CAR T-cell therapy chest CT manifestations

CAR T-cell therapy is an emerging anti-cancer therapeutic using modified T cells to attack a patient's cancer. The purpose of this study was to assess chest CT findings in patients undergoing CAR T-cell therapy to determine the most common CT manifestations.

We performed a retrospective test-retest study analyzing cases of patients who received CAR T-cell therapy who underwent chest CT prior to therapy and after therapy; a total of 349 patients were identified. CAR T-cell therapy was first administered in the mid 2010's, however we assessed for pre-treatment scans prior to this date. We reviewed patient's charts to collect demographic and clinical data. Two cardiothoracic radiologists reviewed chest CT scans prior to and post CAR T-cell therapy to determine new radiologic features post therapy. We analyzed which findings correlated with specific radiologic features on chest CT using student's t-tests or Chi squared tests.

Pleural effusion was the most common CT manifestation resulting from CAR T-cell therapy, found in 26.3 % of patients. Patients with CT manifestations were more likely to present with dyspnea and cough (p = 0.000031 and p = 0.02, respectively).

New symptoms in patients treated with CAR T-cell therapy may be an important harbinger of radiologic abnormalities. Clinicians should have a high index of suspicion for pleural effusions in patients presenting with symptoms who have undergone CAR T-cell therapy.