SYSTEMATIC REVIEW article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
This article is part of the Research TopicCommunity Series in Novel Reliable Approaches for Prediction and Clinical Decision-making in Cancer: Volume IIView all 12 articles
Systematic Review and Meta‑Analysis of PET‑Based Prognostic Metrics in CAR‑T Treatment of DLBCL
Provisionally accepted
- 1School of Basic Medical Sciences, Bengbu Medical University, Bengbu, China
- 2School of clinical medicine, Bengbu Medical University, Bengbu, China
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Objectives: This study aims to conduct a systematic review and meta-analysis to investigate how imaging parameters derived from 18F-FDG positron emission tomography/computed tomography (PET/CT) predict treatment outcomes in patients with diffuse large B-cell lymphoma (DLBCL) receiving chimeric antigen receptor T-cell (CAR-T) therapy. Methods: A comprehensive search was conducted in PubMed, Embase, Cochrane Library, and Web of Science databases to retrieve relevant literature from their inception to December 24, 2024. This study is registered in PROSPERO (CRD42025634694). The protocol was completed in accordance with the PRISMA guidelines recommended by the EJNMMI authors’ guide. Cohort studies were included that enrolled patients diagnosed with DLBCL via 18F-FDG PET/CT and who received CAR-T therapy. Fixed-effect and random-effects models were applied using Stata software to calculate pooled hazard ratios (HR) with 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic. Results: A total of 14 studies were included, involving 1,088 patients (aged 20 to 86 years) diagnosed with DLBCL based on 18F-FDG PET/CT imaging findings. Univariate analysis demonstrated significant associations between several PET-derived parameters and survival outcomes: SUVmax was predictive of both overall survival (OS) (HR: 1.61; 95% CI: 1.20–2.18) and progression-free survival (PFS) (HR: 1.47; 95% CI: 1.09–1.98); higher MTV levels were associated with decreased OS (HR: 2.81; 95% CI: 1.23–6.45) and PFS (HR: 2.39; 95% CI: 1.24–4.61); and TMTV and TLG were also prognostic for PFS and OS. Notably, elevated LDH was linked to inferior OS (HR: 2.76; 95% CI: 2.06–3.71) and PFS (HR: 1.95; 95% CI: 1.50–2.54). ECOG performance status (HR: 2.14; 95% CI: 1.38–3.31) and DS (HR: 6.02; 95% CI: 2.80–12.94) were significantly associated with OS, while IPI was also predictive of OS (HR: 2.04; 95% CI: 1.19–3.50). Elevated LDH and impaired ECOG performance status were independently linked to poorer OS in multivariate analysis (HRs: 3.52 and 2.58, respectively), while the IPI score remained a standalone determinant of PFS (HR: 3.07; 95% CI: 1.59–5.93). Conclusion: The outcomes of DLBCL cases managed using CAR-T cells can be effectively predicted using both metabolic metrics from 18F-FDG PET/CT and conventional clinical prognostic markers. Systematic review registration: identifier CRD42025634694
Keywords: 18F-fluorodeoxyglucose positron emission tomography/computed tomography, Chimeric antigen receptor T-cell, Diffuse large B-cell lymphoma, Meta-analysis, Systematic review
Received: 04 Aug 2025; Accepted: 06 Feb 2026.
Copyright: © 2026 Long, Liu, Fang, Qi, Ma, Wang and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhenghong Li
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