PDF(Pubmed)
Abstract：
Chimeric antigen receptor (CAR)-T cell-based immunotherapy has emerged as a path-breaking strategy for certain hematological malignancies. Assessment of the response to CAR-T therapy using quantitative imaging techniques such as positron emission tomography/computed tomography (PET/CT) has been broadly investigated. However, the definitive role of PET/CT in CAR-T therapy remains to be established. [18F]FDG PET/CT has demonstrated high sensitivity and specificity for differentiating patients with a partial and complete response after CAR-T therapy in lymphoma. The early therapeutic response and immune-related adverse effects such as cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome can also be detected on [18F]FDG PET images. In otherwise asymptomatic lymphoma patients with partial response following CAR-T therapy, the only positive findings could be abnormal PET/CT results. In multiple myeloma, a negative [18F]FDG PET/CT after receiving B-cell maturation antigen-directed CAR-T therapy has been associated with a favorable prognosis. In leukemia, [18F]FDG PET/CT can detect extramedullary metastases and treatment responses after therapy. Hence, PET/CT is a valuable imaging tool for patients undergoing CAR-T therapy for pretreatment evaluation, monitoring treatment response, assessing safety, and guiding therapeutic strategies. Developing guidelines with standardized cutoff values for various PET parameters and tumor cell-specific tracers may improve the efficacy and safety of CAR-T therapy.
摘要：
基于嵌合抗原受体（CAR）-T细胞的免疫疗法已成为某些血液恶性肿瘤的突破性策略。已经广泛地研究了使用定量成像技术(诸如正电子发射断层摄影/计算机断层扫描(PET/CT))评估对CAR-T治疗的响应。然而,PET/CT在CAR-T治疗中的确切作用尚待确定.[18F]FDGPET/CT对区分淋巴瘤中CAR-T治疗后部分和完全反应的患者具有很高的敏感性和特异性。在[18F]FDGPET图像上也可以检测到早期治疗反应和免疫相关的不良反应，例如细胞因子释放综合征和免疫效应细胞相关的神经毒性综合征。在CAR-T治疗后部分反应的无症状淋巴瘤患者中，唯一的阳性发现可能是PET/CT异常结果.在多发性骨髓瘤中，接受B细胞成熟抗原定向CAR-T治疗后[18F]FDGPET/CT阴性与良好预后相关.在白血病中，[18F]FDGPET/CT可以检测髓外转移和治疗后的治疗反应。因此，PET/CT对于接受CAR-T治疗的患者是一种有价值的成像工具，用于预处理评估，监测治疗反应，评估安全性,指导治疗策略。开发具有各种PET参数和肿瘤细胞特异性示踪剂的标准化截止值的指南可以提高CAR-T疗法的功效和安全性。
