Table 3.

Response of medullary/non-CNS EMD to CAR T cells in 17 patients with 18 sets of FDG PET/CT scans pre- and post–CAR infusion

Pre-CAR, at presentation to our institution						Post–CAR infusion, best response				Overall outcome
Patient	CAR	Non-CNS EMD at pre-CAR FDG PET/CT	maxSUV, non-CNS EMD	maxSUV, focal BM disease	BM by morphology (% of MNCs)	Non-CNS EMD at best response FDG PET/CT	SUV, Non-CNS EMD	Non-CNS EMD response	BM response (day +28)
1	CD19	Retroperitoneal lymph node*	17.31	3.25†	0.04	No residual EMD	2.63	CR	CR	Not eligible for second HSCT and experienced initial relapse with disseminated disease (CNS/non-CNS EMD/medullary). Died of PD 222 d post–CAR infusion
2	CD19	Scalp soft tissue, mesenteric, periaortic, retroperitoneal lymph nodes, right kidney,* left kidney, liver	15.20	Not available	0	Right kidney*	4.08	PR	CR	Not eligible for second HSCT and experienced initial relapse with medullary/non-CNS EMD. Died of PD 730 d post–CAR infusion
3	CD22	Liver	6.7	10.91	2.20	Liver*	9.18	PD	PD	Died of PD 47 d post–CAR infusion
4	CD22	Right kidney,* left kidney	8.70	4.91	0.05	Right kidney,* left kidney, vertebral bodies, rib, left humerus	8.93	PD	Stable  disease	Died of PD 913 d post–CAR infusion
5	CD22	Mesenteric, retroperitoneal lymph nodes, right kidney,* left kidney, extrusion from vertebral BM into psoas muscle	13.51	8.7	27.0	No residual EMD	2.20	CR (6 mo)	CR	Not eligible for second HSCT and experienced initial relapse with medullary disease. Died of PD 622 d post–CAR infusion6
6	CD22	Mesenteric, peritoneal lymph nodes, mediastinum, pericardium, pleura,* intramuscular lesion	8.97	6.80	44.0	Mesenteric, peritoneal, supraclavicular lymph nodes, pleura,* spleen, liver	6.93	PD	Stable  disease	Died of PD 157 d post–CAR infusion
7	CD22	Orbital bone, parotid gland, cervical, supraclavicular, axillary, peritoneal lymph nodes, pancreas*	12.09	7.9	93.3	Supraclavicular, axillary lymph nodes, orbital bone, parotid gland	2.50	PR (4 mo)	CR	Not eligible for second HSCT and experienced initial relapse with medullary/non-CNS EMD. Died of PD 1063 d post–CAR infusion54
8a‡	CD22	Temporal bone,* subcutaneous tissue surrounding external auditory canal, cervical, supraclavicular lymph nodes, pancreas	63.27	2.99†	0.50	No residual EMD	4.50	CR (3 mo)	CR	Not eligible for second HSCT and monitored. Received subsequent CAR infusion after initial relapse with antigen-positive CNS/non-CNS EMD. See 8b
8b‡	CD22	Thoracic, lumbar neural foramen*	19.96	2.75†	0	No residual EMD	3.82	CR	CR	Not eligible for second HSCT and experienced initial relapse with isolated CNS disease and a myeloid sarcoma. Died of progressive myeloid disease 424 d post–CAR infusion55
9	CD22	Right kidney, left kidney, pleura*	4.18	2.56†	56.6	No residual EMD	1.19	CR	CR	Proceeded to HSCT and experienced initial posttransplant relapse with disseminated disease (CNS/non-CNS EMD/medullary). Died of PD 330 d post-HSCT (395 d post–CAR infusion)
10	CD22	Supraclavicular, mesenteric lymph nodes, pleura, left kidney*	5.43	2.23†	53.3	Pleura, left kidney*	3.67	PR	CR	Proceeded to HSCT and experienced posttransplant relapse (sites unknown). Died of PD 174 d post-HSCT (240 d post–CAR infusion)
11	CD19/22	Parotid gland, maxillary sinus, cervical, supraclavicular, mesenteric lymph nodes, mediastinum, liver,* stomach, scrotum	22.5	15.40	0.35	Parotid gland, maxillary sinus, stomach, scrotum	2.9	PR	CR	Not eligible for second HSCT and experienced initial relapse with medullary/non-CNS EMD. Died of PD 457 d post–CAR infusion
12	CD19/22	Breast,* subcutaneous left lower extremity lesions, extrusion from right lower extremity BM to soft tissue	11.70	8.30	0.004	Breast,* subcutaneous left lower extremity lesions	4.74	PR	CR	Proceeded to second HSCT and experienced initial relapse with isolated non-CNS EMD. Died of PD 668 d post-HSCT (834 d post–CAR infusion)
13	CD19/22	Cervical, axillary,* retroperitoneal, mesenteric, inguinal, pelvic lymph nodes, mediastinum, right kidney, left kidney, pancreas	11.66	9.80	90.1	No residual EMD	2.09	CR	CR	Proceeded to HSCT and experienced initial relapse with medullary disease. Died of PD 593 d post-HSCT (720 d post–CAR infusion)
14	CD19/22	Retroperitoneal, pelvic wall lymph nodes, pancreas,* testes	8.29	3.2	4.96	Retroperitoneal lymph node, pancreas,* adrenal gland, testes	11.67	PD	CR	Died of PD 346 d post–CAR infusion
15	CD19/22	Breast,* cervical, axillary lymph nodes, mediastinum	34.93	38.8	0.49	Breast*	11.58	PR	Stable  disease	Received additional therapies. Experienced medullary disease progression followed by CNS/non-CNS EMD relapse. Remains alive with disseminated disease 682 d post–CAR infusion
16	CD19/22	Liver*	6.05	2.57†	0	No residual EMD	1.99	CR	CR	Proceeded to HSCT and experienced initial relapse with medullary/non-CNS EMD. Died of PD 335 d post-HSCT (390 d post–CAR infusion)
17	CD19/22	Inguinal, pelvic wall,* popliteal, deep thigh lymph nodes, skin, left foot periosteum	10.39	2.07†	0.01	Inguinal lymph node,* left foot periosteum	3.18	PR	CR	Not eligible for second HSCT and experienced initial relapse with medullary/non-CNS EMD. Died of PD 302 d post–CAR infusion

Patient 5 was previously reported in an article by Fry et al.⁶ Patient 7 was reported as a case by Shah et al.⁵⁴ Patient 8a/8b was reported as a case by Mo et al.⁵⁵ BM, bone marrow; maxSUV, maximum standardized uptake; MNCs, mononuclear cells.

^*Site of non-CNS EMD corresponding to maxSUV.

^†BM maxSUV calculated as average maxSUV of vertebral bodies (L3, L4, and L5) in the absence of focal BM disease. In patients with no residual non-CNS EMD, maxSUV value at best response reflects physiological FDG uptake at site of non-EMD identified on pre-CAR scan.

^‡8a and 8b represent outcomes for a single patient who received 2 separate infusions of the same CAR product at initial treatment and subsequent disease recurrence.