- Statistical analysis to correlate imaging findings with CRS/ICANS grade and treatment response (Deauville criteria).
Main Results:
- 63% of patients experienced grade 1 or higher CRS, and 29% experienced grade 1 or higher ICANS.
- Patients with grade 2 or higher CRS were significantly more likely to show abnormal thoracic imaging findings, including pleural effusions (P=.04) and atelectasis (P=.048).
- Neuroimaging identified positive findings in 43% of patients with grade 2 or higher ICANS.
Conclusions:
- Thoracic imaging findings, specifically pleural effusions and atelectasis, are associated with the severity of cytokine release syndrome after CAR T-cell infusion.
- CAR T-cell therapy demonstrated high overall response rates in this patient cohort.
- Imaging plays a role in identifying and potentially managing CAR T-cell therapy-related toxicities.
