Döbert Natascha, Martin Hans, Kranert W Tilman, Menzel Christian, Klein Stefan A, Mose Stephan, Grünwald Frank
Department of Nuclear Medicine, Johann Wolfgang Goethe University Hospital, Frankfurt, Main, Germany.
Clin Nucl Med. 2003 Sep;28(9):738-42. doi: 10.1097/01.rlu.0000082660.35154.55.
The authors present their experience with dose calculation of Retin1,1-hydroxyethylidene-186-diphosphonate (Re-186 HEDP) therapy used as part of an intensified conditioning regimen before allogeneic stem cell transplantation in 2 patients with advanced acute lymphoblastic leukemia during the second partial or third complete remission. Kidneys were shielded during total-body irradiation (TBI) to limit the TBI-mediated renal radiation dose to 7 Gy. The aim of this dose calculation of Re-186 HEDP therapy was to deliver additional radiotherapy to the red bone marrow without exposing more than an additional 5 Gy to the kidneys in addition to the TBI standard dose of 12.6 Gy. Pretherapeutic kidney scintigraphy (Tc-99m mercaptoacetyltriglycine) showed normal results. Thus, dynamic Tc-99m methylene diphosphonate bone scintigraphy was used to calculate the expected bone marrow and kidney doses. A total amount of 8.8 GBq (238 mCi) Re-186 HEDP was given to patient no. 1 and 14.3 GBq (387 mCi) Re-186 HEDP was given to patient no. 2. Re-186 HEDP activity was monitored based on its gamma radiation measurement daily for 5 days in patient no. 1 and 7 days in patient no. 2. Therapeutic Re-186 isotope distribution and biologic half-life correlated well with the prediction by a pretherapeutic Tc-99m methylene diphosphonate scan. The calculated effective Re-186 bone marrow dose was 3.3 Gy for patient no. 1 and 5.6 Gy for patient no. 2. Effective kidney doses were 1.6 Gy and 2.1 Gy respectively. No unexpected complications occurred after completing conditioning and allogeneic stem cell transplantation. Posttransplant kidney function remained normal. Patient no. 1 remains in a second complete remission of his advanced acute lymphoblastic leukemia 18 months after HEDP therapy. Patient no. 2 relapsed 5 months after transplantation and eventually died as a result of progressive disease. The authors conclude that Re-186 HEDP will be able to increase the total additional bone marrow dose. In patients in whom the kidney dose is limited to 5 Gy in addition to TBI, doses near 10 Gy can be achieved on the bone marrow.
作者介绍了他们在2例处于第二次部分缓解或第三次完全缓解期的晚期急性淋巴细胞白血病患者接受异基因干细胞移植前，将1,1 - 羟基亚乙基 - 186 - 二膦酸盐（Re - 186 HEDP）治疗作为强化预处理方案一部分时的剂量计算经验。在全身照射（TBI）期间对肾脏进行屏蔽，以将TBI介导的肾脏辐射剂量限制在7 Gy。Re - 186 HEDP治疗的剂量计算目的是在不使肾脏除TBI标准剂量12.6 Gy外再额外接受超过5 Gy辐射的情况下，对红骨髓进行额外的放射治疗。治疗前肾脏闪烁扫描（Tc - 99m巯基乙酰三甘氨酸）结果正常。因此，采用动态Tc - 99m亚甲基二膦酸盐骨闪烁扫描来计算预期的骨髓和肾脏剂量。给1号患者总共给予了8.8 GBq（238 mCi）的Re - 186 HEDP，给2号患者给予了14.3 GBq（387 mCi）的Re - 186 HEDP。根据其γ辐射测量对1号患者的Re - 186 HEDP活性进行了5天的每日监测，对2号患者进行了7天的监测。治疗性Re - 186同位素分布和生物半衰期与治疗前Tc - 99m亚甲基二膦酸盐扫描的预测结果相关性良好。计算得出1号患者的有效Re - 186骨髓剂量为3.3 Gy，2号患者为5.6 Gy。有效肾脏剂量分别为1.6 Gy和2.1 Gy。完成预处理和异基因干细胞移植后未发生意外并发症。移植后肾功能保持正常。1号患者在接受HEDP治疗18个月后仍处于晚期急性淋巴细胞白血病的第二次完全缓解期。2号患者在移植后5个月复发，最终因疾病进展死亡。作者得出结论，Re - 186 HEDP将能够增加总的额外骨髓剂量。在肾脏剂量除TBI外限制在5 Gy的患者中，骨髓剂量可接近10 Gy。
