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Evaluation of Thrombocytopenia in Patients Treated with Rhenium-186-HEDP: Guidelines for Individual Dosage Recommendations

Department of Nuclear Medicine, Department of Internal Medicine, Oncology Section and the Center for Hospital Pharmacy, University Hospital Utrecht, Utrecht, The Netherlands

Correspondence: For correspondence or reprints contact: J.M.H. de Klerk, MD, Dept. of Nuclear Medicine, University Hospital Utrecht Room E 02.222, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.

ABSTRACT

A potential limitation of rhenium-186-1,1-hydroxyethylidene diphosphonate (¹⁸⁶Re-HEDP) therapy in patients with painful bone metastases is thrombocytopenia. Given the palliative character of this therapy, it is essential to be able to predict the degree of thrombocytopenia before therapy. Methods: Thus far, 39 prostatic cancer patients with multiple painful bone metastases were treated. Twenty-one patients underwent the therapy twice, resulting in 60 therapies. From the pre-therapy ^99mTc-HDP scintigram, the bone scan index (BSI) was determined as an index of the extent of bone involvement. Results: The administered activity ranged from 1104 to 3479 MBq ¹⁸⁶Re-HEDP. The platelet count was lowest 4 wk following therapy. From this value and the pretreatment level, the percentage decrease in the platelet count was determined (47% ± 19%, range 14%–89%). The BSI ranged from 8 to 93. Regression analysis showed a functional relation (R = 0.78; p < 0.001) of the percentage of platelet decrease with BSI and administered activity normalized to standard body surface area. Conclusion: Using this relation, it is possible to predict thrombocytopenia by pretreatment bone scintigraphy and to adjust the dosage to each patient to avoid unacceptable toxicity.

Key Words: painful bone metastases • rhenium-186-HEDP • thrombocytopenia • bone scan index

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