Baseline Spleen Volume is Independently Associated With Survival After CD19-Directed Chimeric Antigen Receptor T-Cell Therapy in Relapsed/Refractory Diffuse Large B-Cell Lymphoma.
- 1Department of Medicine A, University Hospital Münster, Münster, Germany.
- 2Department of Radiology, University Hospital Münster, Münster, Germany.
- 3Department of Oncology and Hematology, University Hospital Oldenburg, Oldenburg, Germany.
Abstract
Clinical outcomes after CD19-directed chimeric antigen receptor (CAR) T-cell therapy in patients with relapsed or refractory (r/r) diffuse large B-cell lymphoma (DLBCL) remain heterogeneous, underscoring the need for improved risk stratification. As CAR T-cell efficacy is shaped not only by tumor-intrinsic features, host-related factors may also contribute to outcome variability. The spleen, the largest secondary lymphoid organ and a key regulator of immune cell trafficking, is a biologically plausible yet underexplored imaging marker in this setting. We retrospectively analyzed 88 patients with r/r DLBCL and available baseline imaging who received commercial CD19-directed CAR T-cell products between September 2019 and July 2025. Spleen volume was analyzed as a continuous variable (per 100 mL), without dichotomization or prespecified cutoffs, and clinical outcomes were examined in relation to baseline spleen volume. With a median follow-up of 24.4 months, 2-year progression-free survival and overall survival were 40.9% and 56.4%, respectively. Higher baseline spleen volume was associated with inferior overall survival, a higher cumulative incidence of relapse/progression, and inferior post-progression survival. The 24-month risk of death increased progressively with increasing spleen volume. Baseline spleen volume remained independently associated with inferior overall survival after adjustment for established pretreatment risk factors (aHR 1.136 per 100 mL, 95% CI, 1.012-1.275; p = 0.030). Findings were consistent in sensitivity analyses including adjustment for BMI and after exclusion of patients with splenic lymphoma manifestations. Baseline spleen volume thus emerges as a readily available imaging-derived marker that could complement established risk factors and refine baseline risk stratification prior to CAR T-cell therapy in r/r DLBCL. Beyond the pretreatment setting, it also has potential utility for prognostication after relapse/progression.
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BibTeX
@article{brehm2026baseline,
title = {{Baseline Spleen Volume is Independently Associated With Survival After CD19-Directed Chimeric Antigen Receptor T-Cell Therapy in Relapsed/Refractory Diffuse Large B-Cell Lymphoma.}},
author = {Lucas Brehm and Philipp Schindler and Christian Römer and Akhil Behringer and Valeria Carobin and Georg Evers and Cyrus Khandanpour and Julia Marx and Christian Reicherts and Jörn Albring and Matthias Stelljes and Evgenii Shumilov and Georg Lenz and Alexander Pohlmann},
journal = {Hematological oncology},
year = {2026},
month = nov,
doi = {10.1002/hon.70284},
url = {https://europepmc.org/article/MED/42967598},
note = {CC BY},
}
RIS
TY - JOUR
TI - Baseline Spleen Volume is Independently Associated With Survival After CD19-Directed Chimeric Antigen Receptor T-Cell Therapy in Relapsed/Refractory Diffuse Large B-Cell Lymphoma.
AU - Lucas Brehm
AU - Philipp Schindler
AU - Christian Römer
AU - Akhil Behringer
AU - Valeria Carobin
AU - Georg Evers
AU - Cyrus Khandanpour
AU - Julia Marx
AU - Christian Reicherts
AU - Jörn Albring
AU - Matthias Stelljes
AU - Evgenii Shumilov
AU - Georg Lenz
AU - Alexander Pohlmann
PY - 2026
DA - 2026/11/01
JO - Hematological oncology
DO - 10.1002/hon.70284
UR - https://europepmc.org/article/MED/42967598
AB - Clinical outcomes after CD19-directed chimeric antigen receptor (CAR) T-cell therapy in patients with relapsed or refractory (r/r) diffuse large B-cell lymphoma (DLBCL) remain heterogeneous, underscoring the need for improved risk stratification. As CAR T-cell efficacy is shaped not only by tumor-intrinsic features, host-related factors may also contribute to outcome variability. The spleen, the largest secondary lymphoid organ and a key regulator of immune cell trafficking, is a biologically plausible yet underexplored imaging marker in this setting. We retrospectively analyzed 88 patients with r/r DLBCL and available baseline imaging who received commercial CD19-directed CAR T-cell products between September 2019 and July 2025. Spleen volume was analyzed as a continuous variable (per 100 mL), without dichotomization or prespecified cutoffs, and clinical outcomes were examined in relation to baseline spleen volume. With a median follow-up of 24.4 months, 2-year progression-free survival and overall survival were 40.9% and 56.4%, respectively. Higher baseline spleen volume was associated with inferior overall survival, a higher cumulative incidence of relapse/progression, and inferior post-progression survival. The 24-month risk of death increased progressively with increasing spleen volume. Baseline spleen volume remained independently associated with inferior overall survival after adjustment for established pretreatment risk factors (aHR 1.136 per 100 mL, 95% CI, 1.012-1.275; p = 0.030). Findings were consistent in sensitivity analyses including adjustment for BMI and after exclusion of patients with splenic lymphoma manifestations. Baseline spleen volume thus emerges as a readily available imaging-derived marker that could complement established risk factors and refine baseline risk stratification prior to CAR T-cell therapy in r/r DLBCL. Beyond the pretreatment setting, it also has potential utility for prognostication after relapse/progression.
SN - 0278-0232
SN - 1099-1069
ER -