Kosmin Michael, Makris Andreas, Jawad Noorulhuda, Woolf David, Miles David, Padhani Anwar R
Breast Cancer Research Unit, Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex, HA6 2RN, UK.
Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex, HA6 2RN, UK.
Target Oncol. 2017 Apr;12(2):229-234. doi: 10.1007/s11523-017-0477-6.
An association between trastuzumab-emtansine (T-DM1) and splenic enlargement is reported in preclinical data, and has been noted anecdotally in patients receiving T-DM1 at our institution. Use of whole-body MRI examinations (WB-MRI) allows for detailed bone marrow assessment and semi-automated splenic volume calculations.
To retrospectively evaluate changes in splenic volume versus evidence of bone marrow hyperplasia and/or changes in portal venous pressure in patients receiving T-DM1 for metastatic breast cancer.
Twelve metastatic breast cancer patients underwent 29 WB-MRIs before and during T-DM1 therapy. Splenic volume, portal vein diameter, bone marrow diffusion-weighted normalised signal intensity (nSI), quantitative water diffusivity (apparent diffusion coefficient, ADC) and fat fraction (rF%) were measured and correlated.
Splenic volume increases were observed in 92% of patients. Mean splenic volume increased from 144 cm (95% CI 110-177 cm) to 209 cm (95% CI 161-257 cm) on T-DM1 therapy (p = 0.006). Splenic volume increases correlated with treatment duration (r = 0.43). Bone marrow hyperplasia was evidenced by an increase in bone marrow nSI (3.5 to 4.8, p = 0.12), and decreases in rF% (64.3% to 57.3%, p = 0.12) and ADC (655 μm/s to 543 μm/s, p = 0.11). No changes to portal vein diameter were seen.
Previously unreported increases in splenic volume and bone marrow hyperplasia are observed on WB-MRI in patients on T-DM1 therapy. Caution must be applied to avoid misinterpreting T-DM1-induced bone marrow hyperplasia as diffuse disease progression in bone.
临床前数据报道了曲妥珠单抗-恩美曲妥珠单抗（T-DM1）与脾肿大之间的关联，在我们机构接受T-DM1治疗的患者中也有相关个案报道。全身MRI检查（WB-MRI）可用于详细的骨髓评估和脾体积的半自动计算。
回顾性评估接受T-DM1治疗的转移性乳腺癌患者脾体积变化与骨髓增生证据和/或门静脉压力变化情况。
12例转移性乳腺癌患者在T-DM1治疗前及治疗期间接受了29次WB-MRI检查。测量脾体积、门静脉直径、骨髓扩散加权标准化信号强度（nSI）、定量水扩散率（表观扩散系数，ADC）和脂肪分数（rF%）并进行相关性分析。
92%的患者观察到脾体积增加。T-DM1治疗期间，平均脾体积从144 cm（95%CI 110 - 177 cm）增加到209 cm（95%CI 161 - 257 cm）（p = 0.006）。脾体积增加与治疗持续时间相关（r = 0.43）。骨髓nSI增加（从3.5至4.8，p = 0.12）、rF%降低（从64.3%至57.3%，p = 0.12）和ADC降低（从655μm²/s至543μm²/s，p = 0.11）证明有骨髓增生。门静脉直径未见变化。
接受T-DM1治疗的患者在WB-MRI上观察到了此前未报道的脾体积增加和骨髓增生。必须谨慎避免将T-DM1诱导的骨髓增生误解为骨的弥漫性疾病进展。
