FDG-PET in Chimeric Antigen Receptor T-Cell (CAR T-Cell) Therapy Toxicity: A Systematic Review
by
, , , , , and
Akram Al-Ibraheem
1,2,*
,
Ahmed Saad Abdlkadir
1
,
Egesta Lopci
3
,
Sudqi Allouzi
1, 
Diana Paez
4,
Maryam Alkuwari
5,
Mohammad Makoseh
6,
Fuad Novruzov
7,
Sharjeel Usmani
8, 
Kamal Al-Rabi
6 and
Asem Mansour
9 1
Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Al-Jubeiha, Amman 11941, Jordan
2
School of Medicine, University of Jordan, Amman 11942, Jordan
3
Nuclear Medicine Unit, IRCCS—Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
4
Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, 1220 Vienna, Austria
5
Clinical Imaging Department, Hamad Medical Corporation, Doha 7GPR+3M9, Qatar
6
Department of Medical Oncology, King Hussein Cancer Center (KHCC), Amman 11941, Jordan
7
Department of Nuclear Medicine, The National Centre of Oncology, Ministry of Health of Azerbaijan Republic, Baku AZ1012, Azerbaijan
8
Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat 5661, Oman
9
Department of Radiology, King Hussein Cancer Center (KHCC), Al-Jubeiha, Amman 11941, Jordan
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(9), 1728; https://doi.org/10.3390/cancers16091728
Submission received: 1 April 2024
/
Revised: 24 April 2024
/
Accepted: 26 April 2024
/
Published: 29 April 2024
(This article belongs to the Special Issue PET/CT in Tumor Immunotherapy Assessment)
Simple Summary
This manuscript systematically reviews the role of positron emission tomography (PET) in the assessment of toxicity associated with chimeric antigen receptor T-cell therapy (CAR T-cell therapy). CAR T-cell therapy, a revolutionary form of immunotherapy, activates immune mechanisms against malignant cells. By doing so, it can also provoke immune-mediated responses against healthy tissues. These responses exhibit diverse clinical, radiological, and functional manifestations across multiple physiological systems. Adverse events include cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome. Both can cause life-threatening complications. Given the critical imperative of timely identification and vigilant monitoring of these adverse events to enable targeted interventions, PET has emerged as an indispensable imaging biomarker facilitating their detection, prediction, and surveillance. Hence, our investigation is specifically tailored to examine the utility of PET in evaluating adverse events induced by CAR T-cell therapy.
Abstract
The utilization of chimeric antigen receptor (CAR) T-cell therapy to target cluster of differentiation (CD)19 in cancer immunotherapy has been a recent and significant advancement. Although this approach is highly specific and selective, it is not without complications. Therefore, a systematic review was conducted to assess the current state of positron emission tomography (PET) in evaluating the adverse effects induced by CAR T-cell therapy. A thorough search of relevant articles was performed in databases such as PubMed, Scopus, and Web of Science up until March 2024. Two reviewers independently selected articles and extracted data, which was then organized and categorized using Microsoft Excel. The risk of bias and methodological quality was assessed. In total, 18 articles were examined, involving a total of 753 patients, in this study. A wide range of utilities were analyzed, including predictive, correlative, and diagnostic utilities. While positive outcomes were observed in all the mentioned areas, quantitative analysis of the included studies was hindered by their heterogeneity and use of varying PET-derived parameters. This study offers a pioneering exploration of this promising field, with the goal of encouraging further and more focused research in upcoming clinical trials.
