Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany;
Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany.
J Nucl Med. 2023 Jul;64(7):1009-1016. doi: 10.2967/jnumed.122.265199. Epub 2023 Jun 8.
In the early 2000s, major clinical trials provided evidence of a favorable outcome from antibody-mediated radioimmunotherapy for hematologic neoplasms, which then led to Food and Drug Administration approval. For instance, the theranostic armamentarium for the referring hematooncologist now includes Y-ibritumomab tiuxetan for refractory low-grade follicular lymphoma or transformed B-cell non-Hodgkin lymphoma, as well as I-tositumomab for rituximab-refractory follicular lymphoma. Moreover, the first interim results of the SIERRA phase III trial reported beneficial effects from the use of I-anti-CD45 antibodies (Iomab-B) in refractory or relapsed acute myeloid leukemia. During the last decade, the concept of theranostics in hematooncology has been further expanded by C-X-C motif chemokine receptor 4-directed molecular imaging. Beyond improved detection rates of putative sites of disease, C-X-C motif chemokine receptor 4-directed PET/CT also selects candidates for radioligand therapy using β-emitting radioisotopes targeting the identical chemokine receptor on the lymphoma cell surface. Such image-piloted therapeutic strategies provided robust antilymphoma efficacy, along with desired eradication of the bone marrow niche, such as in patients with T- or B-cell lymphoma. As an integral part of the treatment plan, such radioligand therapy-mediated myeloablation also allows one to line up patients for stem cell transplantation, which leads to successful engraftment during the further treatment course. In this continuing education article, we provide an overview of the current advent of theranostics in hematooncology and highlight emerging clinical applications.
在 21 世纪初，几项大型临床试验为血液系统恶性肿瘤的抗体介导的放射免疫治疗提供了有利结果的证据，随后获得了食品和药物管理局的批准。例如，现在，血液肿瘤学家的治疗武器库包括用于难治性低级别滤泡淋巴瘤或转化 B 细胞非霍奇金淋巴瘤的 Y-碘替比单抗替曲膦，以及用于利妥昔单抗难治性滤泡性淋巴瘤的 I-替西莫单抗。此外，SIERRA 三期试验的首次中期结果报告了使用 I-抗-CD45 抗体（Iomab-B）治疗难治性或复发性急性髓系白血病的有益效果。在过去十年中，血液肿瘤学中的治疗学概念通过 C-X-C 基序趋化因子受体 4 定向分子成像得到了进一步扩展。除了提高潜在疾病部位的检测率外，C-X-C 基序趋化因子受体 4 定向 PET/CT 还选择了使用针对淋巴瘤细胞膜上相同趋化因子受体的 β 发射放射性同位素进行放射性配体治疗的候选者。这种基于图像的治疗策略提供了强大的抗淋巴瘤疗效，并期望消除骨髓龛，例如在 T 或 B 细胞淋巴瘤患者中。作为治疗计划的一个组成部分，这种放射性配体治疗介导的骨髓清除也允许患者进行干细胞移植，这导致在进一步的治疗过程中成功植入。在这篇继续教育文章中，我们概述了血液肿瘤学中治疗学的当前发展，并强调了新的临床应用。
