Herrmann Ken, Wieder Hinrich A, Buck Andreas K, Schöffel Marion, Krause Bernd-Joachim, Fend Falko, Schuster Tibor, Meyer zum Büschenfelde Christian, Wester Hans-Jürgen, Duyster Justus, Peschel Christian, Schwaiger Markus, Dechow Tobias
Department of Nuclear Medicine, Technische Universität München, Munich, Germany.
Clin Cancer Res. 2007 Jun 15;13(12):3552-8. doi: 10.1158/1078-0432.CCR-06-3025.
To evaluate 3'-deoxy-3'-[(18)F]fluorothymidine-positron emission tomography (FLT-PET) for early monitoring response of high-grade non-Hodgkin's lymphoma to treatment with cyclophosphamide-adriamycin-vincristine-prednisone chemotherapy with or without rituximab immunotherapy (R-CHOP/CHOP).
Twenty-two patients with histologically proven high-grade non-Hodgkin's lymphoma scheduled to undergo first line treatment with R-CHOP/CHOP were included. All patients received baseline imaging before therapy with FLT-PET. For noninvasive assessment of treatment response, FLT-PET was repeated at following time points: group 1 (n = 6), 1 and 6 weeks after R-CHOP/CHOP; group 2 (n = 16), 2 days after rituximab and 2 days after CHOP application. Emission images were acquired 45 min after injection of 300 to 370 MBq of FLT. FLT uptake was quantified by region-of-interest technique on a lesion basis. Maximum standardized uptake values (SUV) for FLT were calculated using circular region of interest (diameter, 1.5 cm).
In all patients, morphologically proven lesions showed initially high FLT uptake (mean SUV, 8.1 +/- 3.9). In group 1, mean FLT SUV decreased 7 days after R-CHOP/CHOP by 77% (P < 0.001), the reduction in FLT SUV from baseline was 85% after 40 days (P = 0.003). In group 2, FLT uptake in patients without dexamethasone pretreatment revealed no significant reduction after rituximab (P = 0.3) but significantly decreased 2 days after CHOP to 32% compared with the baseline value (P = 0.004).
Administration of R-CHOP/CHOP is associated with an early decrease in lymphoma FLT uptake. Interestingly, there was no reduction of FLT uptake after rituximab alone, indicating no early antiproliferative effect of immunotherapy. FLT-PET seems to be promising for early evaluation of drug effects in lymphoma.
评估3'-脱氧-3'-[(18)F]氟代胸苷正电子发射断层扫描（FLT-PET）用于早期监测高级别非霍奇金淋巴瘤对环磷酰胺-阿霉素-长春新碱-泼尼松化疗联合或不联合利妥昔单抗免疫治疗（R-CHOP/CHOP）的反应。
纳入22例经组织学证实的高级别非霍奇金淋巴瘤患者，计划接受R-CHOP/CHOP一线治疗。所有患者在接受FLT-PET治疗前均进行基线成像。为了对治疗反应进行无创评估，在以下时间点重复进行FLT-PET检查：第1组（n = 6），R-CHOP/CHOP治疗后1周和6周；第2组（n = 16），利妥昔单抗给药后2天和CHOP给药后2天。在注射300至370 MBq的FLT后45分钟采集发射图像。通过基于病变的感兴趣区域技术对FLT摄取进行定量。使用圆形感兴趣区域（直径1.5 cm）计算FLT的最大标准化摄取值（SUV）。
在所有患者中，形态学证实的病变最初显示出较高的FLT摄取（平均SUV，8.1±3.9）。在第1组中，R-CHOP/CHOP治疗7天后，平均FLT SUV下降了77%（P < 0.001），40天后FLT SUV相对于基线的降低为85%（P = 0.003）。在第2组中，未接受地塞米松预处理的患者在接受利妥昔单抗治疗后FLT摄取无显著降低（P = 0.3），但在CHOP治疗2天后与基线值相比显著下降至32%（P = 0.004）。
R-CHOP/CHOP治疗与淋巴瘤FLT摄取的早期降低有关。有趣的是，单独使用利妥昔单抗后FLT摄取没有降低，表明免疫治疗没有早期抗增殖作用。FLT-PET似乎有望用于早期评估淋巴瘤的药物疗效。
