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Three methods assessing red marrow dosimetry in lymphoma patients treated with radioimmunotherapy
Author(s) -
Ferrer Ludovic,
KraeberBodéré Françoise,
BodetMilin Caroline,
Rousseau Caroline,
Gouill Stephen Le,
Wegener William A.,
Goldenberg David M.,
Bardiès Manuel
Publication year - 2010
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.24797
Subject(s) - radioimmunotherapy , medicine , lymphoma , dosimetry , bone marrow , nuclear medicine , oncology , leukemia , medical physics , immunology , monoclonal antibody , antibody
BACKGROUND: Maximum injected activity in radioimmunotherapy (RIT) is limited by bone marrow toxicity. Many dosimetric approaches have been proposed, leading to high variability in the results and elusive absorbed dose‐effect relations. This study presents the results of red marrow (RM) absorbed dose estimates performed with 3 methods. METHODS: Five patients received 2 co‐infusions of 90 Y‐labeled (370 MBq/m2) and 111 In‐ labeled (120 MBq) epratuzumab (1.5 mg/kg) 1 week apart. RM‐absorbed dose was estimated by 3 methodologies. The first approach (M1) used L 2 ‐L 4 lumbar vertebrae imaging. M2 and M3 methods used different red marrow to blood ratios (RMBLR) to assess RM‐absorbed dose. RMBLR was set to a fixed value of 0.36 in M2 or assessed according to each patient's hematocrit in M3. RESULTS: Median RM‐absorbed doses were 4.1 (2.9‐8.4), 2.3 (2.0‐2.7), and 2.3 (1.6‐2.5) mGy/MBq for M1, M2, and M3, respectively. No trend could be found between total RM‐absorbed dose and toxicity for M2 and M3. Conversely, M1 seemed to provide the best absorbed dose‐effect relation. The 4 patients with the highest RM‐absorbed doses exhibited grade 4 toxicity. The fifth patient, with the lowest RB absorbed dose, exhibited only a mild (grade 2) toxicity. CONCLUSIONS: Image‐based methodology (M1) seems to better predict hematological toxicity as compared with blood‐based methods. Only this method provides for bone marrow involvement. Cancer 2010;116(4 suppl):1093–100. © 2010 American Cancer Society.